Pre-Existing Conditions and Disability Ratings in Florida: Workers Comp Lawyer Explains

Florida’s workers compensation system does not expect perfect bodies. The law assumes real people come to work with prior injuries, chronic conditions, and the wear that comes with age or hard jobs. The challenge is separating what the job did from what was already there, then translating that into medical care, wage benefits, and a final disability rating that affects settlement value. If you have a pre-existing condition and a new work injury, you are not barred from benefits. You do, however, face a different evidentiary path and a tougher fight.

I have seen backs with old MRI findings flare up after one awkward lift, knees with prior arthroscopies swell after a routine step, and quiet carpal tunnel explode during a rush season. What matters is whether the work accident is the major contributing cause of the need for treatment or disability, and how the permanent impairment is measured when the dust settles.
Florida’s standard: major contributing cause
Florida uses a specific medical-legal test called “major contributing cause,” often shortened to MCC. Under section 440.09(1), the industrial accident must be more than a minor factor. It must be the primary driver of the need for treatment or the resulting disability, compared to all other causes combined. Doctors express this in percentages. If they say the work event is 51 percent or more responsible, you clear the MCC hurdle. If they put work at 40 percent and a degenerative condition at 60 percent, the insurer will deny ongoing benefits tied to that issue.

This standard is not about pain levels. You can hurt more now and still lose if a doctor attributes the flare to natural progression. The carriers know this and push for causation opinions that emphasize pre-existing degeneration, age, or prior accidents. A good workers compensation attorney knows how to frame a complete medical history, highlight mechanism of injury, and question doctors in deposition to anchor a sound MCC opinion.
Aggravation versus new injury
The law recognizes two tracks. One is a direct new injury, such as a herniated disc appearing for the first time on post-accident imaging. The other is an aggravation of a pre-existing condition, like advanced spondylosis that was stable until a fall at work turned background stiffness into daily radicular pain.

Aggravations are compensable if the workplace accident is the major contributing cause of the aggravation. Florida Statutes section 440.02(1) defines injury to include aggravation of a pre-existing condition. The catch is that once the aggravation resolves and the condition returns to baseline, the employer and carrier can cut off benefits tied to the aggravation. That is why precise baselines and consistent medical entries matter. If your chart shows minimal complaints for years, then a sudden spike after the accident, you have a stronger case that the aggravation is real and ongoing.
What doctors must do, and how the process actually plays
Treating physicians in workers compensation cases serve a legal function. They do not simply heal. They become expert witnesses. The insurer usually chooses the doctor from its network, unless you prevail in a motion or secure an independent medical examination. Those physicians must:
Identify diagnoses and relate each one to the accident, the pre-existing condition, or both. Assign work restrictions and evaluate whether you reached maximum medical improvement, often called MMI. Rate permanent impairment using the Florida Uniform Permanent Impairment Rating Schedule, which is based largely on the AMA Guides, 1996 edition.
Expect the carrier to push the narrative of degeneration. Expect the doctor to note age-related changes on MRI reports, which often use phrases like desiccation, osteophytes, or stenosis. Those words do not defeat your case by themselves. Most adults have degenerative findings on imaging by their 40s, even without pain. The key is linking new symptoms, objective changes, and functional limits to the accident.
Disability ratings: how Florida translates injuries into numbers
Permanent impairment ratings in Florida run from 0 to 100 percent of the person as a whole, though most workers comp ratings are in the single digits or teens for common orthopedic injuries. The rating controls entitlement to impairment income benefits, which start after MMI and after temporary benefits end.

Here is the practical flow. You treat until your doctor believes additional medical care will not meaningfully improve your condition. That is MMI. At that point, the doctor issues a permanent impairment rating for each affected body part and states whether the impairment is due to the industrial injury, a pre-existing condition, or an apportionment of both. The rating triggers weekly impairment payments calculated as a percentage of your average weekly wage. For many injuries, the statute sets the payment at 75 percent of your temporary total rate, reduced by 50 percent if you return to work at the same or greater earnings. The duration depends on the percentage of impairment according to a schedule in section 440.15(3)(g).

