Florida’s workers’ compensation system tries to be straightforward on paper: if you get hurt in the course and scope of employment, the insurer covers medical care and wage replacement while you recover. Real life is messier, especially when you walk into a claim with a history. Back pain from years on job sites, a shoulder you injured in high school baseball, diabetes that slows healing, arthritis that flares in humidity — these lived-in realities complicate how lost wages are calculated and paid. Knowing how preexisting conditions interact with wage benefits can save you months of frustration and keep your claim on track.
I have sat with roofers, nurses, theme park techs, and warehouse workers across Orlando who heard the same refrain from adjusters: “We think your current disability is mostly your old condition.” That phrase becomes the lever for delayed checks, minimized average weekly wage, and offers that land far short of what the law supports. If you are searching for a workers compensation lawyer near me or comparing a workers comp law firm against going it alone, focus on one question: how will they handle causation and apportionment with your medical history? The answer tells you how your wage benefits will play out.
The legal lens: major contributing cause and why it matters
Florida uses a standard called major contributing cause, often shortened to MCC. In plain terms, your work accident has to be more than a minor factor in causing your disability or need for treatment. If a preexisting condition is in the mix, the employer or insurer will argue that your current lost wages are primarily due to the old problem, not the new event.
The statute doesn’t require a perfect body at baseline. It requires competent substantial evidence, usually a doctor’s opinion, that the work accident is the major contributing cause of your present disability. This is where the choice of physician matters. The authorized treating doctor, the independent medical examiner, and any experts brought in by a workers compensation attorney can each frame the medical story differently. If your record is thin or scattered, an adjuster can cherry-pick notes to diminish the work-related piece of your disability and pay less in wage loss.
From an advocacy standpoint, the best workers compensation lawyer anticipates MCC fights early. They gather prior records, clarify symptom history before and after the accident, and push for precise language in clinic notes. A casual sentence like “patient has had back pain for years” without details about function and work capacity can become Exhibit A for reducing your benefits.
Lost wages 101 in Orlando claims
Most people in Orange County first encounter wage benefits when a doctor writes “no work” or issues restrictions your employer cannot accommodate. Florida calls this temporary total disability or temporary partial disability, paid at a percentage of your average weekly wage, typically 66 2/3 percent for total disability and up to 80 percent for partial in limited circumstances. Average weekly wage is not just your hourly rate times hours. It should include overtime, certain bonuses, and the fair value of employer-provided benefits in some cases. If you work seasonal shifts for a theme park, a hospitality venue, or a construction outfit with variable hours, the calculation can swing your check by hundreds of dollars each week.
Preexisting conditions come into play at two levels. First, they are used to argue that you are not disabled from the accident at all. Second, they are used to push an early return to work at light duty that doesn’t exist or is impractical, which converts your benefit type and often lowers the amount. A seasoned workers comp attorney will scrutinize the average weekly wage calculation and fight for accurate inclusion of overtime and concurrent employment. Missing one weekend job from your AWW computation can cost thousands over the life of a claim.
The tug-of-war between old pain and new disability
Here is the pattern that repeats in Orlando claims:
- You report a workplace incident. Emergency or urgent care documents it. You mention prior aches because you are honest. The authorized doctor acknowledges prior issues, prescribes imaging, and writes restrictions. The insurer authorizes conservative care, then sends you to a specialist who emphasizes the degenerative findings on imaging: disc bulges, osteophytes, rotator cuff tendinopathy. The adjuster requests an independent medical exam. The IME report suggests your current disability stems largely from underlying degeneration, not the lift, slip, or twist at work.
By month three, wage checks shrink or stop. You are offered a modified duty job that looks like a paper exercise: a “greeter” role with no clear hours, or a desk task unrelated to your training, often with pressure to return before you are stable. If you refuse, benefits get suspended. If you try and fail, the insurer questions your effort. This is where an experienced workers compensation lawyer anchors the record with specifics: what tasks the employer offered, whether they exist, their physical demands, how they relate to restrictions, and how your symptoms track with objective findings after the accident.
Good records beat assumptions
Doctors are not adversaries, but their shorthand can hurt a claim. “Chronic back pain” may reflect years of intermittent soreness that never kept you from work. If that pain was a 2 out of 10 for years, and after the accident it’s an 8 with numbness down the leg, the change matters. Judges and adjusters respond to chronology, function, and documented change.
What helps:
- A baseline narrative: before the accident, what could you do, what did a normal day at work feel like, how often did you see a doctor for the same area? A timeline of escalation: what changed after the event, in what sequence, with what measurable limits? For example, “I went from lifting 50 pounds repeatedly to struggling with a gallon of milk,” or “I stood six hours at Epcot comfortably, now my leg gives out after 20 minutes.” Objective findings that correlate with the event. A new herniation compressing a nerve in the same distribution as your new numbness weighs more than generalized degenerative changes.
