Florida’s workers’ compensation system promises medical care and wage benefits if you are hurt on the job. That promise feels less clear when you already have a bad back, a prior knee surgery, or a degenerative shoulder. Many injured workers hear a version of the same refrain: That was there before, so it’s not work related. The truth under Florida law is more nuanced. Pre-existing conditions do not bar a claim. The question is whether work aggravated, accelerated, or combined with that condition to produce the need for treatment or disability.
I have represented warehouse pickers with long histories of back spasms, hotel housekeepers with arthritic knees, and electricians with old rotator cuff tears. Some recovered quickly and returned to work. Others faced denials and months of litigation. The patterns repeat, and they are predictable. This guide explains how Florida law treats pre-existing conditions, what evidence actually moves the needle, and how to navigate the traps that derail legitimate claims.
The legal standard that controls these claims
Florida uses a major contributing cause standard for both medical and indemnity benefits. Translated into plain English, you must show the work accident is more than 50 percent responsible for your current need for treatment or limitations when compared to all other causes, including any pre-existing condition. If you had a worn-out disc before and you lifted a case of tile at work, your case does not turn on whether the disc already had wear and tear. It turns on whether Workers comp lawyer that lift, on that day, is the main reason you now need an MRI, injections, or surgery.
There is a second piece that gets overlooked. Once the accident is accepted, the employer or carrier cannot force you to prove major contributing cause over and over for each routine step of care. They can, however, challenge major contributing cause when a physician recommends a new modality like surgery or when there is a break in treatment. That’s often where the pre-existing condition resurfaces as a defense.
Defense attorneys lean on one more rule: if the need for care is caused primarily by the natural progression of your pre-existing condition, benefits can be denied. The fight is in the phrase primarily. Doctors rarely speak in percentages unless prompted. Your case rises or falls on how a physician describes causation and whether they tie their opinion to objective findings and a coherent timeline.
Aggravation, exacerbation, acceleration: the words matter
Medical language makes a difference. An aggravation suggests a lasting worsening of the underlying condition. An exacerbation can mean a temporary flare that eventually returns to baseline. Acceleration implies work sped up the timeline of a condition that would have gotten worse anyway. In legal practice, we focus less on labels and more on documented change.
A roofer with chronic low back pain who lifted a bundle of shingles, felt a sharp pop, and immediately developed radiating leg pain presents a different picture than a worker with slow, intermittent aching after long shifts. The first scenario, with new neurological symptoms, points to a specific event that changed the body. If an MRI shows a new large disc herniation compressing a nerve root, that is objective support for aggravation. If imaging shows only old degeneration and the symptoms look the same as six months prior, the argument for a temporary exacerbation gains traction.
The carrier will try to slot your case into exacerbation and natural progression. Your job, with a work injury lawyer guiding the process, is to document what changed and why that change is linked to work.
How claims with pre-existing conditions go off the rails
The most common problems do not involve obscure legal points. They involve routine choices in the first days after an accident.
Late reporting invites skepticism. Florida requires prompt notice, and delays longer than 30 days can be fatal to a claim unless a specific exception applies. Even within a few days, a vague or inconsistent initial report can color the entire file.
Inconsistent histories are poison. If your urgent care note says you hurt your back moving furniture at home and your employer report lists lifting at work, that inconsistency will shadow the case. The same is true when a worker downplays prior pain with a primary care doctor, then later tells a panel doctor about years of chiropractic care.
The wrong words in the wrong note hurt. A clinic intake that checks “no injury” because the receptionist framed the question as a personal injury case, not a work injury, can be twisted later. A light-duty assignment refused without a clear medical reason can jeopardize wage benefits.
Finally, imaging often shows degeneration in workers over 30. That is normal. It is not a defense by itself. The defense gains power when a medical record says, essentially, symptoms are the same as before and imaging looks no different. Objective differences carry weight. So do coherent timelines.
What evidence actually changes outcomes
The best cases, including those with serious pre-existing conditions, are built on chronology, objective findings, and clear medical opinions.
