Pre-Existing Medical Conditions and Workers’ Compensation Claims

If you are injured at work while performing your regular job duties, and you have a pre-existing condition, it can complicate a workers’ compensation claim. Medical benefits and lost wages could be impacted if there is a previous medical issue which contributed to the current work related medical condition. 

When a Pre-Existing Condition is Related to a New Workers’ Compensation Claim

Legally, insurance companies cannot deny a workers’ compensation claim for an injury sustained while on the job solely because someone has a pre-existing condition. Florida Statute 440.09 requires that the accident be the Major Contributing Cause (MCC) for the need for treatment. This generally means that the accident is more than 50% the cause of the need for treatment when compared with all other potential causes.

If the accident is the MCC for the injury, treatment and lost wages are payable until, or unless, you reach your pre-accident state. If you have a permanent injury or worsening of the underlying condition, it would also be considered accident related, if the MCC standard is met.  

What complicates this matter further is that old injuries may result from previous workers’ compensation issues, sports-related injuries, and even car accidents. Other types of illness such as arthritis of the joints can also be a factor. Each type of previous ailment is viewed and handled differently and should be reviewed by a knowledgeable worker’s compensation attorney due to its complexity. 

When a Pre-Existing Condition is Not Related to a New Workers’ Compensation Claim

If you have a pre-existing condition that is entirely unrelated to your new workplace injury, it should not affect your benefits. However, this is a medical issue, and due to the complications of MCC, an attorney must be involved as well.

Reduced Benefits

If you meet the MCC standard, you are entitled to medical expenses and lost wages. However, your benefits may be reduced by the percentage applicable to your previous injury. For example if the work accident is 60% of the cause and need for treatment, treatment and benefits will be provided but these benefits will be reduced by 40%. When this occurs, you will be responsible for paying for the difference in medical care and your lost wages will be reduced as well.  

These types of situations pose particular challenges that an experienced workers’ compensation attorney can handle. If you have a workers’ compensation claim and a pre-existing condition, contact us today to find out how we can help you get the benefits you deserve.

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