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Aging and Its Impact on Injured Workers Claims under Florida’s Workers Compensation Laws

Florida’s workers’ compensation law provides that employers and insurance companies are only required to provide coverage where the compensable accident is the major contributing cause (MCC). But what does that mean?

Florida Statute 440.09(1)(a) states: “The injury, it’s occupational cause, and any resulting manifestations or disability must be established to a reasonable degree of medical certainty, based on objective relevant medical findings, and the accidental compensable injury must be the major contributing cause (MCC) of any resulting injuries. For purposes of this section, major contributing cause means the cause which is more than 50% responsible for the injury as compared to all other causes combined for which treatment or benefits are sought.”

The definition of major contributor and cause provided in Florida’s Worker’s Compensation laws is vague and difficult to apply to the facts in most cases. For example, what did the legislature mean when it stated “all other causes combined?” Did they intend to have “all other causes” to mean other accidental injuries from things such as prior automobile accidents or could it even include age appropriate degenerative conditions that all of us suffer from as we age? In reality if it did many injured workers over the age of 40 would be denied benefits for many injuries as all of use have what’s commonly referred to as “age appropriate degenerative changes” in our bodies that are the natural consequences of aging.

In the case of Byczynski v. United Parcel Service, a case where the JCC denied entitlement to medically necessary cervical spine fusion, Florida’s 1st DCA stated that the “case illustrates the complex nature of Florida’s current Worker’s Compensation Law, and the myriad of thorny legal and medical issues which accompany even the most fundamental decisions regarding an injured worker’s entitlement to, and the carrier’s liability for, medical treatment.” They went on to reverse and remand for entry of an order authorizing surgery because all of the medical evidence established that the need for the surgery was brought about solely by occupational injuries and, thus, the Judge of Compensation Claims erred in applying [age appropriate degenerative changes] the major contributing cause standard to deny the surgery.

Since the degeneration which predated the accident merely spoke of the claimant’s age and that the degenerative changes did not independently require any level of treatment the appeals court ruled in favor of the injured worker and required the insurance carrier provide the surgery.

But how will the appeals court rule if the degenerative changes were more severe or more than what is considered age appropriate is unclear at this point.

If you have recently been injured at work, contact Payer & Associates.

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