A recent Florida workers’ compensation case sheds light on the challenges injured workers face when seeking benefits for ongoing care. The case involved a cashier who suffered an electrical shock while plugging in a cash register at work. Although her initial injury was accepted as compensable, her employer and insurer later denied her claims for additional treatment, arguing that a preexisting genetic condition was the major contributing cause (MCC) of her medical needs. This case highlights the importance of understanding your rights and options when facing a denial in Florida’s workers’ compensation system.
Injured Worker’s Fight for Ongoing Care
The worker initially reached maximum medical improvement in 2020 after treatment for her workplace injury. However, in 2022, her symptoms worsened significantly, leading to issues such as balance problems, hand weakness, and bladder dysfunction. Further evaluation revealed a genetic condition, neurofibromatosis type I, which had caused tumors compressing her spinal cord. She underwent surgery to remove the most problematic tumor, but her doctor noted that additional tumors would require ongoing care.
Despite the severity of her symptoms and the connection to the initial work injury, her employer and insurer denied her claims for continued treatment. They argued that the genetic condition, not the work injury, was the MCC of her medical needs. The worker filed a petition for benefits to secure the necessary care, but the employer disputed her claim, relying on earlier medical opinions.
Florida’s Major Contributing Cause Standard
Under Florida Statutes § 440.09(1)(b), workers’ compensation benefits are only awarded if the workplace accident is the major contributing cause of the injury or need for treatment. This standard requires showing that the work injury is more than 50% responsible for the condition compared to any preexisting conditions.
In this case, the employer relied on medical testimony stating that the worker’s genetic condition was primarily responsible for her symptoms. However, the doctor’s opinion changed as the case progressed, which created a significant hurdle for the worker’s claims. The delay in clarifying the medical testimony underscores how critical timely and accurate medical evidence is in workers’ compensation cases.
What to Do If Your Claim Is Denied
If your workers’ compensation claim is denied, you can challenge the decision and fight for your rights. Here are some steps you can take:
Request a second opinion. If your employer disputes the cause of your injury, obtaining an independent medical opinion can strengthen your case.
File a petition for benefits. Filing a petition with the Judge of Compensation Claims (JCC) initiates the legal process for resolving your dispute.
Document your symptoms and treatment. Keeping thorough records of your medical visits, symptoms, and how the injury has impacted your life is crucial for building a solid case.
Work with an attorney. Florida’s workers’ compensation system can be challenging, especially when dealing with complex medical issues or legal arguments about MCC. Legal guidance can make a significant difference in the outcome of your claim.
Protecting Your Rights in Florida Workers’ Compensation Cases
Workers’ compensation disputes involving preexisting conditions can be particularly difficult for injured employees. Employers and insurers often argue that these conditions, rather than workplace injuries, are the primary cause of ongoing medical needs. Florida law places the burden of proof on workers to show that their injury is work-related and meets the MCC standard. This case highlights the importance of acting quickly to gather evidence, seek medical evaluations, and file claims within statutory deadlines.