Under the Florida Workers’ Compensation Act, to be eligible to receive benefits, an injured workers must establish that his or her accidental compensable injury is the “Major Contributing Cause” of the need for medical care and/or disability. “Major Contributing Cause” is defined as the cause which is more than 50% responsible for the injury as compared to all other causes combined for which treatment or benefits are sought. In cases involving occupational disease or repetitive exposure, the injured worker must establish causation by the more stringent “clear and convincing” standard.
What if you re-injure or aggravate a pre-existing injury? In Florida, if you re-injure a body part that was previously injured, the Employer/Carrier is only obligated to furnish benefits to the extent the work-related injury is and remains more than 50% responsible for the injury as compared to all other causes combined and remains the reason you need medical treatment. The Courts in Florida have not interpreted pre-existing conditions to include injuries sustained as a result of a prior work-related accident. Therefore, if your prior injury was attributable to work-related accident, whether for the same Employer or a completely different Employer, the Insurance Carrier cannot use this as a means to deny you medical care.
Can the Insurance Carrier deny continued medical benefits after they have accepted my claim as compensable? The Employer/Carrier has a 120 day pay and investigate period from the initial provision of benefits to assert a denial of your claim. After that point, the Employer/Carrier can no longer contest that the accident is the “major contributing cause” of the injuries at issue. They can only contest the connection between a Claimant’s need for specific treatment or benefits, and the work-related accident. Once compensability of the injury is established, the burden shifts to the Employer/Carrier to demonstrate a break in the causation chain, such as the occurrence of a new accident or that the requested treatment was due to a condition unrelated to the injury which it had accepted as compensable.
What if your authorized doctor says your condition or injury is attributable to the normal aging process or arthritis? Case law supports that it is inappropriate to consider an injured workers’ normal-aged condition as a contributing, legal cause of the need for treatment in applying the major contributing cause analysis.
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