This is where pre-existing conditions come to the forefront. If the doctor believes half of your rating is due to pre-existing issues and half due to the accident, the carrier will try to pay only the accident portion. The law allows apportionment in certain permanent impairment scenarios, but only if the doctor can clearly separate the causes. Vague statements or generic reliance on age-related degeneration are not enough. Strong cross-examination can expose when a rating is being discounted without a defensible medical basis.
What apportionment really means in practice
Apportionment is a method to carve out the pre-existing slice from your permanent impairment rating and, in some settings, your permanent benefits. Florida courts require a reasoned medical analysis. The physician must do more than say, “50 percent pre-existing.” He or she should explain the specific pathology that predates the accident, the objective changes after the accident, and how the guidelines allocate impairment between those components.

I have seen fair apportionment when a knee with a documented Grade 3 chondromalacia receives a small meniscectomy at work that worsens mechanics and adds a measurable deficit. The doctor might assign 4 percent whole person for pre-existing arthritis and 2 percent for the meniscal surgery. I have also seen improper apportionment when a doctor reflexively halves a back rating simply because the MRI shows multilevel degeneration, despite the fact that the worker had no sciatica and worked full duty before the lift injury. A deposition can make the difference. If the doctor admits the worker had no prior restrictions, no prior procedures, and no radicular symptoms, it becomes hard to justify assigning half the impairment to the pre-existing changes.
The weight of medical history: honesty helps, silence hurts
When a claim involves pre-existing conditions, credibility underpins everything. If you had a prior chiropractic course for your neck three years ago, say so. If you saw a pain clinic last summer, disclose it. Most carriers obtain past records. Omissions create fertile ground for denial and erode trust with the authorized doctor.

Balance your disclosures with clarity about function. Many people manage pre-existing conditions well. If you were working overtime, lifting 50 pounds regularly, and never missed a shift before the accident, say that too. The stark difference between pre-accident capacity and post-accident limitations often persuades doctors and judges that the accident is the major contributing cause, even in the face of ugly MRIs.
Temporary benefits, light duty, and the path to MMI
While you receive treatment, you may qualify for temporary total disability or temporary partial disability. Pre-existing conditions can complicate wage-loss disputes. Adjusters sometimes claim you would have been out regardless due to the prior condition. Document your job search if on restrictions and the employer cannot accommodate. Keep copies of applications, notes of conversations with supervisors, and photos of posted schedules if relevant. These details often resolve temporary partial disputes without a hearing.

Light duty assignments can be a blessing or a trap. If the employer offers real work within restrictions, accept it. If the assignment is punitive or beyond your restrictions, communicate in writing and request clarification from the doctor. I have stopped more than one retaliatory “paperwork only” assignment that quietly morphed into stocking and lifting, simply by getting an amended note, then holding the company to it.
Independent medical exams and second opinions
Florida allows each side one independent medical examination in most cases. An IME can break a stalemate on MCC or on impairment apportionment. Choose the physician strategically. For spine cases, select a board-certified orthopedic surgeon or neurosurgeon who actually treats injured workers, not just performs forensic exams. Provide complete records, including prior MRIs, therapy notes, and pre-accident job descriptions. A well-done IME can redirect the case and force a higher impairment rating or a clearer causation opinion. Insurers use IMEs too, often to reduce value. Anticipate their arguments and prepare.
Example scenarios that frequently arise
A warehouse picker in his mid-50s with mild chronic low back pain lifts a 70-pound box and feels a pop. MRI shows multilevel desiccation and a new L5-S1 protrusion contacting the S1 nerve root. Before the incident, he took ibuprofen a few times a month and worked full duty. After, he has daily leg pain and cannot stand more than 20 minutes. With solid testimony and a thoughtful doctor, work remains the major contributing cause. Any impairment apportionment should reflect the new radiculopathy and functional shift, not just the presence of degenerative discs.