A workers comp law firm that builds this record early can keep wage benefits flowing. When the matter reaches a mediation or a hearing, the narrative is already coherent. When it does not, the insurer fills in gaps with its own story, and lost wages become the casualty.
Apportionment and the myth of the 50 percent haircut
People often ask if Florida automatically cuts lost wages when there is a preexisting condition. Not automatically. Apportionment can apply to permanent impairment ratings and sometimes to benefits where the medical evidence cleanly separates what the old condition contributes versus the new injury. In practice, clear separation is rare. Degeneration does not tell time on an MRI. What persuades a judge is a credible explanation that links your functional loss to the work event, even with an imperfect spine or shoulder.
Insurers will float percentages in negotiation. I have seen adjusters push for a 50 percent apportionment based on broad language like “degenerative.” A good workers compensation attorney near me will not accept a percentage without rigorous support. They will press the doctor: what deficits existed before, documented by what records, causing what restrictions? If there was no lost time, no restrictions, no treatment in the months leading up to the accident, apportionment often collapses under cross-examination.
The Orlando factor: employers, light duty, and timing
Central Florida’s economy tilts toward hospitality, healthcare, warehousing, construction, and theme park operations. These employers vary in their approach to light duty. Some have well-developed modified duty programs that truly exist. Others generate “light duty” on paper to reduce benefit exposure. Wage benefits depend on whether the offered work is within your restrictions and reasonably available. A warehouse that offers a seated scanning job but requires ten hours without breaks is not honoring a restriction against prolonged sitting. A hotel that asks a housekeeper with a lifting restriction to “shadow” other staff, with intermittent lifting “as needed,” is setting up a trap.
Timing matters. After 180 days, some employers lose patience and start documenting noncompliance. If you are juggling multiple doctors, physical therapy, and shift offers that move week to week, it is easy to miss a box on a form and trigger a benefit suspension. An experienced workers compensation lawyer keeps the calendar tight, pushes the employer for clarity in writing, and documents every acceptance or rejection of work with a reference to the medical restriction that applies.
Calculating average weekly wage the right way
Average weekly wage is where people leave money on the table. Florida typically looks back 13 weeks before the accident. If you had overtime at Universal during Halloween events, or peak season at a distribution center before Christmas, those weeks should factor in. If you worked two jobs, both count if you held them at the time of injury and your employer knew or reasonably should have known. If you recently changed jobs or had fewer than 75 percent of your regular hours due to reasons beyond your control, the law allows alternative calculations.
Where preexisting conditions complicate things is not the AWW formula itself, but the incentive to compress AWW when the insurer suspects a long claim. Once a lower AWW is baked into the system, every check is smaller and harder to fix later. A workers comp lawyer near me will request payroll records early, collect W-2s and paystubs across employers, and confirm whether fringe benefits should be included. With one Orlando bartender, adding declared tips and a second job at a catering company increased her AWW by nearly 40 percent, turning partial disability checks from barely survivable to genuinely protective.
Medical opinions that move the needle
The fulcrum is always medical opinion. Two doctors can look at the same film and write very different conclusions. One focuses on disc dessication at L4-5 as the real story. The other notes the new annular Experienced workers compensation lawyer tear and correlates it with a straight leg raise now positive on the right, which was negative in prior visits. The second opinion often tracks your lived reality after the fall from a ladder.
A work injury lawyer who handles Orlando claims regularly knows which specialists give thorough causation analysis and which tend to default to degeneration. They also know how to prepare you for independent exams. This is not coaching falsehoods. It is ensuring you describe your history with clarity: no embellishment, no minimizing, specificity on dates, prior function, and the new limitations. Bring a written timeline. Detail medications and side effects that impair work capacity. If you cannot sit for more than 20 minutes, note the time and ask for breaks during the exam. That simple act tells the story in real time.
Permanent restrictions and the change from temporary to permanent benefits
If your condition plateaus, the doctor places you at maximum medical improvement. At that point, temporary wage benefits end, and the focus shifts to impairment income benefits and, in some cases, retraining or settlement. Preexisting conditions loom large again. The impairment rating assigned by the doctor can be apportioned if there is evidence of prior impairments in the same area. But the leap many insurers try to make is bigger: they treat MMI as proof that your ongoing limitations are almost entirely degenerative.
The pushback is evidence-based. Were you working full duty before the accident without restrictions? Did your employer ever discipline you for performance issues tied to the old condition? Did you have any permanent impairment rating before? With tight documentation, a workers compensation attorney near me can argue that, even if the spine was not pristine, the work event created a new baseline that prevents a return to the prior wage level, justifying higher settlements and, where appropriate, vocational services.