The chronology starts with a specific work event or an identifiable period of repetitive exposure, followed by a new level of symptoms and prompt care. The absence of a dramatic event is not fatal. Repetitive trauma claims survive in Florida when the worker proves prolonged exposure at work is the major contributing cause of the condition, which is a higher bar, but still possible with tight documentation.
Objective findings include new imaging changes, EMG studies showing acute denervation, positive physical exam signs like new motor weakness or reflex changes, and measurable range-of-motion loss documented across multiple visits. A surgeon’s note that compares a 2018 MRI to a post-accident 2025 MRI and explains the differences in concrete terms carries more weight than a general statement about degeneration.
Clear medical opinions use the proper standard. Doctors need to say the work event is the major contributing cause of the need for treatment or disability, and they need to explain why. Causation opinions based on reasonable medical probability and supported by records, not just patient history, travel better through litigation.
Finally, consistent testimony from co-workers and supervisors about what happened and how you looked or moved after the accident shores up credibility. I have won disputed cases where a forklift operator described a worker who went pale, grabbed a railing, and needed help to sit, even when imaging looked subtle.
Real-world scenarios and how they play out
A warehouse picker with chronic back pain lifts a 60-pound box, feels a snap, and immediate leg numbness follows. He reports the incident the same shift, goes to the authorized clinic, and the doctor documents new radicular symptoms. An MRI shows a large L5-S1 herniation. The carrier argues degenerative disease. The authorized spine surgeon compares the MRI to an older study, notes a new extruded fragment, and states the lift is the major contributing cause of the need for surgery. Benefits go forward. The pre-existing condition remains a fact, but not a bar.
A hotel housekeeper with known knee arthritis cleans rooms for years. There is no fall. Pain worsens over six months with increased workload after staffing cuts. She treats intermittently, then is recommended a knee replacement. Without a precise timeline and a doctor willing to opine that repetitive kneeling and climbing in the job over a sustained period is the major contributing cause, carriers deny. With detailed workload records, co-worker statements, and an orthopedic expert who explains biomechanical stress and the rate of deterioration compared to age expectations, these claims can prevail. They are more complex and often need a workers compensation attorney to shepherd expert evidence.
An electrician with a prior rotator cuff repair slips from a ladder and grabs a rung to catch himself. Pain returns sharply. An ultrasound shows a partial re-tear. The defense cites prior surgery. The treating doctor notes a well-healed repair on prior imaging and new fluid and tendon changes now, and ties the need for revision surgery to the accident. The major contributing cause is the slip. Benefits proceed.
How medical choice and managed care networks factor in
Florida carriers control the initial treating physician. That doctor’s opinion often shapes the claim. Some authorized providers are excellent clinicians who document well. Others write sparse notes and avoid strong causation language. You have the right to a one-time change of physician within the same specialty. Use it strategically. Asking for the change too early, before a weak doctor has tied the need for treatment to work in writing, can backfire. Waiting too long can leave you stuck in a treatment loop that never addresses the underlying problem.
For second opinions, independent medical examination slots exist but are limited. Carriers can schedule defense IMEs, and you may be able to request your own IME when a dispute ripens. The timing and selection of the examiner are critical. A seasoned work injury lawyer knows which physicians understand the standard and will engage with prior records rather than default to degeneration.
Temporary and permanent benefits when pre-existing conditions exist
Medical benefits follow the causation standard. If work is the major contributing cause, the carrier pays for authorized care. If a new intervention, like surgery, is denied due to a pre-existing condition, the dispute often hinges on whether the new need is mainly accident-related or part of natural progression.
Wage benefits depend on work restrictions and your ability to earn. If authorized restrictions prevent you from doing your pre-injury job and your employer offers light duty within those restrictions, your benefits shift accordingly. If you refuse suitable work, indemnity can stop. With pre-existing conditions, light duty assignments are common. Document what tasks you are given and whether they comply with restrictions. If the assignment inflames your condition, report it promptly and request a re-evaluation.