A nurse with a prior rotator cuff repair slips on a wet floor. Post-accident imaging reveals a partial re-tear. She had occasional soreness before, but no lifting limits. The accident likely aggravates the shoulder and, depending on surgical findings, produces a new permanent impairment. An insurer might argue the tear was inevitable. A careful surgical report and therapy notes that show new weakness, reduced range, and nocturnal pain can anchor the rating to the accident.

An office worker develops wrist pain during a crunch period. Nerve studies show moderate carpal tunnel syndrome. Records reveal pregnancy-related tingling years earlier. Carpal tunnel frequently has multiple contributors. A physician must weigh forceful repetitive tasks, posture, endocrine factors, and anatomical variation. If the job involved prolonged keyboarding plus forceful filing and lifting mail trays, the work may be the major contributing cause even with the prior history. Apportionment here is nuanced and depends on objective testing before and after.
Settlements and the role of disability ratings
In Florida workers compensation, you do not receive pain and suffering. Settlements are primarily based on the value of future medical care, exposure on impairment benefits, and litigation risk. The permanent impairment rating informs the wage component and often drives the medical conversation. A 4 percent rating with conservative care predicts one settlement range. A 10 percent rating with recommended injections or possible surgery predicts another, especially if the treating doctor ties the need for future care to the accident without heavy apportionment.

Pre-existing conditions cut both ways in negotiation. Carriers cite them to discount value. Claimants can point to the consistent function they maintained before the accident to argue for higher value. I encourage clients to keep a simple post-accident log: days missed, tasks that now require help, activities abandoned. When presented alongside clean work histories and doctor notes, those logs help quantify impact for adjusters.
Practical steps to strengthen a case with pre-existing conditions Tell every provider the same truthful history, including prior injuries, symptoms, and treatment dates. Consistency builds credibility. Explain your pre-accident baseline in concrete terms. If you coached youth soccer or regularly lifted 60-pound bags, say it. Follow restrictions to the letter. If a task violates them, document it and ask for clarification in writing. Keep copies of MRIs, therapy notes, and work notes. Organize them chronologically. Consult an experienced workers compensation lawyer early to protect your choice of IME and to prepare for depositions.
These steps improve your chance of securing a strong MCC opinion and a fair impairment rating. They also prevent avoidable denial traps, such as missed appointments or inconsistent symptom descriptions.
How judges view pre-existing conditions
Judges of compensation claims evaluate medical testimony, credibility, and statutory requirements. In close cases, credibility often tips the scale. I have watched judges scrutinize gaps between alleged pain and sparse treatment, or between claimed limitations and social workinjuryrights.com Workers comp lawyer near me https://www.youtube.com/channel/UCKrXfZODQj2z8L1JQGAmDLA media showing heavy activity. Conversely, I have seen judges give full weight to a worker who reported modest, well-documented prior issues that turned severe only after the accident. Judges expect physicians to explain apportionment, not assert it. A bare ratio without reasoning is vulnerable.
The impact of second injuries and the Special Disability Trust Fund
Florida used to reimburse employers for certain claims involving pre-existing disabilities through the Special Disability Trust Fund, which encouraged hiring workers with known impairments. The Fund remains active for old accidents but is closed to new dates of injury in modern practice. Insurers sometimes invoke the spirit of that concept to argue that the pre-existing condition should absorb part of the rating. Remember, for current claims, apportionment still requires a medically sound explanation, not a policy argument.
Mental health layers on top of physical injuries
Psychological components often complicate pre-existing conditions. Chronic pain from an aggravated back can lead to depression or anxiety. Florida limits compensability for purely mental injuries, but allows treatment when a mental condition flows from a covered physical injury. The MCC concept still governs. Insurers sometimes point to prior counseling or life stress to deny. Clear timelines and candid mental health histories help. If the mood change follows the accident and correlates with pain patterns and functional losses, treatment can be authorized and may modestly affect impairment.
What changes at MMI, and what does not
Once the doctor places you at MMI, temporary benefits stop. You start impairment income benefits if you have a rating. You might continue receiving authorized medical care, including maintenance medications or occasional injections. Surgery after MMI is unusual but not impossible if circumstances change. The permanency decision, including any apportionment, becomes the backbone for settlement talks. If the rating is clearly low or unfairly apportioned, that is the time to consider an IME or push for a one-time change of doctor if available.

