Need Advise from Senior Member

[ChattiPatti]

What is the name of your state? Florida
Would someone please read this statute from Florida Workman's comp laws and tell me if they think that even with a previous injury the insurance company has to still pay me and fix my injury? My attorney says yes that according to this statute they do, but I am curious to see what someone else thinks or has been through this with insurance saying prior injury and does not want to pay. Thanks in advance.

5) SUBSEQUENT INJURY.-- This is Statute 440.15 (5)

(a) The fact that an employee has suffered previous disability, impairment, anomaly, or disease, or received compensation therefor, shall not preclude her or him from benefits, as specified in paragraph (b), for a subsequent aggravation or acceleration of the preexisting condition or preclude benefits for death resulting therefrom, except that no benefits shall be payable if the employee, at the time of entering into the employment of the employer by whom the benefits would otherwise be payable, falsely represents herself or himself in writing as not having previously been disabled or compensated because of such previous disability, impairment, anomaly, or disease and the employer detrimentally relies on the misrepresentation.

(b) If a compensable injury, disability, or need for medical care, or any portion thereof, is a result of aggravation or acceleration of a preexisting condition, or is the result of merger with a preexisting condition, only the disabilities and medical treatment associated with such compensable injury shall be payable under this chapter, excluding the degree of disability or medical conditions existing at the time of the impairment rating or at the time of the accident, regardless of whether the preexisting condition was disabling at the time of the accident or at the time of the impairment rating and without considering whether the preexisting condition would be disabling without the compensable accident. The degree of permanent impairment or disability attributable to the accident or injury shall be compensated in accordance with this section, apportioning out the preexisting condition based on the anatomical impairment rating attributable to the preexisting condition. Medical benefits shall be paid apportioning out the percentage of the need for such care attributable to the preexisting condition. As used in this paragraph, "merger" means the combining of a preexisting permanent impairment or disability with a subsequent compensable permanent impairment or disability which, when the effects of both are considered together, result in a permanent impairment or disability rating which is greater than the sum of the two permanent impairment or disability ratings when each impairment or disability is considered individually.

 

[weenor]

What is the name of your state? Florida
Would someone please read this statute from Florida Workman's comp laws and tell me if they think that even with a previous injury the insurance company has to still pay me and fix my injury? My attorney says yes that according to this statute they do, but I am curious to see what someone else thinks or has been through this with insurance saying prior injury and does not want to pay. Thanks in advance.

5) SUBSEQUENT INJURY.-- This is Statute 440.15 (5)

(a) The fact that an employee has suffered previous disability, impairment, anomaly, or disease, or received compensation therefor, shall not preclude her or him from benefits, as specified in paragraph (b), for a subsequent aggravation or acceleration of the preexisting condition or preclude benefits for death resulting therefrom, except that no benefits shall be payable if the employee, at the time of entering into the employment of the employer by whom the benefits would otherwise be payable, falsely represents herself or himself in writing as not having previously been disabled or compensated because of such previous disability, impairment, anomaly, or disease and the employer detrimentally relies on the misrepresentation.
(b) If a compensable injury, disability, or need for medical care, or any portion thereof, is a result of aggravation or acceleration of a preexisting condition, or is the result of merger with a preexisting condition, only the disabilities and medical treatment associated with such compensable injury shall be payable under this chapter, excluding the degree of disability or medical conditions existing at the time of the impairment rating or at the time of the accident, regardless of whether the preexisting condition was disabling at the time of the accident or at the time of the impairment rating and without considering whether the preexisting condition would be disabling without the compensable accident. The degree of permanent impairment or disability attributable to the accident or injury shall be compensated in accordance with this section, apportioning out the preexisting condition based on the anatomical impairment rating attributable to the preexisting condition. Medical benefits shall be paid apportioning out the percentage of the need for such care attributable to the preexisting condition. As used in this paragraph, "merger" means the combining of a preexisting permanent impairment or disability with a subsequent compensable permanent impairment or disability which, when the effects of both are considered together, result in a permanent impairment or disability rating which is greater than the sum of the two permanent impairment or disability ratings when each impairment or disability is considered individually.

See the bolded areas because they are key. If the medical records indicate that your new injury made your pre-existing condition worse then the company is responsible for paying the portion of treatment and disability attibutal to the second injury. Your state case law should be checked because in my experience, the employer will generally be held responsible to all of the disability if it cannot be apportioned out between the pre-existing condition and the current condition.

 

[ChattiPatti]

Thanks Weenor...
When I suffered my injury my medial meniscus was torn. I never knew I had osteo arthitis in knee. I don't know if you recall but I was told I would need knee replacement as the meniscus could not be repaired. They sent me for second opinion. Well, their doctor said that my main problem was the arthitis and the insurance company went by that and stopped paying me. They totally ignored the meniscus being torn. My treating physician had said that the torn meniscus is what made the arthitis flare up and cause additional pain. This is where the lawyer told me about that law stating it did not matter if there was another injury.....So, now I am waiting to hear from attorney. He said to give him a month and he would have me back on comp. and that he just had a similiar case and what the insurance company is doing is against the law. The insurance company had even set up the appointment for me to see the surgeon to have meniscus repaired and when they heard it could not and I needed the knee replacement, they put a complete halt on things and I waited a good month and a half until they had second opinion done. So, I will have to wait to hear from attorney. I had never been to doctor for knee problems before this happened, so I don't know how they can say I had previous injury.
Thanks for your response. They help.