There are a number of reasons why a worker’s compensation carrier will refuse to provide treatment for a work related injury. One of the reasons a workers’ compensation carrier will use in an attempt to avoid paying future benefits is known as the major contributing cause defense; hereafter major contributing cause will be abbreviated with “MCC.” The phrase MCC means the cause that is more than 50% responsible for the injury as compared to all other causes combined. The statutory language can be found in Florida Statute 440.09 .
Included with the definition of MCC, the statutory section states that MCC can be established by medical evidence only. This means that medical opinions are the only means through which an employee can prove they are entitled to both medical treatment and lost wages. A “medical opinion,” is not an opinion from your physical therapist or from a doctor whose opinion would be inadmissible in your workers compensation claim. For the sake of establishing MCC, the medical opinion is one that comes from a doctor with expertise in the particular field of medicine involving your injury. The doctor is either a physician authorized by the worker’s compensation carrier, your independent medical examiner, or an expert medical advisor. If the opinion comes from a source other than those named above, the rules of evidence as they relate to medical opinions in workers’ compensation cases means that a Judge of Compensation Claims cannot consider an opinion from another source.
You will want the benefit of an opinion from a doctor with the necessary expertise as it related to your injury. Meaning, if the injury is to your spinal cord, the opinion that the MCC of your injury and need for treatment would come from a neurosurgeon. If your injury was to your knee, elbow, shoulder, hip, hand, foot, ankle, toe or otherwise an injury that requires treatment with a specific type of orthopedic physician, tha orthopedic physician’s opinion will be necessary. The significance of the statement that MCC can be established by medical evidence only means that your testimony alone is not sufficient to establish MCC. It does not matter what lay witness or witnesses you have that would testify on your behalf. A lay witness would be someone like your supervisor, your spouse, friend, or family member.
It is not enough to show that prior to your accident, you were asymptomatic. Regardless of the fact that you did not have treatment before your accident, you will still need to establish MCC through medical evidence only if the workers’ compensation carrier is denying treatment to you through use of the MCC defense. Certainly, the fact you did not have treatment prior to your work accident will be beneficial. However, such evidence alone will not be sufficient.
You are likely to be more limited in your daily activities or with respect to the range of motion in the extremity injured than you were before the accident. Unfortunately, it is not enough to show the existence of such limitation alone. Similar to NOT having such symptoms before your work accident, it is helpful to demonstrate the change in your condition from before the accident, to after. However, that change will need to be expressed through a medical opinion as expressed above.
As explained, the goal for the workers compensation carrier is to try and argue that the reason you need treatment is due more to an idiopathic or personal condition than the work injury. What are some idiopathic or personal conditions? Arthritis is often used. A pre-existing back injury that resolved can be used. Just because a worker’s compensation carrier raises this defense does not mean they will be successful. We have represented individuals with significant pre-existing conditions that went on to establish entitlement to treatment through worker’s compensation despite the use of the MCC defense. The problem for our clients is that once the workers compensation carrier alleges that the work injury is not the need for treatment, treatment for the injury is delayed until we can successfully resolve the issue in your favor. Resolving issues concerning MCC is something we are very familiar with at Dolman Law Group. We are not suggesting that we can guarantee a successful outcome every single time this defense is raised. However, our familiarity with it helps put you in the best position possible. A consultation with us is free.
We understand that the burden is proving that at least 51% of the reason you need treatment is due to the work injury alone. In that regard, our experience allows to handle cases involving pre-existing injuries, evidence of arthritis, and various kinds of degenerative conditions. If you have questions about this issue, or your workers compensation claim in general, please don’t hesitate to contact us. (727) 853-6275.
Dolman Law Group
5435 Main Street
New Port Richey, FL 34652