The workers’ compensation program was designed to benefit both workers and employers. Injured employees are given medical treatment and lost wage benefits to help them recover, while employers are given protection from personal injury (negligence) lawsuits.
This system is designed to work without legal involvement, but unfortunately, instances occur when you need the guidance and assistance of an attorney.
For instance, what if you have a pre-existing injury…can you still get workers compensation? This is one issue that isn’t quite so cut-and-dry, yet it’s one that Florida workers struggle with on a daily basis.
How Does a Pre-Existing Injury Affect Workers Compensation?
Despite what coworkers, doctors, employers, or the insurance company has led you to believe, a pre-existing injury does not make you ineligible for workers’ compensation benefits.
Florida law states only that your job must be more than 50% responsible for your condition when compared to all other causes. But it can be difficult for doctors to determine what percentage your work accident contributed to your condition versus, say, a prior car accident.
Insurance companies are not typically going to give you the benefit of the doubt here and are more likely to deny benefits to you, forcing you to retain an attorney and start the litigation process.
Just as with any workers’ compensation claim, whether or not you receive benefits will depend on the details of your individual case.
If your accident at work results in an injury that is unrelated to your pre-existing condition (and did not aggravate it), you are entitled to workers’ comp benefits for your new injury, but will have to cover treatment for the pre-existing injury through your health insurance policy.
If your accident at work makes a pre-existing condition worse, you are only entitled to benefits if your job was more than 50% responsible for your injuries.
Things get slightly more complicated if your pre-existing injury was also work-related, as case law currently states that an on-the-job accident cannot create a pre-existing condition. In these circumstances, you will be entitled to benefits for the new accident unless the insurance company can establish that your prior workplace accident is 100% the cause of your condition or need for treatment from the second accident.
Why Was My Claim Denied?
As mentioned earlier, it can be very difficult to prove that your job was the biggest contributor to your injury. In fact, this is one of the most common reasons for a workers’ compensation claim to be denied.
Remember, the insurance company’s loyalty is not to you, or even to your employer. Their primary consideration is their bottom line. They will look for reasons to deny or undervalue your claim, and a pre-existing injury is any easy excuse for them to do just that.
So what can you do if your claim was denied due to a pre-existing injury?
- Get a second opinion. Florida law entitles you to a one-time change of your authorized treating physician during your workers’ compensation case.
- If you have already gotten a second opinion, see an Independent Medical Examiner (IME). Again, you are entitled to a one-time visit to an IME to review your case; although this is at your expense.
- Hire a workers’ compensation attorney who can help fight for you. The insurance company has an entire legal team on their side; it will be nearly impossible to win your fight against them without your own form of legal representation.
Pre-existing injuries don’t have to derail your claim, but they will make it more challenging.
It is certainly likely that an insurance company that is aware of a pre-existing condition will deny your claim. It will take a lot of effort on your part to prove that your job was the biggest contributor to your injury.
Remember, your insurance company has the right to choose which doctor you see. Additionally, they have the right to hire their own Independent Medical Examiner to gather information they can potentially use to deny your claim.
Without hiring a workers’ compensation attorney, you might not be able to obtain the medical opinions you need to win your case or to maximize settlement, if that is the direction you decide to take with your claim.
At the Law Office of Brian D. Tadros, we don’t just want to be your advocate, we want to educate you on your case so that you are as prepared as possible for any outcome. Whether you decide to settle or go to trial, we will remain by your side at every step along the way.
Schedule a free consultation today to get your questions answered.