Employers and their insurance companies are responsible for providing workers' compensation benefits for work-related injuries and illnesses, even though the employee suffers from a preexisting condition. However, if you have a preexisting condition and your “work injury” combines with that preexisting condition, you may only receive medical care and wage benefits for as long as the work injury was and remains the major contributing cause (MCC) of the disability or need for treatment.
§440.09, Florida Statutes, provides that an insurance company must provide compensation and medical treatment for work-related injuries if the work-related injury is the major contributing cause of the need for treatment or disability. The statute defines major contributing cause as follows:
“For purposes of this section, “major contributing cause” means the cause which is more than 50 percent responsible for the injury as compared to all other causes combined for which treatment or benefits are sought.”
Whether your accident is and/or remains the major contributing cause for your need for treatment is a determination made by either the physician authorized by the workers’ compensation carrier, an Independent Medical Examiner, or an Expert Medical Advisor.
Your workers’ compensation insurance carrier has a duty under Florida law to investigate your need for care. If they believe that your accident is no longer the major contributing cause of your need for treatment, they are required to deny benefits within certain time frames. See §440.20(4), Florida Statutes, and Sierra v. Metropolitan, 188 So. 3d 863 (Fla. 1st DCA 2015). Should your carrier fail to act within those time frames, it may waive its right to deny care and benefits, meaning you may still be entitled to receive compensation and medical care for your injury. Your workers’ compensation carrier will never tell you this, but instead will try to deny your case and hope you do not hire an attorney.
It is no secret that Southwest Florida’s population is older than average. Many workers who injure a knee, hip, shoulder, back or neck may show preexisting arthritic changes on X-rays or MRI scans that came about through years of hard work. Carriers are quick to try to deny benefits to older workers who, because of years of living and working, no longer have the joints comparable to those of a teenager. Not surprisingly, preexisting conditions often complicate workers' compensation claims. Navigating this minefield is just one reason you need the services of a skilled and experienced workers’ compensation attorney to help you.
Getting The Compensation Benefit You Deserve
All Injuries Law Firm has successfully represented thousands of injured workers who had preexisting medical conditions before they had an injury on the job. We have utilized our experience to ensure that workers’ compensation carriers do not wrongfully deny compensation and medical care to our clients by improperly maintaining a major contributing cause defense.
If your workers’ compensation carrier is refusing to provide medical care or wage benefits to you based upon a preexisting condition, call the workers compensation lawyers at (941) 625-4878 for a free evaluation to discuss your case. Case evaluations are free, and we prioritize attorney availability to serve you.