Hindrance to Recovery in Work Comp

Maria worked for Dollar General as a clerk. Part of her duties included stocking shelves. On the day of her accident, heavy boxes fell from above landing on her head, neck and shoulder. The injury to her shoulder was considered severe by her doctor and surgery was recommended.

Maria had a pre-existing high blood pressure condition mostly controlled with medication. However, after the accident, the medication was no longer working. The surgeon that was to perform the shoulder surgery recommended Maria get clearance from a cardiologist before undergoing surgery. The work comp insurance company denied coverage for cardiology exam stating the hypertension was a pre-existing condition and not covered under work comp. Maria was not able to move forward with her surgery without the recommended cardiac clearance. Her medical treatment, and ultimate recovery of her work injury, was stalled until this issue could be resolved.

Currently, Florida workers’ compensation statutes provide coverage does not extend to compensation or medical care needed as a result of a pre-existing condition. However, there are definite exceptions to this general statement of coverage. For instance, if the work injury caused an aggravation to the pre-existing condition, compensation and medical care must be provided as long as the work injury remains the major contributing cause for the need for treatment of the condition.

Additionally, there is the “hindrance to recovery” theory of coverage. If a condition (pre-existing or otherwise) interferes with the ability of the injured worker to obtain remedial treatment of the work injury, then such condition is deemed a hindrance to recovery and must be covered by workers’ compensation. When faced with a recommendation from an authorized doctor for evaluation or treatment of a condition that has not been directly caused by the work accident, many insurance companies choose to deny care outright without completely assessing the situation to determine if an exception to the general rule exists. This is what happened in Maria’s case.

Fortunately, the judge correctly used the hindrance to recovery theory to decide the case in Maria’s favor. The work comp insurance company was ordered to pay for a cardiac evaluation and the treatment of the hypertension so as to allow for the shoulder surgery to be performed. The hindrance to recovery theory does not mean that the hypertension is permanently covered by work comp. It is a covered condition only as long as it remains an obstacle to Maria being able to receive medically necessary treatment of her work injury.

If you have been denied coverage of a pre-existing or other condition that is limiting your ability to recover from your work injury, help may be available. The workers’ compensation attorneys at Syfrett, Dykes & Furr are available to review your case and help you get the medical treatment you need. Call us for a free consultation.

Kimberly J. Syfrett

Attorney at Law

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