Apportionment in South Florida Workers’ Compensation Cases
Insurance makes risk-averse people feel safe until an accident or illness happens that requires the insurance company to pay. You might confidently hand your insurance card to the front desk receptionist in the doctor’s office but then get an unpleasant surprise when your bill arrives weeks later, because your insurance only paid for a small portion of your treatment. Likewise, you might grit your teeth and swipe your credit card at the body shop, thinking that eventually the car insurance company will eventually reimburse you, but when the check arrives, it is for a measly amount, and you have to spend years paying off the repairs you charged to your credit card. Unfortunately, it is possible to run into the same problem with workers’ compensation insurance. Your employer’s insurance is supposed to cover 100 percent of treatment, but it doesn’t always work out that way. Your employer might invoke the doctrine of apportionment to get out of paying for part of your medical bills. If your employer tries to spring apportionment on you when you seek treatment for a work injury, contact a South Florida workers’ compensation lawyer.
How Apportionment Works in Workers’ Compensation Claims
Apportionment in a workers’ compensation claim is similar to comparative fault in a car accident. You can still be awarded damages if you get injured in a car accident that was partially your fault, but the amount of money you get will be less. Pre-existing conditions are employers’ favorite card to play in workers’ compensation claims. Sometimes the employer denies the injured workers’ claim by arguing that the condition for which the worker needs treatment is because of a pre-existing condition (such as an old injury suffered at a previous job) and not from the current work accident. With apportionment, the employer argues that the need for treatment is partially because of the recent accident and partially because of a pre-existing condition. In one such case, a woman named Sandra needed rotator cuff surgery after a work accident, but the workers’ compensation doctor asked for apportionment because Sandra’s new injury had aggravated a previous shoulder injury. In this case, the workers’ compensation doctor and the expert medical adviser disagreed about how much Sandra’s old injury had contributed to her current need for rotator cuff surgery.
The good news for injured workers is that it is the employer’s responsibility to prove that apportionment is applicable. The employer must prove what is preexisting versus what was caused by your new accident. It is a challenge for your employer to prove this, especially if you have a workers’ compensation lawyer to help you tell your side of the story in a convincing way.
Reach Out to Us Today for Help
A Sunrise workers’ compensation lawyer can help you get the treatment of your work injuries covered, even if you were not in perfect health before the work accident. Contact the Law Offices of David M. Benenfeld for assistance with your case.