Florida’s workers’ compensation system covers medical care for injuries that arise out of and in the course of employment. When you already have a medical condition, that simple phrase gets complicated. A sprained back is never just a sprained back if you have degenerative disc disease on your MRI. A shoulder tear collides with years of overhead work and a history of bursitis. Claims adjusters lean on that history to deny care, shrink treatment plans, or argue that your problems are “just personal.” The law does not require a perfect body to qualify for benefits. It requires proof that your job caused or materially aggravated your condition.
I have sat through countless recorded statements and depositions where a claim lives or dies on the words a worker uses to describe what changed. The difference between “it hurt before” and “I had good days and bad days, but after the incident I couldn’t lift a gallon of milk without pain” is often the difference between full medical benefits and months of appeals. This guide lays out how Florida handles pre-existing conditions, where the pitfalls are, and what a seasoned workers compensation lawyer will do to push your claim forward.
The legal core: Major contributing cause and aggravation
Florida centers these cases on a single idea: major contributing cause. The statute asks whether the industrial accident is more than 50 percent responsible for the need for treatment when compared to all other causes combined. If you already had knee arthritis, the question becomes whether the ladder fall at the hotel made that knee worse to the point you now require care, and whether that accident tips the scale past 50 percent.
Aggravation matters. The law recognizes that work can aggravate, accelerate, or combine with a pre-existing condition. If the aggravation is the major contributing cause of your disability or need for treatment, medical benefits are due. If objective evidence shows the accident made your condition symptomatic or pushed it from manageable to disabling, that can meet the standard. The “thin skull” notion applies in a practical sense. Employers take workers as they find them. A fragile shoulder that tears during a routine lift still counts if that lift at work Workers comp lawyer near me materially contributed to the tear and drove the need for care.
The insurer will test that proof from day one. Adjusters drill into your medical history, looking for gaps between the mechanism of injury and the symptoms you report. They will order prior primary care notes, chiropractic records, ortho files, and imaging to frame your claim as a continuation of old problems. That is expected, not personal. Your job is to provide clean, consistent facts and to anchor those facts to credible medical opinions that meet the major contributing cause standard.
What medical benefits look like in real life
When your claim is accepted, Florida workers’ comp pays for medically necessary treatment for the work-related condition. That includes doctor visits with an authorized provider, diagnostic imaging, medications, physical therapy, injections, surgery when appropriate, and necessary medical devices. There is no co-pay when care is authorized, and mileage reimbursement applies for most medical travel.
With pre-existing conditions, two features of the system become pivotal. First, the insurer picks your treating provider. If they choose a conservative doctor who downplays the work accident, your course of care slows. Second, utilization review leans on guidelines and documentation. The more specific the clinical findings and the more clearly the doctor ties those findings to the work event, the smoother the approvals. Vague complaints or a chart that reads like a copy-and-paste from last year’s visit invites denials.
If a doctor says your need for care is 60 percent due to the work accident and 40 percent due to degeneration, the insurer is on the hook for the full amount of recommended treatment for the compensable condition, not just 60 percent. Florida does not slice a shoulder arthroscopy bill into pro rata pieces. The battle sits at the front door: whether the accident is the major contributing cause at all.
Pre-existing conditions that frequently collide with work injuries
Back and neck degeneration is ubiquitous. Most adults over 40 show wear on MRI: disc bulges, facet arthropathy, spinal stenosis. Many have no symptoms until a lift, twist, or fall triggers pain, weakness, or numbness. Defense doctors often argue that imaging looks “age appropriate” and that the accident was minor. A strong claim shows a clean timeline, new neurological deficits, or a measurable functional decline after the incident, corroborated by exam findings such as positive straight leg raise or decreased reflexes.
Shoulder pathology is another minefield. A rotator cuff tendon can be frayed for years. Then a pull or overextension at work finishes the tear. An MRI read may say “chronic appearing tear,” which insurers use to deny. Yet the worker who could do overhead stocking last month and cannot lift a coffee mug today presents a compelling functional shift. If the authorized orthopedist documents new loss of strength, positive impingement signs, and correlates those with the workplace mechanism, the case often turns.
