Florida’s workers’ compensation system is built on a tradeoff. You do not have to prove your employer did anything wrong, and in return you get medical care and partial wage replacement for work-related injuries. That sounds straightforward until a doctor opens your chart and sees a prior back injury, degenerative arthritis, or an old knee tear from high school football. Suddenly adjusters start asking pointed questions, an independent medical exam appears on your calendar, and the conversation shifts from “How are you feeling?” to “How much of this is really work-related?”
I have helped hundreds of injured Floridians with precisely this problem. A pre-existing condition is not a disqualifier, but it can change the path of your claim. If you understand how Florida law treats prior injuries, you can make smart choices early, avoid avoidable denials, and protect your wage-loss benefits.
The legal backbone: Major contributing cause and apportionment
Two concepts drive nearly every dispute when a worker has a medical history: major contributing cause and apportionment. They sound similar, but they serve different purposes.
Florida Statutes define “major contributing cause” as more than 50 percent of the reason for your need for treatment or your disability, as judged by medical evidence. In practice, a doctor has to say that the workplace accident outweighs everything else combined, including degenerative changes that come with age. If you had no symptoms for years and then a specific lift or twist at work sent you to urgent care, most physicians have no trouble identifying the accident as the major contributing cause, at least at first.
Apportionment happens later, when doctors parse how much of your ongoing impairment and future care stems from the accident versus your underlying condition. Florida’s apportionment statute allows an employer or carrier to reduce permanent impairment benefits, and sometimes ongoing care obligations, by the percentage a doctor attributes to the prior condition. The carrier does not get to apportion initial emergency care. They cannot apportion wage-loss benefits until your treating doctors release you to maximum medical improvement and assign ratings. But once apportionment enters the file, the value of the claim can drop sharply if you do not challenge unsupported percentages.
This is where the words on the medical line matter. A good workers comp attorney will work with your authorized treater to document pre-accident status, symptom-free periods, and the nature of the accident, then cross-check those notes against any independent medical examination the insurer orders.
A real-world picture of how claims unfold
Consider a warehouse picker with mild degenerative disc disease. He has occasional stiffness but never misses work. One afternoon he tries to stop a toppling pallet, feels a sharp pop in his lower back, and can barely stand. He reports the accident the same day and sees an authorized orthopedic specialist the next morning. MRI shows a herniated disc at L4-5 on top of degeneration at multiple levels. The doctor prescribes physical therapy and limits him to light duty.
For the first few weeks, benefits flow. The carrier approves therapy and pays two-thirds of his lost wages up to the statutory cap. Everyone agrees that he suffered a compensable injury. The debate starts later, when the orthopedic surgeon considers an injection or surgery and the carrier sends him for an independent medical exam. The IME doctor writes that the degenerative disease was significant and the work event only aggravated it temporarily. If the IME’s view becomes the “major contributing cause” opinion, the carrier will try to cut off treatment and reduce exposure to permanent benefits.
That is not the end of the road. A workers compensation attorney can request a one-time change of physician, arrange a claimant IME, or bring the dispute to the judge of compensation claims to resolve the medical conflict. When the evidence shows a clean, bright line between pre-accident baseline and post-accident disability, judges often credit the treating physician who has followed the patient over time.
The duty to disclose your history, and how honesty helps your case
Nothing torpedoes a claim faster than a hidden medical history. Adjusters have prescription databases, prior claim indexes, and clinic networks. If you saw a chiropractor six months ago for the same body part, it will surface. Omitting it can make a manageable apportionment fight look like fraud. Honesty lets your doctor write a nuanced report that distinguishes chronic background issues from a new, acute problem.
Tell your authorized doctor, in plain terms, how you felt before the accident. If you had pain, describe frequency, intensity, and limitations. If you were symptom-free for years, say so. When physicians can state that you were functioning without restrictions, that you had no recent treatment, and that a specific incident produced new objective findings, they usually have no trouble assigning major contributing cause to the work event. I have seen many cases won on that simple clarity.
What counts as a compensable aggravation
Florida law covers aggravations of pre-existing conditions if the workplace accident is the major contributing cause of the need for care. That applies across the body. An arthritic knee that becomes unstable after a misstep on a wet loading dock, a shoulder with tendon fraying that tears during overhead assembly, a degenerative neck that becomes radicular after a forklift jolt, all are classic patterns.
The dispute turns on duration and objective evidence. Carriers love phrases like “temporary exacerbation” and “symptom magnification.” They will point to MRIs that show changes doctors often call age related. Your best evidence is a combination of functional change and credible diagnostics. A positive straight-leg raise coupled with new weakness, a documented loss of range of motion with painful crepitus, or a nerve conduction study that lights up after the accident, these details separate a transient flare from a lasting injury.
Independent medical exams: what they are and how to handle them
An insurer’s IME is not neutral. The doctor is paid by the carrier and often selected for a conservative approach. Still, these exams can be navigated without damage if you prepare.