Do not confuse MMI with the end of your rights. If your condition objectively worsens and the work accident remains the major cause, you can sometimes reopen conversations about care. The key is documentation. Sporadic complaints without objective change rarely move the needle.
The role of a workers compensation lawyer when pre-existing conditions exist
Pre-existing conditions multiply the issues: causation battles, apportionment fights, rating disputes, and conservative medical plans that undervalue functional loss. An experienced workers compensation lawyer knows which doctors explain apportionment correctly, how to use depositions to anchor MCC, and when to deploy an IME. They also know local norms. Some venues see lower average impairment ratings for shoulders or knees. Others have treating physicians who rarely apportion without strong evidence. Local knowledge matters.

If you are searching “workers compensation lawyer near me” or “workers comp lawyer near me,” focus less on slogans and more on case experience with aggravation claims. Ask how often the attorney handles spinal degeneration cases, prior arthroscopies, or repetitive trauma claims. A seasoned workers comp attorney can pressure the insurer to authorize realistic diagnostics, push back on premature MMI, and prepare you for testimony. The best workers compensation lawyer for your case is the one who combines medical fluency with litigation judgment, not the loudest ad on your phone.
When settlements make sense, and when they do not
Not every claim should settle quickly. If you are early in treatment and the work remains the major contributing cause, focus on care. Settling before reaching MMI can leave future needs unfunded. On the other hand, once you reach MMI with a solid rating and predictable future care, settlement can provide control and closure. Pre-existing conditions create long-term uncertainty that sometimes justifies resolution at a fair value, even if litigation could squeeze out a bit more. Weigh tax status of benefits, Medicare considerations if you are near eligibility, and the impact on other benefits like short-term disability or Social Security Disability Insurance.
Common mistakes that cost money
Rushing to deny prior treatment. When records surface, credibility suffers. You can explain anything but a lie.

Ignoring job searches while on restrictions. Temporary partial benefits often hinge on documented efforts.

Accepting an apportionment without asking the doctor to explain it using the Guides. A bare percentage can often be improved.

Skipping the IME when the treating doctor’s rating is clearly off. A targeted IME frequently pays for itself in negotiation leverage.

Posting heavy activity online during a contested period. Carriers check, and judges notice.
Final thoughts for Floridians with prior injuries
A pre-existing condition is not a scarlet letter in Florida workers compensation. It is a variable that must be handled with precision. Be candid about your past, meticulous with your present, and strategic about your future. The law requires the accident to be the major contributing cause, not the only cause. Many fair outcomes flow from that simple truth when the medical story is told clearly.

If you are navigating this with a tender back, a cranky shoulder, or a wrist that now tingles every night, you do not need perfect imaging or a spotless past to win. You need coherence. Good records, consistent testimony, and a doctor who grounds opinions in objective findings go a long way. A knowledgeable workers compensation attorney can orchestrate those pieces, challenge lazy apportionment, and translate your reality into the rating and benefits the statute promises.

Whether you call a work injury lawyer, a work accident attorney, or a workers compensation law firm, make sure they understand how pre-existing conditions interact with disability ratings in Florida. Ask for examples, not platitudes. The right advocate will show you how the system actually works and help you move from fear to a plan.