Settlements, projections, and realistic expectations
When the dispute centers on preexisting conditions, settlements rise and fall on projections. The insurer projects limited future medical based on degeneration, a modest impairment rating, and quick return to work at light duty. Your side projects sustained care, possible injections or surgery, and a longer path before earning capacity recovers. The truth usually lands between.
What pushes numbers up:
- A solid AWW that accurately reflects all income. A persuasive MCC opinion from a specialist, not a generalist. Work history proving consistent full-duty performance before the accident. Employer conduct that undermines the credibility of light duty offers.
If you are searching for the best workers compensation lawyer for a claim that involves an old injury, ask them to walk you through two or three past cases where MCC and apportionment were at issue. Listen for specifics about doctor selection, AWW corrections, and how they handled light duty misfires. Generalities are a red flag. An experienced workers compensation lawyer should talk about dates, clinic note language, and the kind of practical obstacles Central Florida workers face when they try to return to modified roles.
When the claim is denied outright
Some insurers deny from the start, citing a preexisting condition even when the accident report is clean. This is not the end. It triggers a petition process, mediation, and often a court hearing. Deadlines tighten. If you are unrepresented, it is easy to miss the exchange of evidence or fail to secure an IME in time. A workers compensation attorney near me will file the petition, request the right records, and schedule depositions of physicians who tried to minimize the work event’s role. Many denials soften after the first mediation, once the record is organized and the insurer sees the MCC risk at hearing.
Practical steps workers can take in the first 30 days
If you suspect your preexisting condition will be used against your lost wages, these early moves pay dividends.
- Tell the doctor exactly what changed after the accident, in terms of function, not just pain level. Ask that the note reflect work capacity before and after. Gather the last 13 weeks of pay records from all jobs. Note overtime cycles, seasonal spikes, and tips if applicable. Write a one-page timeline of prior treatment for the same body part: dates, providers, diagnoses, time off work, and when you last felt at baseline. If offered light duty, ask for a written description with hours, duties, and break policies. Compare it to your restrictions in writing. Consult a workers compensation lawyer early to audit AWW, prepare for IMEs, and secure supportive medical opinions before the insurer sets the narrative.
Edge cases that trip people up
Diabetes and wound healing: A foot wound in a hospital custodian with diabetes may become complicated after a puncture at work. The insurer points to diabetes as the main driver. Yet if you had intact skin and stable A1C before, and the puncture created the portal for infection that forced you off your feet, MCC can still favor the accident.
Prior surgery, new event: A worker with a prior lumbar discectomy lifts luggage and feels a pop with immediate radicular pain. Imaging shows scar tissue plus a new herniation. Carriers like to label everything scar-related. The pattern of symptoms, the comparison to prior films, and pre-injury work function often carry the day for wage loss benefits.
Mental health overlay: Chronic pain superimposed on a preexisting anxiety disorder can compound disability. Florida tightly limits psychiatric benefits unless connected to a physical injury. Documenting the pain generator and its functional effects is key to keeping wage benefits in place while mental health care proceeds under the physical injury umbrella.
Out-of-state prior care: Many Orlando workers moved from other states and treated years ago elsewhere. Insurers argue lack of records means unverifiable claims of prior baseline. Your own testimony, family witnesses, prior supervisors, and Social Security earnings records can still build a credible picture of full-duty function before the Florida accident.
Choosing the right advocate
Not every work accident attorney brings the same tools to a preexisting condition dispute. Look for a workers compensation law firm with a track record in MCC litigation and apportionment. Ask about their approach to average weekly wage reconstruction. Ask which independent examiners in Central Florida provide thorough causation analysis. Ask how they handle “paper” light duty. The best workers compensation lawyer for this niche will talk about building the story in the medical chart, not just arguing at mediation.
If you are typing workers comp lawyer near me into your phone after a claim stalls, your instinct is right. Preexisting condition disputes are won in the details, and those details are easiest to secure in the first six weeks. A responsive workers comp law firm can relieve immediate pressure by fixing wage calculations, coordinating medical opinions, and keeping you from stepping into procedural potholes that insurers set out for unrepresented workers.
The bottom line for Orlando workers with prior conditions
You do not need a perfect medical history to receive lost wage benefits. You need competent medical evidence that the work event is the major contributing cause of your current disability and a clean record showing what changed. Preexisting degeneration is common. What matters is function before the accident, the mechanism of injury, the escalation of symptoms after, and a precise paper trail.
When your checks slow or stop and the explanation sounds like “it’s mostly your old problem,” pause and get help. A workers compensation attorney near me who understands the local employer landscape, the rhythms of seasonal work, and the preferences of Central Florida IME doctors can turn a vague denial into a documented claim. With preexisting conditions, the fight is not about perfection. It is about proof, timing, and telling the medical story with enough clarity that the system has to listen.