How do pre-existing conditions affect workers’ compensation?

It is no secret that some industries are inherently more dangerous to work in than others. In Florida, some of the most hazardous lines of work involve construction, farming, commercial driving, manufacturing, and groundskeeping, according to the Bureau of Labor Statistics. If, however, you have a pre-existing condition, just about any job can be dangerous.

meeting with a workers' compensation attorney

No matter what you do for a living, accidents happen. If you have been injured on the job, it is essential to be aware of your legal rights and obligations. You may be eligible for benefits to manage your medical expenses and a portion of your lost wages.

However, your claim could be more complex if you have a pre-existing condition. That’s where a Treasure Coast workers’ compensation lawyer from Hoskins Turco Lloyd & Lloyd can help.

What Is a Pre-Existing Condition?

A pre-existing condition is a medical illness or injury you were officially diagnosed with prior to any accidents or injuries occurring within the scope of your employment. The pre-existing condition could have developed before employment with your current employer or during work, so long as it happened before the work-related injury that is most relevant to your current (or impending) claim. Pre-existing claims’ impact on workers’ compensation claims varies depending on a number of factors.

Unfortunately for the injured party, a pre-existing condition can sometimes make it more challenging to recover total and fair compensation for work-related accidents.

Examples of Pre-Existing Conditions

Various medical conditions and chronic illnesses are considered pre-existing conditions under workers’ compensation. They are often long-term or regularly recurring. Some of the most common examples include:

  • Arthritis
  • Asthma
  • Cancer
  • Carpal Tunnel Syndrome
  • COPD
  • Depression
  • Diabetes
  • Epilepsy
  • Lupus
  • Sleep Apnea
  • Prior knee or back injury

It is important to note that the list above is in no way comprehensive.

If you were diagnosed with another pre-existing condition you believe was aggravated by a new work-related injury, you might still have grounds to pursue additional workers’ compensation benefits.

Pre-Existing Conditions and Workers’ Compensation in Florida

Like the majority of states, Florida allows for the disbursement of workers’ comp benefits when a work-related injury exacerbates (worsens) a pre-existing illness, injury, or condition and leads to another medical condition. Unfortunately, despite the availability of this benefit, it isn’t always easy for injured employees to obtain additional benefits when a pre-existing condition is part of a workers’ compensation claim.

Your situation and when the pre-existing condition developed significantly impact your workers’ compensation claim. If, for example, you had a diagnosed pre-existing condition unrelated to work and a work accident worsened that condition, you can file for additional benefits to manage your accident-related injury and the exacerbated pre-existing condition.

If your pre-existing condition occurred at a previous workplace and you were injured at your new workplace and re-injured yourself in the same way, you can receive benefits. However, your total compensation may be reduced.

In the event your pre-existing condition is not bothered by an on-the-job accident, you can only recover compensation related to medical bills specifically arising from the work accident, along with the applicable salary benefits. Any past, current, or future bills related to your pre-existing condition are not eligible for benefits.

No matter your situation, it is crucial to understand that a pre-existing condition does not exempt you from workers’ compensation benefits. There is also a risk that your case could be assessed by a provider or insurer in such a way that the role of a pre-existing condition is exaggerated.

To fully understand what your award could look like, you will want to consult a workers’ compensation attorney.

How to Improve Your Chances of Maximizing Your Workers’ Comp Benefits

Numerous factors could impact your claim and your ability to receive benefits.

To improve your chances of your workers’ compensation claim being approved the first time, you will want to have your pre-existing condition and new injury thoroughly documented. You will also need to follow Florida’s workers’ compensation claims process closely. Failing to do so could delay or jeopardize your claim and benefits eligibility.

You should seek medical attention for an evaluation and diagnosis following your accident, or from the first moment you notice an injury or illness that could be related to your occupation. Your doctor should be able to explain the best recovery process and your prognosis. Before or shortly after you meet with your doctor, you must report the accident and injury to your employer in written form. In Florida, you only have 30 days from the date of the accident to file your claim. Your information will be submitted to your employer’s insurance company. You will also be required to go to a physician of the insurer’s choosing for your official diagnosis, but the documentation from your initial treating physician will be useful, relevant, and important.

It is imperative to follow your doctor’s instructions in terms of recovery. If you fail to do so, the insurance company could claim your injuries as not as severe as you say and find a reason for denial. They may also request you see a different physician, referred to as an independent medical examiner. That doctor will conduct their own examination and review your medical records. If you refuse to follow through with the request, your claim will likely be denied.

Ultimately, per Florida law, you will need to be able to prove that at least 51% of your current debilitating condition was the result of your recent work accident and not your pre-existing condition.

Denials and Appeals

Whether your pre-existing condition is related to your workers’ compensation claim or not, it is possible your employer’s insurance company could deny your original claim or severely reduce the benefits available. In either happens, you have the right to file an appeal. You will need a copy of your medical records to prove you are eligible for benefits. Additional information may be required, as well.  The appeals process is complicated, so it is best to have an attorney by your side when undergoing an appeal.

Contact a Treasure Coast Workers’ Compensation Lawyer Today

At Hoskins Turco Lloyd & Lloyd, we understand the challenges of pursuing a workers’ compensation claim. Dealing with insurance companies is never easy, but the situation is that much more difficult when you have been injured and are trying to figure out how to continue supporting your family.

If you have been injured at work and are looking to obtain workers’ compensation benefits, we can help you file your claim, and we will fight on your behalf to get you the compensation you are entitled to.

Call 866-460-1990 or contact us online to schedule a free, no-obligation case evaluation with one of our Treasure Coast workers’ compensation attorneys today.

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