- Keep your answers short, accurate, and consistent with the medical records. If you do not remember a date, say so. Do not guess. Describe your baseline honestly. If you had mild aches after mowing the lawn but never missed work, say exactly that. Focus on function. Explain what you cannot do now that you could do before. Concrete examples help. Lifting your toddler or climbing three flights without stopping carries more weight than generic “pain.”
Your attorney can often attend or at least brief you in advance. If the IME opinion is unfavorable, Florida’s dispute process allows you to counter with your authorized treater’s opinions or your own claimant IME. Consistency and credible specifics tend to win when two experts disagree.
Light duty, TTD, and the practical effect of restrictions
When a doctor restricts you to light duty, your employer must either provide suitable work or, if they cannot, the carrier pays temporary partial or temporary total disability depending on your restrictions. Pre-existing conditions complicate this stage when employers argue that you could do the job but for old problems. The record has to show that the current restrictions stem from the industrial accident.
If your job requires repetitive overhead work and your shoulder surgery is on the injured side, most adjusters will accept that as work-caused. If a supervisor tries to send you home because they “don’t have light duty,” call your adjuster and document the refusal. Keep a daily log of job offers, tasks, and pain response. Judges like contemporaneous notes when credibility is on trial. A work injury lawyer will organize these facts and present them in a way that ties restrictions and wage loss to the industrial accident under Florida’s standards.
Permanent impairment ratings and the apportionment moment
Maximum medical improvement is a turning point. Your doctor assigns a permanent impairment rating using the Florida Impairment Guide or a similar accepted method. That rating drives the value of your impairment benefits, paid in weeks. This is when apportionment is most aggressively pushed.
If your knee had osteoarthritis and you undergo a meniscectomy after a workplace twist, a carrier doctor may claim 50 percent of the final rating is pre-existing. Your treating surgeon may say 15 percent. The difference can mean thousands of dollars. Lawyers dig into pre-accident imaging, activity level, and medical literature to challenge inflated apportionment numbers. We also compare language. Did the rating explicitly separate impairment due to the pre-existing condition from the post-traumatic changes? Vague statements invite reduction. Clear analysis resists it.
The credible medical record: where cases are won
The quality of your chart often matters more than anything you say at hearing. I often suggest simple habits that lead to better notes.
Describe pain in concrete ways. Point with a finger to the area, compare to common sensations, and report how specific tasks trigger symptoms. “Stabbing pain along the outer elbow with gripping the drill” produces better documentation than “My arm hurts.”
Bring a list of medications, prior providers, and dates of significant treatment. Consistency across visits builds trust. Inconsistent or evasive answers hand the carrier an argument.
Follow the plan. Florida adjusters are quick to label patients as noncompliant. If you cannot attend therapy due to transportation or a schedule conflict, tell the clinic and the adjuster before you miss sessions. An experienced workers compensation lawyer can secure transportation vouchers or adjust appointment times so your attendance remains strong.
Degeneration is common, not disqualifying
Most adults over 40 have some degenerative changes on imaging, even without pain. Radiology reports often use alarming terms like severe spondylosis or high-grade chondromalacia. Do not let the language scare you into silence. Many of my clients performed physically demanding jobs for years with those findings sitting quietly in the background. A specific event at work can convert silent degeneration into disabling injury.
A good doctor will separate chronic wear from acute damage by correlating imaging with your exam and the timeline. The MRI might show multi-level degeneration, but a new annular tear at L4-5 lines up with your sharp, radiating pain after the incident. That correlation matters more than a generic “degenerative” label.
Surveillance, social media, and the credibility trap
When pre-existing conditions are involved, carriers often hire investigators. A two-minute clip of you carrying groceries can get blown into an argument that you are fully capable. Context is everything. Lifting a light bag once does not equal eight hours of warehouse picking.
Do not post about your case. Simple, harmless posts get twisted. If you get caught on surveillance, be honest about the activity and the aftermath. Many times I have neutralized a video by showing that the same worker lay flat with ice for hours after pushing through a task for family reasons. Judges are people. Credible context beats edited clips.
Claims with psychiatric overlays
Physical injuries can aggravate pre-existing anxiety or depression, especially when chronic pain and job loss enter the picture. Florida sets a high bar for psychiatric conditions, requiring a physical injury that is the major contributing cause of the need for mental health treatment. Document your symptoms and ask your authorized doctor for a referral if mental health is affected. Carriers fight these claims, but when properly documented and tied to the physical injury, counseling and medications can be authorized. A workers compensation attorney near me who understands both sides of the statute is invaluable in these mixed cases.
When a denied claim is worth litigating
Not every denial is worth a year of litigation. The best workers comp lawyers practice triage. We weigh the medical strength, witness quality, job availability, and your tolerance for delay. Small denials on discrete treatments sometimes resolve with targeted depositions and a short hearing. Large denials on major contributing cause may require dueling IMEs and a full merits hearing.
Good counsel will tell you where the evidence likely lands, not what you want to hear. And the best workers compensation lawyer for you is often the one who can explain your odds in plain English and adjust the plan as the medical record evolves.
