The Impact of Pre-Existing Conditions on Workers' Compensation Claims
Workers’ compensation is designed to provide benefits to employees who sustain injuries or illnesses related to their jobs, ensuring that they can cover medical expenses and receive income while recovering. However, when you have a pre-existing condition, it’s natural to wonder how it might affect your claim. Questions like “Will my injury be covered?” or “How does my medical history come into play?” are common, and an attorney is here to address them.
At Reese Legal, Attorney Michael Reese understands that workers’ compensation claims can be challenging, especially when pre-existing medical conditions are involved. Over the past 27 years, he's dedicated himself to helping injured workers.
Attorney Michael Reese proudly serves clients in Orlando and the surrounding areas, including Windermere, Winter Park, Doctor Phillips, and Bay Hill. With his office conveniently located just a mile from Universal Studios, he prides himself on being a trusted firm for locals and tourists alike. Below, Attorney Michael Reese will explore how pre-existing conditions impact workers' compensation claims and what steps you can take to protect your rights.
What Are Pre-Existing Conditions?
Pre-existing conditions are medical issues or injuries that existed prior to the workplace accident or illness. These could include chronic conditions like arthritis, previous back or neck injuries, or repetitive strain injuries like carpal tunnel syndrome.
It’s important to note that having a pre-existing condition doesn’t automatically disqualify you from receiving workers’ compensation benefits. Florida’s workers’ compensation system acknowledges that some employees may already have existing health concerns.
What matters most is determining whether your work-related injury worsened or “aggravated” the pre-existing condition in any way. If the aggravation is significant and directly tied to your job duties or workplace accident, you may still be eligible for compensation.
Pre-Existing Conditions and the “Major Contributing Cause” Rule
Florida law uses the “major contributing cause” rule to evaluate workers’ compensation claims involving pre-existing conditions. Under this rule, the workplace accident must be the primary reason for your injury in order for you to qualify for benefits.
For example, if you have a history of lower back issues and you injure your back lifting heavy supplies at work, your claim will be examined closely. If the work injury is determined to be the major contributing cause of your worsened condition, your claim may still be approved.
Conversely, if your pre-existing condition is deemed the primary cause, your claim could face denial.
This isn’t to say that all hope is lost if your employer’s insurance carrier challenges your claim based on a pre-existing condition. With proper legal representation, you can present evidence to demonstrate how your job aggravated or exacerbated your medical issue.
Common Challenges in Claims with Pre-Existing Conditions
While workers’ compensation laws aim to provide employees with fair access to benefits, navigating the system can become more complicated when pre-existing conditions are involved. Here are some common challenges we see at Reese Legal:
Insurance company denials: Insurance carriers may argue that your symptoms stem entirely from your pre-existing condition, rather than a work-related incident. This is a common tactic used to deny or minimize valid claims.
Disputes over medical records: Insurers often scrutinize your medical history in search of evidence they can use to attribute your current condition to prior injuries. This can feel invasive and overwhelming for injured workers.
Independent medical examinations (IMEs): You may be required to undergo an IME, where a doctor hired by the insurance company evaluates your condition. Unfortunately, these evaluations can sometimes be biased, with the doctor downplaying or dismissing your work-related injury.
Complicated legal requirements: Understanding the “major contributing cause” rule and the legal details surrounding pre-existing conditions can be daunting without professional guidance.
How We Help You With These Challenges
At Reese Legal, we understand the importance of building a strong case with compelling evidence, particularly when addressing pre-existing conditions. Here’s how we work to protect your rights and maximize your chances of securing benefits:
Gathering Comprehensive Medical Evidence
Attorney Michael Reese will collaborate with your treating physicians to gather detailed evidence that demonstrates how your work injury aggravated your condition. Diagnostic tests, medical records, and expert opinions can play a vital role in supporting your claim.
Challenging Unfair Denials
If your claim is denied due to a pre-existing condition, Attorney Michael Reese doesn't back down. He will thoroughly analyze the reasons for denial and build a strategic case to appeal the decision on your behalf.
Preparing for IMEs
If you’re required to attend an IME, an attorney can prepare you in advance so you know what to expect. They have the resources to review the results and challenge any unfair conclusions drawn by the insurance company’s physician.
Providing personalized support
With nearly three decades of experience, the attorney at Reese Legal understands that each case is unique, and he's committed to giving clients the personalized attention they deserve. The goal is to help you secure benefits while also making the process as smooth and stress-free as possible.
Tips for Protecting Your Workers’ Compensation Claim
If you have a pre-existing condition and are filing a workers’ compensation claim, there are steps you can take to strengthen your case:
1. Report your injury promptly.
Report any workplace injury immediately to avoid issues with your claim's credibility.
2. Be honest about your medical history.
Transparency is key. While you may worry that disclosing a pre-existing condition could hurt your case, being upfront actually helps prevent potential disputes down the line.
3. Seek immediate medical attention.
Visiting a doctor promptly after your injury ensures that you receive proper care and creates a medical record that documents the incident.
4. Work with an experienced attorney.
Starting a workers’ compensation claim alone can be overwhelming, especially when pre-existing conditions are involved. Partnering with an experienced attorney can provide peace of mind, knowing that your rights are effectively advocated for at every step.
Dedicated Legal Advocacy
At Reese Legal, Attorney Michael Reese believes that all injured workers deserve access to the benefits they’re entitled to under the law—even if they have pre-existing conditions. The Orlando-based firm has helped countless clients by providing skilled and compassionate representation.
If you’ve suffered a workplace injury and have concerns about how a pre-existing condition may impact your claim, Attorney Michael Reese is here to guide you through the process. Call him today for a consultation.