Permanent impairment ratings are based on objective criteria. Degenerative findings that pre-dated the accident can lead to apportionment of impairment in some circumstances, but Florida does not generally apportion medical care between causes. Carriers often try to blur these lines. A careful review of the AMA Guides rating and the physician’s apportionment reasoning can correct overreaching.
Surveillance, social media, and credibility
Pre-existing conditions give carriers an easy story. They will test it. Surveillance videos tend to surface before significant hearings or right after you report increased pain. A 10-second clip of you lifting groceries can be distorted if your records say no lifting at all, rather than a 10-pound limit. Words matter in restrictions. Be precise with your doctor. If you had a good day and overdid it, tell your physician. Good records explain variability and blunt the impact of selective surveillance.
Social media posts taken out of context create headaches. Even if your profile is private, screenshots have a way of entering evidence. Do not discuss your case online. Avoid posting physically demanding activities until your doctor clears you, and even then, understand how it may look.
When a denial cites pre-existing conditions, what happens next
A denial letter that blames prior conditions is not the end. The dispute process involves a petition for benefits, mediation, and potentially a hearing before a judge of compensation claims. The calendar moves in weeks and months, not days. Meanwhile, you still need care. Some workers use group health insurance to bridge gaps, although reimbursement and lien issues follow. Others pursue conservative care out of pocket while the case proceeds. Strategic decisions here are fact specific. An experienced workers compensation lawyer will weigh the strength of causation evidence against the cost and risk of delay, and may push for expedited hearings on specific medical issues.
Mediation is not window dressing in Florida comp. Most cases settle there or soon after. If your pre-existing condition is serious, settlement demand strategy should account for future care needs and the risk a judge could side with the carrier’s medical expert. That risk is quantifiable when you know the quality of the records and the reputations of the doctors involved.
Practical steps to protect your claim from day one
- Report the incident promptly with specific details about what you were doing, what you felt, and how symptoms changed from your baseline. Give consistent, complete prior history to every provider, including prior injuries, treatment, and ordinary daily pain levels. Ask your doctor to document objective findings and to compare new imaging with old, in writing, with clear causation language. Use your one-time change of physician at a strategic moment, not reflexively or too late to matter. Follow restrictions at work and at home, and keep a simple daily log of symptoms, tasks, and any flare-ups.
Those steps sound basic, and they are. They are also the difference makers in close cases.
The role of the lawyer and the value of local knowledge
Any lawyer can recite the major contributing cause standard. Applying it in messy, real-life medical records is a different skill. A seasoned work accident attorney reads between the lines of clinic templates, knows which authorized providers engage with causation, and understands which independent examiners are persuasive to particular judges.
Local knowledge matters. A workers compensation law firm that practices regularly in your district will know the rhythms of mediators and judges, the defense experts carriers prefer, and the pressure points that move adjusters. When people search for a workers compensation lawyer near me or a workers compensation attorney near me, they are not just looking for convenience. They are looking for counsel who understands the local terrain and who can get you in front of the right specialists.
Budget-conscious clients often ask whether they need a lawyer if the claim is accepted. If you have a significant pre-existing condition, the answer tends to be yes. The claim may start smoothly, then stall at a surgical recommendation or turn when you need a specialist the carrier does not want to authorize. Having a workers comp attorney engaged early often prevents problems rather than merely reacting to them.
Common carrier tactics and how to answer them
Two tactics dominate aggravated-condition disputes. First, carriers characterize the event as minor and unrelated to your underlying pathology. They will point to a lack of emergency room visit, a few days’ delay in care, or a normal x-ray. Counter with the right form of evidence: internal consistency in your reports, objective findings from appropriate imaging, and testimony about functional change.
Second, they anchor on a prior MRI or clinical note showing similar complaints. The remedy is a competent comparison. When your surgeon or neurologist addresses the prior findings head-on, and explains why the new symptoms and imaging indicate a different or worsened condition, the defense loses steam. Avoiding the prior records never works. Owning them, and explaining the delta, does.
