Seek Fair Benefits with Our Hialeah Lawyers

Workers’ compensation should cover any work-related injury, but there are situations where you may be denied coverage based on a preexisting condition. What does this mean? It means that the insurance provider thinks you have a prior medical condition that is responsible for your injuries, which would jeopardize your right to workers’ comp benefits. 

It is important to note that there are situations where a preexisting medical condition will not impact your right to workers’ compensation. Our Hialeah attorneys at Morales & Cerino can talk to you about your particular case to determine how this could influence your claim and how to pursue the benefits you need. With over a century of collective legal experience and attorneys on our team who are former insurance defense lawyers, we know the ins and outs of both sides of the Florida workers’ comp process. We are here to help you.

Call (305) 340-2630 or contact us online for a free consultation and review of your claim.

Understanding Preexisting Conditions and Workers' Compensation

In workers' compensation cases, preexisting conditions refer to medical conditions or injuries that existed before the work-related injury occurred. This can include chronic illnesses, old injuries, or health issues that were present before the accident.

• How to Prove Your Injury is Work-Related:
  • Document the injury: It’s essential to have detailed medical records and witness statements proving that the new injury is separate from any prior condition.
  • Medical evaluations: Having an independent medical professional assess and confirm that your work injury is not exacerbated by a preexisting condition is crucial.
  • Expert opinions: If there is a dispute, medical experts can testify that your injury is work-related and not due to your preexisting condition.
• Impact on Workers' Compensation Claims:
  • Claim Denials: Insurance companies may try to deny or reduce your benefits by claiming that the preexisting condition caused the injury.
  • Benefit Reduction: If the insurer agrees that the preexisting condition contributed, they may only provide partial benefits, which could impact your overall compensation.

How Insurance Companies Handle Workers' Compensation Claims

Insurance companies play a key role in approving or denying workers' compensation claims. However, their primary goal is to minimize payouts, so they may use various tactics to reject claims.

• How Claims are Evaluated:
  • Review of medical records: Insurers will look at your medical history to determine if your current injury is related to a preexisting condition.
  • Investigation of the incident: They may scrutinize the circumstances of your injury to find evidence that it is not work-related.
• Common Tactics Used to Deny Claims:
  • Blaming preexisting conditions: They might argue that your injuries were caused by a prior condition rather than the work accident.
  • Misinterpretation of evidence: Insurers may use any ambiguity in your medical records or incident report to deny your claim.
• Why an Attorney is Crucial:
  • Negotiation: An experienced attorney can negotiate with insurance companies to ensure your rights are protected.
  • Appeals: If your claim is denied, a lawyer can help you appeal the decision and fight for the compensation you deserve.

The Importance of Medical Evidence in Workers' Compensation Cases

In workers' compensation claims, medical evidence is crucial for proving the extent and cause of your injuries.

• Role of Medical Records:
  • Proving injury severity: Medical records provide detailed information about the nature of your injury and treatment history.
  • Connecting your injury to the workplace: Doctors’ reports can show that your injury is linked to your job, not just a preexisting condition.
• Gathering Medical Evidence:
  • Keep detailed records: Always maintain a record of medical visits, treatments, and recommendations from healthcare providers.
  • Obtain expert opinions: Independent medical evaluations can offer clarity on the relationship between your injury and your preexisting condition.
• Dealing with Conflicting Medical Opinions:
  • Second opinions: If you face conflicting medical reports, obtaining a second or third opinion can help.
  • Legal support: Your attorney can assist in gathering and presenting medical evidence to counter any unfavorable opinions.

Appealing a Denied Workers' Compensation Claim

If your workers' compensation claim is denied, it’s important to take swift action to protect your rights.

• Steps to Take If Denied:
  • Request a written explanation: Understand why your claim was denied by obtaining the insurer’s official decision.
  • File an appeal: Florida law allows you to challenge the denial by filing an appeal with the state’s workers' compensation board.
• How an Attorney Can Help:
  • Legal guidance: An experienced workers' compensation lawyer can guide you through the appeals process, ensuring all necessary paperwork is filed on time.
  • Representation at hearings: Attorneys can represent you at hearings or settlement conferences, strengthening your case for a successful appeal.
• Timeframe for Appealing:
  • Act quickly: Florida has strict time limits for filing appeals. Typically, you have 30 days from the denial to file a petition for benefits.
  • Attorney deadlines: Your lawyer will ensure that all required documents are submitted before the deadline, protecting your right to appeal.

By understanding how to handle preexisting conditions, insurance claims, medical evidence, and denials, you can improve your chances of a successful workers' compensation claim. Having an attorney on your side can significantly ease the process and help ensure that you get the benefits you deserve.

FAQ: Workers' Compensation and Preexisting Conditions

• Can I receive workers' compensation if I have a preexisting condition?
  Yes, you can still receive workers' compensation even if you have a preexisting condition. The key is proving that the injury or accident occurred as a result of your work duties and not because of your preexisting condition. If the work-related injury aggravated or worsened the preexisting condition, you may still be entitled to compensation.
• How do insurance companies determine if my injury is work-related or due to a preexisting condition?
  Insurance companies will review your medical history and the specifics of the injury. They may look at the date of your injury, prior medical treatments, and whether the injury occurred in the course of your work duties. They often rely on your doctor’s medical opinions to make this determination.
• What happens if my workers' compensation claim is denied due to a preexisting condition?
  If your claim is denied because of a preexisting condition, you can appeal the decision. It is important to have legal representation during this process to gather additional medical evidence, get second opinions, and present a strong case that the injury was caused by your work duties.
• Do I need to disclose my preexisting condition when filing a workers' compensation claim?
  Yes, it is essential to be honest and transparent about any preexisting conditions. Failing to disclose this information could hurt your credibility and may cause complications in the claims process.
• How long does the workers' compensation claims process take if I have a preexisting condition?
  The duration of the claims process can vary, especially if there are disputes over preexisting conditions. The process can take longer if the insurer requires additional medical evidence or if you need to file an appeal. On average, claims take several months to resolve, but it may take longer for more complex cases.
• Can I be denied workers' compensation if my injury only worsened a preexisting condition?
  Not necessarily. If the work injury aggravated an existing condition, you may still be entitled to workers' compensation benefits. It is important to prove that the work-related injury caused the increase in severity, which may require medical documentation and expert opinions.

Call (305) 340-2630 or contact us online for a free consultation and review of your claim.