How settlements work when you have a medical history
Most Florida comp cases end in a settlement, often after MMI. Apportionment reduces the insurer’s exposure, which in turn can reduce offers. The flip side is leverage on ongoing disputes. If the carrier’s IME is weak, your authorized doctor is credible, and your job cannot accommodate restrictions, settlement values rise even with a prior condition.
Carriers typically pay a lump sum in exchange for closing your case, including future medical care. When a pre-existing condition exists, be careful. If the work accident worsened the condition permanently, and you will need care for years, a low settlement can backfire. A thorough workers comp law firm will price out the medical plan, obtain cost estimates from treating providers, and push for fair value that covers likely injections, hardware removal, or therapy. If Medicare is involved, a set-aside analysis might be necessary.
Choosing help that fits the problem
If you search for a workers compensation lawyer near me, you will find long lists. Focus less on the slogan and more on the fit. Do they regularly handle major contributing cause and apportionment cases? Do they take depositions of IME doctors or simply wait for offers? Ask how many cases they have tried in the last two years. Trials are rare, but a lawyer who avoids them at all costs tends to get smaller settlements.
The right workers compensation law firm will ask detailed questions about your medical past without judgment. They will want records from before and after the accident, not because they doubt you, but because they know the carrier will comb through them. A seasoned workers comp attorney builds your case before the Work accident attorney dispute peaks, aligning the medical record, witness statements, and your testimony into a consistent, believable narrative.
Practical steps that make a difference in Florida pre-existing injury claims
- Report the accident immediately and describe the specific event, not just the pain. A date, time, and mechanism create a clean anchor for medical opinions. Be candid about prior treatment and symptoms, including dates and providers. Your credibility is a core asset. Keep a simple weekly log of symptoms, restrictions, and work interactions. Short entries win disputes. Follow the authorized care plan, and notify the clinic if you cannot attend. Missed appointments cost far more than they save. Consider legal counsel early if an adjuster raises major contributing cause or apportionment. The first medical opinions often set the trajectory.
How insurers think, and how to anticipate their moves
Understanding the other side reduces frustration. Adjusters measure risk in buckets. Early care, diagnostic imaging, injections or surgery, indemnity exposure, and long-term medical. A pre-existing condition suggests apportionment and the possibility of an early cutoff if an IME can label the event a temporary flare. That is why you might see quick approval for an X-ray but resistance to an MRI, or an early IME request after conservative care fails.
Anticipate and document. If therapy stalls, ask your doctor to explain why an MRI is the next logical step based on objective findings. If the IME calls it a temporary exacerbation, ask your treater to address chronicity, function, and any new objective evidence. A workers comp lawyer near me with experience will push for precise language so judges have something solid to rely on.
When pre-existing really means pre-accident disability
There is a difference between a pre-existing condition and a pre-accident disability. If you were already on permanent restrictions or out of work for the same body part, carriers will argue that the workplace event changed nothing materially. These are tougher cases. Success turns on showing a measurable, medically supported change after the accident. Sometimes the best route is limited treatment and a narrower settlement, rather than a bruising fight you are unlikely to win. An experienced workers compensation lawyer will level with you and focus on attainable goals.
A word on second jobs, side gigs, and wage calculation
Average weekly wage drives your indemnity benefits. Side gigs complicate the math. If you drove rideshare or worked part-time construction, tell your attorney. Proper documentation can increase your average weekly wage and boost temporary benefits. On the flip side, working in a physically demanding side job can give carriers ammunition to claim that ongoing problems are not work-related. Handle these details with care and consistency. A work accident attorney who understands wage documentation can add real dollars to your benefits without damaging your credibility.
When your employer becomes your ally or adversary
Some employers work with you to provide modified duty, park the heavy tasks, and keep you earning. Others push you to do more than your restrictions allow or pressure you to resign. Document every modified duty offer and your responses. If you are told to perform tasks outside your restrictions, ask politely for written clarification. If you are sent home because there is no light duty, inform the adjuster. A paper trail helps a judge determine whether wage loss is due to lack of accommodation rather than your pre-existing condition.
Bringing it together
A Florida work injury layered on an old problem is manageable with the right approach. Tell the truth about your history, nail down the accident details, and make each medical visit count. Understand the difference between major contributing cause and apportionment, because those two words will show up in letters and reports. If disputes arise, move quickly to secure favorable medical opinions and keep your documentation clean.
There is no single blueprint. A 28-year-old electrician with a labral tear over mild degeneration needs a different strategy than a 58-year-old nurse with multilevel disc disease and a new herniation after lifting a patient. The law provides room for both to recover benefits when the workplace event is the true driver of treatment and disability. A skilled workers compensation attorney can read your file the way an adjuster reads it, then turn the facts in your favor.
If you are weighing your next step, speak with an experienced workers compensation lawyer who handles Florida claims every week. Ask direct questions. Share your full medical history. Demand clear explanations of your options. Whether you resolve the case with continued care, a targeted hearing, or a settlement that responsibly funds future treatment, the right guidance turns a complicated pre-existing condition into a claim you can live with. And if you do not have someone in your corner yet, looking for a workers compensation attorney near me or a reputable workers comp law firm in your county is a practical place to start.