Knee, wrist, and ankle claims follow similar patterns. Degenerative meniscal tears, carpal tunnel in a worker with diabetes, or ankle sprains on top of old instability raise the same question: what changed, and how do we prove it?
Respiratory and dermatologic cases add another wrinkle. A worker with mild asthma gets exposed to strong cleaning agents and ends up in the ER. Or a technician with prior eczema develops a severe rash after contact with new solvents. Causation here leans on environmental histories, MSDS sheets, and sometimes industrial hygiene records. Pre-existing vulnerability does not negate coverage if the work exposure is the major contributing cause of the current need for treatment.
Mental health claims, if tied to a physical injury, can be compensable. Anxiety or depression that worsens after a serious injury may qualify when the physical injury is the major contributing cause of the psychiatric condition. Purely mental claims face stricter standards. With a prior history, treating providers need to trace the arc of symptoms and document why the workplace trauma changed the clinical picture.
How timeline and documentation win these cases
Time stamps matter. Report the accident promptly, ideally the same day. If you think you just “tweaked” something and try to push through, tell your supervisor anyway. In my files, the most defensible claims follow a clean sequence: incident, immediate report, same-day or next-day clinic visit, consistent symptoms noted at each follow-up. Gaps and shifting explanations give adjusters an easy hook to deny.
Content matters too. Your initial history in the urgent care chart is the foundation. If you tell the provider about the work event and identify where it hurts, and that note shows no prior similar complaints in the last few months, the insurer faces an uphill climb on denial. If the first record reads “no injury, pain woke him up two days ago,” expect a fight. When you have a pre-existing condition, say so, but be precise. For example: “I had occasional low back stiffness before, but I could work full duty. After lifting the safe on Tuesday I felt a pop, and now my pain shoots down my right leg and I can barely stand.”
Imaging comparisons help. A pre-accident MRI that shows mild degeneration and a post-accident MRI that reveals a new herniation at the same level as your new radiculopathy creates a powerful causal bridge. When prior imaging is unavailable, objective exam changes, EMG results, or new functional limits can fill the gap.
The independent medical examination and its limits
Insurers often send workers to an IME, a one-time evaluation with a chosen physician. These reports can be skeptical of causation, especially with pre-existing conditions. While IMEs are part of the process, they are not the final word. Your lawyer can request a one-time change of physician within the authorized specialty, secure a claimant IME, or push for an expert medical advisor if there is a conflict between authorized physicians. The goal is not doctor shopping, it is to obtain a medically reasoned opinion grounded in the record and the law’s causation standard.
A practical note: doctors write for readers like themselves. When I ask a treating orthopedist for an opinion on causation, I request a short, clear paragraph that ties mechanism to pathology. Something like, “In my medical opinion, within a reasonable degree of medical probability, the lifting incident on 5/2/24 is the major contributing cause of the patient’s need for right shoulder arthroscopic repair. The patient was working full duty without shoulder complaints before the event, and the post-event MRI demonstrates a full-thickness supraspinatus tear consistent with the described mechanism.” That single paragraph, properly placed in the record, can unlock care.
Maximum medical improvement, ongoing care, and when the insurer says you are “fixed”
Eventually, authorized providers will place you at maximum medical improvement, or MMI. That means further recovery is not expected, not that you are perfect. For many with pre-existing conditions, MMI includes a permanent impairment rating and restrictions. Medical benefits typically continue for palliative care related to the compensable injury, but the intensity of treatment drops. If your pre-existing condition requires care beyond what the work injury demands, the insurer is likely to deny that portion.
Disputes often arise when a provider tries to treat the whole joint rather than the part attributed to the work accident. For instance, a surgeon may recommend a multilevel cervical fusion when only one level is tied to the accident. In those cases, the insurer may authorize a more limited surgery. This is where negotiation and medical nuance matter. Sometimes the parties agree to authorize a broader procedure if the treating doctor can separate billing or articulate why a limited approach would fail.