Carriers also send you to an independent medical examiner who frequently testifies for the defense. Preparing for that exam with your attorney, bringing a concise timeline, and answering questions precisely can prevent mischaracterizations. Do not minimize or exaggerate. Describe what you can no longer do and what increases symptoms. Specifics beat generalities.
The settlement question when you have a pre-existing condition
Settlements in workers’ comp trade certainty for finality. When a pre-existing condition is at play, estimating future medical costs requires realism. Ask the treating specialist to outline likely care over three to ten years. That could include injections every year or two, physical therapy cycles, medications, and possible surgeries. If the carrier is denying major contributing cause for some or all of those items, the settlement value reflects the litigation risk.
Medicare considerations matter if you are a current beneficiary or have a reasonable expectation of Medicare within 30 months. Set-aside allocations can complicate settlements. An experienced workers comp law firm will map the medical and legal risks and explain ranges rather than a single magic number. Do not chase the highest headline figure if it leaves you with inadequate funds for the care you realistically need.
When repetitive trauma is the story
Not every aggravated condition comes from a single accident. Nurses who turn patients, distribution workers who scan and lift thousands of items per shift, and custodians who scrub and climb experience wear that tips into injury. Florida recognizes repetitive trauma claims, but they require proof of prolonged exposure and a medical opinion that work is the major contributing cause compared to all other causes. That is harder than the single-incident case. It is not impossible.
The strongest repetitive trauma cases feature detailed job descriptions, time-and-motion evidence, ergonomic assessments, and a physician who quantifies the exposure. A short declaration from a co-worker that you both cleaned 20 rooms per shift, each with repeated kneeling and lifting of mattresses, often carries more weight than a broad statement about hard work. Documenting micro-events and progressive symptom patterns helps the physician connect the dots.
What to do if your claim is partially accepted
Sometimes carriers accept a sprain or strain but deny more serious diagnoses like herniated discs or meniscus tears as pre-existing. That partial acceptance can limit care to anti-inflammatories and therapy that does not touch the real issue. The path forward involves developing the medical record to link the more serious diagnosis to the accident. That might mean a change of physician, a specialist referral, or targeted imaging. Do not assume that partial acceptance is the final answer. It is often a placeholder defense waiting for you to give up.
When to look for help and how to choose representation
If you hear any version of “that’s just your arthritis,” “we only approved conservative care,” or “the MRI shows degeneration, not injury,” it is time to at least consult a work injury lawyer. If communication with the adjuster stalls or you are pushed back to full duty while still restricted, the stakes increase. Look for an experienced workers compensation lawyer who can speak clearly about major contributing cause, who has handled aggravated-condition cases to hearing, and who has real relationships with credible medical experts.
Searches for a workers comp lawyer near me or a work accident attorney will yield many names. Ask about their recent results with pre-existing conditions, whether they regularly try cases, and how they approach authorized doctor selection. The best workers compensation lawyer for your case is the one who will build a record that holds up under scrutiny, not just promise a quick settlement. A reputable workers comp law firm will discuss fees transparently, explain costs for experts, and give you a realistic view of timelines.
Final thoughts from the trenches
Pre-existing conditions are common. Degeneration on imaging is normal as we age. Florida’s workers’ compensation system is supposed to account for that by focusing on whether work is the major contributing cause of your current need for care. The system does not always live up to that ideal automatically. Precision in reporting, quality in medical documentation, and a thoughtful legal strategy make the difference.
If you are dealing with a claim where the carrier keeps pointing backward to your old injury or age-related changes, do not accept a quick “no” or a shallow approval for therapy that does not solve the problem. Get clear on what changed, gather old records so a doctor can compare them to new findings, and consider partnering with an experienced workers compensation lawyer who knows the Florida landscape. The right evidence, presented the right way, turns the pre-existing defense into what it often is in practice, a speed bump rather than a roadblock.