If you were hurt on the job in Miami-Dade County, Florida’s workers’ compensation law applies to your claim, even if you have an earlier injury or condition. A preexisting injury does not automatically bar your claim. However, insurers often deny claims by arguing that the work accident is not the main cause of your current condition, so how your injury is documented from the start matters.
“Most people over 30 have some wear and tear on their body. That doesn’t mean you weren’t actually hurt at work.” — James D. Payer
What Is Florida’s “Major Contributing Cause” Rule?
Under Florida Statute § 440.09, a work injury generally qualifies for workers’ compensation if the workplace accident is the major contributing cause of the worker’s injury and need for treatment. This means that the accident must account for more than 50% of the cause when compared with all other causes, including any pre-existing conditions.
“Florida has a rule called major contributing cause. If you get hurt at work and you have a pre-existing condition, the insurance company may be off the hook. They dig through all your medical records looking for similar injuries or similar complaints of pain.” — James D. Payer
How an Old Injury Can Affect Your Claim
Sometimes, an insurer may try to blame a preexisting condition like arthritis, degenerative disc disease, old accident injuries, or past complaints of similar pain to avoid paying a workers’ compensation claim. However, wear and tear on your body is normal.
Having an old injury does not automatically disqualify you from receiving workers’ compensation benefits. You may still qualify for workers’ compensation if a workplace accident caused a new injury or made an existing condition worse. For example, if you had a back injury years ago but could work without much pain, a lifting accident that worsens your symptoms may qualify you for benefits.
Reaching Maximum Medical Improvement
While Florida law can require insurers to cover a work injury that worsens an existing condition, insurers can still dispute future treatment or benefits. Once you reach maximum medical improvement, meaning your condition is not expected to improve significantly with further treatment, the insurer may also reassess your eligibility for ongoing benefits.
What To Do if You Have a Preexisting Condition
If you have a preexisting condition and you are worried about being able to file for workers’ comp after a work injury, there are some steps you can take to help preserve your right to recover from a workers’ comp claim. These steps include:
- Seek treatment: See your authorized doctor. At every visit, explain exactly how you got hurt at work, when the new pain started, and how it’s different from before.
- Disclose your prior injury: Be honest about the old injury. Hiding it can cost you your whole claim.
- Keep records: Get and save any communications with the insurer in writing. If your claim is denied, ask for a copy of your claim file.
- Gather proof of your preexisting condition: Anything that shows how you were doing before the accident: the accident report, full-duty work, no recent treatment, ER visits, and older X-rays or MRIs to compare.
- File a claim: Report your accident to your employer and file a Petition for Benefits before the deadline.
- Consult a lawyer: An experienced Miami workers’ compensation attorney can advise you on how to build a successful claim.
“What matters is getting the right medical documentation from day one. Your doctor’s notes need to clearly connect your current symptoms to your workplace accident. That connection is what protects your claim.” — James D. Payer
How Do You Know If Your Claim Gets Denied and What Should You Do If It Does?
Under Florida law, insurers are legally required to tell you if a specific benefit or if your workers’ comp claim gets denied. If the insurer has already started paying and has not denied your claim within 120 days, it may have lost the right to deny future payments.
If your workers’ compensation claim is denied because an insurer argues that you had a pre-existing injury or condition, you can take steps to challenge that decision with supporting medical evidence. Our legal team at Payer Law can help.
It Pays To Call Payer.
At Payer Law, attorney James D. Payer has 30 years of experience helping injured people pursue compensation and has recovered more than $100 million for our clients. As a family-owned firm, we offer Spanish-language services and handle cases on a contingency fee basis, meaning you do not pay attorney’s fees unless we recover compensation. You will also know who your lawyer is from day one.
Case Results
$300,000
Fort Lauderdale
A worker tripped and fell in a warehouse while retrieving parts and suffered spinal cord injuries. The employer and insurer denied the claim and the cause of her injuries. Payer Law litigated, brought in a medical expert, and proved to the judge the injuries came from the work accident.
$675,000
Miami
Multiple herniated lower-back discs with foot drop and neuropathy. The comp doctor’s surgery failed; Payer Law got the client to a University of Miami spine surgeon for corrective surgery, plus $670,658 in medical and lost-wage benefits before settlement.
Client Reviews
“I recommend Payer Law to anyone who needs to be protected and fought for against the big workers’ comp companies and law firms who are out to deny you and/or pay you as little as possible.”
Denise P.
“The entire time I received their undivided attention and concern while going through this very frightening and involved process.”
Karen F.
“I’m so grateful for their assistance and guidance through this difficult time in my life!”
Sonia G.
Are You Worried About A Preexisting Condition? Speak To Us For Free.
If you were injured at your Florida workplace, and you are worried about filing a workers’ compensation claim because of a preexisting condition, we offer free initial consultations. Additionally, if your workers’ comp claim was denied due to an old injury, we can review your case and explain your legal options.
Let a workers’ compensation attorney at Payer Law evaluate your case. It Pays to Call Payer. Our team is Available 24/7. We want to listen to your concerns and help you understand what comes next. Visit our Miami office at 12000 Biscayne Blvd STE 503, Miami, FL 33181, or contact us at (305) 363-7099.
