In order for a workers compensation claim to be accepted as compensable by the Employer/Carrier, the major contributing cause of the injuries or symptoms must be the work accident. The Florida Statutes define major contributing cause to mean that the work accident is at least 50 percent responsible for the injuries or symptoms as compared to all other causes combined. Major contributing cause can only be established by medical evidence which means that the opinions of physicians make the determination. Further, it must be established that the accident or injury arose out of the injured worker’s employment. The two elements that an injured employee must prove are that the employee must have been performing work in the course and scope of their employment at the time of the accident and the employment must have constituted more than a contributing, precipitating, competent, or accelerating cause of the accident or injury.
There are many reasons why a case may be denied based on major contributing cause. One of the more common reasons is that an injured worker suffered an injury to the same body part in the past and the Employer/Carrier believes that the reason for the symptoms is the prior injury. A denial may be asserted in this situation, but the opinions of medical physicians will make the determination whether the denial is correct. In this situation, both the Employer/Carrier and the injured worker are entitled to an independent medical examination (“IME”). Each party is permitted to select a physician to give their opinion on the causation of the injury. If one of the doctors opines that the major contributing cause of the injury is the work accident, while another gives the opinion that the causation is something else, an expert would be appointed by the Judge to break the tie.
According to Florida Statutes section 440.09, causation must be established to a reasonable degree of medical certainty and by objective medical findings. This basically means that a doctor establishes their opinion based on all of the medical evidence presented which generally includes any treatment received by a prior physician and any diagnostic testing that has been performed.
Another thing to consider is that a workers compensation claim may be denied based on major contributing cause at any time. For example, if a claim has been accepted as compensable by the Employer/Carrier, the claim may be denied based on the opinion of an authorized physician. If this was to occur, an injured worker is generally still entitled to use a one-time change in physician in order to get the opinion of another authorized physician.
Major contributing cause is a complex part of the Florida Workers Compensation law. That is why it is important to hire a workers compensation attorney who handles these types of situations. If you were injured on the job or know of someone who was, have them give us a call at (844) 762-8155.