Insurance companies are in business to make money, and one of the best ways to maximize profits is to deny payment on injury claims. As a result, many people’s worker’s compensation claims are denied because of “pre-existing conditions.”
Some workers have their claims denied based on failure to disclose preexisting conditions or for preexisting conditions that they were not aware of. Even when a person has a preexisting condition, it does not necessarily prevent them from being able to obtain workers’ compensation benefits.
Lawyer for Workplace Injuries with Pre-Existing Conditions in Miami, FL
Was your workers’ compensation claim denied or do you have concerns about filing your claim because of a pre-existing condition? The Hoffman Firm provides legal services for workplace injury victims on a contingency fee basis so there are absolutely no fees unless you get a monetary award.
Evan A. Hoffman is an experienced workers’ compensation attorney in Miami who represents clients all over South Florida, including communities in Palm Beach County, Broward County, and Miami-Dade County. He can provide a full evaluation of your case to help you understand your legal options as soon as you call (305) 940-2307 to schedule a free, no obligation consultation.
Florida Pre-Existing Conditions in Workers’ Compensation Claims Information Center
- What is the “major contributing cause” in workers’ compensation cases?
- How does an independent medical examination work?
- Where can I learn more about pre-existing conditions in Florida workers’ compensation laws?
A key element in Florida workers’ compensation claims is the determination of the “major contributing cause” of the injuries. Florida Statute § 440.09 defines major contributing cause for the purposes of workers compensation claims as being “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.”
Florida Statute § 440.09(1)(b) further states:
If an injury arising out of and in the course of employment combines with a preexisting disease or condition to cause or prolong disability or need for treatment, the employer must pay compensation or benefits required by this chapter only to the extent that the injury arising out of and in the course of employment is and remains more than 50 percent responsible for the injury as compared to all other causes combined and thereafter remains the major contributing cause of the disability or need for treatment. Major contributing cause must be demonstrated by medical evidence only.
The injured worker has the burden of proof to demonstrate that the accident on the job is more than 50 percent responsible for his or her injury and medical treatment.
In accordance with Florida Statute § 627.736(7) and Rule 1.360 of the Florida Rules of Civil Procedure, an injured worker may have to undergo an independent medical examination (IME) in order to have a supposedly independent party offer his or her professional medical opinion. Despite the use of the term “independent,” many doctors or other health care professionals who provide IMEs are specifically chosen by insurance companies because they will usually determine that the injury victim is not eligible for benefits.
In some cases, the physician will claim that a worker’s injuries are not as serious as he or she claimed they were or as serious as the victim’s own doctors deemed them to be. In other cases, the doctor chosen by the insurance company will claim that a pre-existing condition largely contributed to the injury.
Injured workers will generally have to comply with requests to submit to IMEs, as failure to agree to an examination can be construed as a breach of the insurance policy that effectively allows the insurance company to avoid paying the claim. Victims can take the necessary steps to prepare before appearing at these examinations by first contacting a Miami workers’ compensation lawyer for advice on what to say during and how to handle the entire IME process.
Florida Statutes Chapter 440 | Workers’ Compensation — View the full text of the state laws relating to workers’ compensation in Florida. Pre-existing conditions are addressed in multiple sections, including the definitions, coverage, and compensation for disability sections.
Division 69L: Division of Worker's Compensation | Florida Administrative Code — Rules promulgated by state regulatory agencies are published in the Florida Department of State’s Administrative Code. Division 69L covers workers’ compensation issues such as workers' compensation claims, assessments, and drug testing rules.
The Hoffman Firm | Miami Workplace Injury with Pre-Existing Conditions Lawyer
If you are concerned about filing a workers’ compensation claim or you have already had your claim denied because of a pre-existing condition, it is in your best interest to immediately seek legal representation. The Hoffman Firm represents clients in Miami Beach, West Palm Beach, Aventura, Boynton Beach, Fort Lauderdale, Hallandale Beach, Homestead, and many surrounding parts of South Florida.
Miami workers’ compensation attorney Evan A. Hoffman fights to get workplace accident victims the workers’ compensation benefits they are entitled to, and he may also be able to hold other negligent third parties accountable. Call (305) 940-2307 or fill out an online contact form to have our lawyer review your case during a free consultation.
Evan A. Hoffman
Mr. Hoffman’s philosophy is "our knowledge and experience is your best defense." He has been a featured author on criminal law issues such as driving under the influence, domestic violence and illegal searches.Read More