The role of a workers comp attorney when history complicates causation
When you search for a workers compensation lawyer near me, evaluate more than proximity. Pre-existing condition cases require an experienced workers compensation lawyer who has lived through contested causation hearings and knows the doctors, the claims adjusters, and the local judges’ preferences. Ask about their experience with independent medical examinations, their approach to obtaining a persuasive major contributing cause opinion, and how they prepare you for recorded statements and depositions.
A capable workers compensation attorney will do several things early. They will secure and review your prior records so there are no surprises. They will prepare a clean narrative chronology that maps symptoms, work demands, and treatment. They will push for the right specialist, use your one-time change strategically, and challenge denials with targeted petitions rather than blanket demands. In mediation, they will quantify exposure by combining impairment ratings, restrictions, and the cost of likely future medical care. When you read reviews for the best workers compensation lawyer, look for mentions of specific wins on causation, not just fast settlements.
If your injury involved a fall from height, a struck-by incident, or defective equipment, a work accident lawyer may also explore third-party claims. Those run outside workers’ comp and can cover pain and suffering, but they require proof of negligence by someone other than your employer. The workers comp law firm you choose should screen for this in the first interview.
Common insurer arguments and how to counter them
I hear the same four refrains in disputed cases. First, “Imaging shows degenerative change only.” Response: degeneration is common, and the issue is whether the accident materially changed function and created the current need for care. Compare pre- and post-accident function, look for new deficits, and obtain an opinion that ties mechanism to pathology.
Second, “Symptoms are inconsistent with the mechanism.” Response: anchor your story. If you lifted and twisted and now have radicular pain, have the provider document nerve root findings. If you slipped and jammed the shoulder, document impingement signs. Consistency across time is more persuasive than volume.
Third, “Delayed reporting breaks causation.” Response: document why you delayed. Many workers hope a strain will pass. Describe how the pain worsened, when you told a supervisor informally, and what finally prompted a visit. Corroboration from a coworker helps.
Fourth, “Prior similar complaints show this is ongoing.” Response: distinguish frequency, intensity, and function. “Yes, I had stiffness twice a month. After the fall, it became daily, with numbness. I had to stop overtime.” Doctors can translate that into objective impairment.
When your own words hurt or help
I once represented a hotel houseman with a meniscus tear. He told the clinic he “always had knee pain,” trying to be honest. The adjuster denied the claim within 48 hours. We salvaged it because we obtained gym logs showing he had just finished a 5K two weeks before the injury, and his supervisor confirmed full-duty performance. The authorized orthopedist amended his note to reflect that the worker had occasional soreness but no functional limits before the ladder slip, and that the tear aligned with the twisting mechanism. The claim turned.
Contrast that with the warehouse worker who insisted in a recorded statement that he felt nothing at the time of the lift and the pain started the next day “for no reason.” He feared being blamed. The claim was denied and never recovered because every subsequent note echoed that phrasing, and there was no imaging change to rescue causation. Your words are evidence. Be accurate, not casual. If a symptom started later the same day, say so and link it to activity after the event. “It tightened up that evening and kept me awake” sounds like a body reacting to strain, not “no reason.”
Navigating authorized providers, one-time change, and managed care networks
Florida allows one one-time change of physician within a given specialty. Timing and specialty selection matter. If the initial orthopedist is dismissive, you can request the change in writing. The insurer then has a short window to provide the new doctor. If they miss the deadline, you may select your own provider. Workers and their attorneys can use this to course correct without escalating into full litigation. Choose specifically. Rather than “orthopedist,” ask for “shoulder and sports medicine orthopedist.” Precision helps, especially where a pre-existing condition requires a sub-specialist who can distinguish old from new.
Managed care networks can limit the pool. An experienced workers comp lawyer knows the local network and which doctors are balanced in their approach. A workers compensation attorney near me who regularly appears before your county’s judges will also know which medical narratives hold up at final hearing.
When surgery is on the table
Surgery with a pre-existing condition triggers careful scrutiny. For spine procedures, expect the insurer to push conservative care longer and to favor selective injections over multilevel interventions. For shoulders and knees, they may accept debridement but balk at repair if the radiologist labels the tear chronic. Your surgeon’s operative report and intraoperative photos become critical. A description of acute fraying or fresh hemorrhage can counter the “chronic” tag.
Post-surgical recovery intersects with past history too. A worker with diabetes may heal slower. A smoker may face complications. The insurer might argue that these comorbidities, not the accident, drive delays. Work with your providers to control the controllables, document adherence, and keep causation focused on why the procedure was necessary in the first place.
Settlements, future medical, and the long arc of care
Many cases resolve in mediation once MMI is near, or when litigation risk sharpens both sides’ views. In a case with pre-existing conditions, settlement valuation hinges on the permanence of restrictions, the likelihood of future procedures, and the cost of medications and therapy. A workers comp law firm with experience will not guess. They will obtain an itemized future care estimate from the treating physician or an outside nurse case manager. If a repeat MRI and periodic injections are likely every 12 to 18 months, that number should be in the demand. If a knee will need a total replacement within five to seven years, build that into the cash flow.
Be honest about trade-offs. Settling closes the workers’ comp medical file. If your pre-existing condition will require care separate from the work injury, settlement can simplify your life. If you expect to need surgery that you connect to the accident and have a strong major contributing cause opinion, keeping the claim open through surgery may make sense. The best workers compensation lawyer will walk you through both paths with numbers, not just gut feelings.
Practical steps you can take today
- Report the incident in writing to your employer and keep a copy. Even a short email with the date, time, and what happened creates a timestamp that will matter later. At the first medical visit, give a clear, consistent history that includes any prior issues and the new changes since the incident. Ask the provider to note your pre-injury work status. Keep a simple symptom and function log. Two lines a day is enough: pain level, activity limits, medications. Patterns persuade adjusters and doctors more than adjectives. Request your one-time change promptly if the assigned provider minimizes your injury or seems fixated on your history. Target the right specialty. Consult an experienced workers compensation lawyer early, especially if you have prior medical history in the same body part or a complex diagnosis.
How Florida’s process actually unfolds
Your claim starts with an accident report and an intake visit at a clinic or occupational health provider. If accepted, you move through conservative care: therapy, medications, light duty if available. Denials arrive by letter with references to causation or medical necessity. Your lawyer files a petition to benefit, which triggers mediation, discovery, and possibly a final hearing. Along the way, you may attend an IME, give a deposition, and see an expert medical advisor if there is a conflict in medical opinions.
Cases with pre-existing conditions often turn at one of three points. First, an early major contributing cause opinion from a credible specialist. Second, post-imaging when objective change appears. Third, after a failed conservative course when the practical need for surgery is clear and the surgeon draws a direct line to the work event. Your credibility and the chart’s internal consistency are the constant threads.
When to get help and what to look for
If you have an aggravation of a prior condition, a denial based on “degenerative findings,” a delayed report, or a case stuck at conservative care without progress, talk to a workers comp attorney. Search for workers comp lawyer near me, but interview more than one. Ask about their hearing experience on major contributing cause disputes. Ask which orthopedists and neurologists they prefer for contested cases in your region. Ask how often they request expert medical advisors and with what results. A seasoned work injury lawyer should answer in specifics, not generalities.
Some firms market as a broad work accident attorney practice and do both third-party negligence cases and comp. There is value in a team that spots both avenues, but ensure there is a dedicated comp lawyer handling your file day to day. The workers compensation law firm that knows your adjuster’s playbook, your local authorized doctors, and your judge’s expectations is the one that moves your claim, not just promises to.
Final thoughts from the trenches
Pre-existing conditions do not disqualify you from medical benefits in Florida workers’ compensation. They complicate proof. The insurer’s job is to question causation. Your job is to tell a consistent, accurate story and to anchor it to medical evidence that meets the major contributing cause standard. The difference between a denied MRI and an approved surgical repair often lives in a single paragraph of a doctor’s note or a single sentence in an urgent care chart.
If you are searching for a workers compensation attorney near me because a claims rep told you your MRI shows “wear and tear,” do not accept that as the last word. With a thoughtful strategy, credible medical support, and an experienced workers compensation lawyer at your side, you can secure the care you need and protect your future.