Florida workers’ compensation law gives employers and carriers a powerful tool called an EMA, short for expert medical advisor. When two authorized doctors disagree on a key medical question, a judge of compensation claims can appoint an EMA to break the tie. What many injured workers do not realize is how decisive that evaluation can be, especially if you have a pre-existing condition. An EMA’s opinion often becomes the most persuasive medical evidence in the case. A strong record and careful preparation can make the difference between a fair award and years of frustration.
I have guided injured workers through EMAs involving degenerative spine issues, prior shoulder repairs, diabetes-related neuropathy, and even old injuries from military service. The common thread is always the same: pre-existing conditions magnify the stakes. Carriers cite apportionment, major contributing cause, and causation defenses at every turn. Your job, with the help of an experienced workers compensation lawyer, is to meet those defenses head on before you ever set foot in the EMA office.
This article is a field guide to EMA evaluations in Florida, built for people with prior injuries or degenerative conditions. It blends law with the practical mechanics of medical evaluations so you can prepare intelligently and protect your case.
What an EMA Is, and Why It Matters More With Pre-Existing Conditions
Under section 440.13(9), Florida Statutes, when there is a conflict in the authorized medical opinions, the judge can appoint an EMA to resolve it. Think of the EMA as a court-selected tie breaker. The EMA is not your treating doctor, and not the employer’s handpicked physician. The EMA’s job is to review records, examine you, and produce an opinion on disputed issues, such as causation, permanent impairment, work restrictions, maximum medical improvement, and the need for specific treatment.
Here is the catch. Florida law gives EMA opinions “presumptive correctness” on medical issues, unless there is clear and convincing evidence to the contrary. That is a high bar. In practice, if an EMA says your work accident is only a minor factor and your pre-existing arthritis is the real culprit, your benefits can shrink or vanish. If the EMA says your work event aggravated your underlying condition and remains the major contributing cause, you have a far stronger position for ongoing treatment, medication, and wage benefits.
With pre-existing conditions, the major contributing cause standard takes center stage. To win, the industrial accident must be more than a mere trigger. It needs to be the primary cause, more than 50 percent responsible as compared to other causes, for the need for treatment or disability. Carriers attempt to shift the analysis toward wear and tear, age-related degeneration, or prior trauma. That is why the documentation of your baseline before the accident, the acute change at the time of injury, and the trajectory afterward becomes critical.
The Anatomy of a Medical Dispute That Leads to an EMA
EMA referrals usually arise from disagreements between authorized providers, often the treating physician and the employer’s IME doctor, or between two different specialties. These disputes typically concern:
- Causation and apportionment: Is the work accident the major contributing cause, and if not, what percentage is apportioned to pre-existing conditions? Maximum medical improvement and impairment: Have you reached MMI, and if so, what is your permanent impairment rating? Work restrictions and capacity: Can you return to your pre-injury job, or do you need modified duty or vocational retraining? Reasonableness and medical necessity: Are injections, surgery, therapy, or medications medically necessary due to the work event?
If you have a prior condition, the dispute often turns on details like a single MRI slice, a timeline of symptoms, or the language in a surgeon’s note. Carriers will point to prior pain complaints or old scans and argue your current condition was inevitable. A strong case demonstrates a clear baseline before the accident and a measurable change afterward.
Building the Record Before the EMA Is Even Appointed
Good outcomes begin long before the appointment letter arrives. The judge often looks for consistency, credibility, and objective anchors in the record. Get these in place:
- Establish your baseline. If you were asymptomatic or managing well before the accident, make sure your primary care notes, athletic or gym records, and even attendance records at work reflect that. I once represented a technician with degenerative disc disease who had not missed a day of work in five years. His spotless attendance record helped the EMA accept that the work incident caused a dramatic change, not a trivial flare. Document the delta. You need evidence showing a material shift after the incident. ER records, immediate clinic notes, and early imaging carry weight. A note that says “new numbness in two fingers since lifting motor” or “acute onset radicular pain” can be worth more than a pile of later opinions. Fill gaps promptly. Missed therapy visits, delayed diagnostics, and long gaps between appointments create room for doubt. If transportation or childcare made attendance hard, tell your work comp attorney so they can document the barriers early. Clarify old injuries. The most dangerous holes are vague references to past pain. If you had an old shoulder surgery, track down the operative report and any final notes showing resolution or return to full function. The sharper the pre-accident picture, the harder it is for the EMA to chalk everything up to history. Communicate consistently. When you give a history, use the same timeline and descriptors for every provider. Carriers love inconsistent statements. For example, if your back pain started while lifting a pallet on March 3, stick with that detail to the letter. “About early March” invites arguments about weekend yard work.
What the EMA Will Look For
Most EMAs focus on three pillars. First, objective findings: imaging, nerve studies, intraoperative photos, measurable range-of-motion deficits. Second, the timeline: symptom onset, escalation, failed conservative care, and response to interventions. Third, consistency: does your history align with the physical exam and the records.
For pre-existing cases, EMAs pay particular attention to imaging progression. Compare an MRI from two years ago with the post-accident scan. If there is a new herniation, extrusion, edema, or endplate changes, that helps. If the imaging looks similar but your neuro exam has changed, then a careful narrative linking the work event to a new functional deficit becomes crucial. Some EMAs undervalue pain reports unless those reports are tied to reproducible findings, such as dermatomal distribution, positive Spurling’s or straight-leg raise, or quantifiable weakness.
Managing Major Contributing Cause With Precision
Major contributing cause is not a gut feeling. EMAs must base their opinions on competent substantial evidence, which is why details win cases. I often coach clients to explain their experience in concrete terms. Instead of “my back got worse,” say “before the accident, I ran a mile twice a week without numbness. After the accident, my left foot tingled daily and I could not sit 30 minutes without shooting pain.” Numbers and vivid particulars bring the medical story to life for the EMA and, later, the judge.
Apportionment is related but distinct. Even when your accident is the major contributing cause, a doctor might assign a portion of impairment to pre-existing degeneration. Florida allows apportionment of permanent impairment but not of temporary benefits for care related to the accident while it remains the major contributing cause. An experienced workers compensation lawyer will fight to keep the accident as the dominant causal factor for ongoing treatment and wage loss, and push back on any premature apportionment that tries to shrink your impairment rating.
Preparing for the EMA Exam Without Overpreparing
EMA visits feel like high-stakes job interviews. Nervousness can make you ramble or overstate symptoms. Practice with your attorney so your account is accurate, concise, and complete. The goal is not to memorize a script. It is to anchor your story to dates, tasks, and measurable limits.
A short, disciplined pre-EMA routine helps. The day before the exam, review a one-page timeline your attorney prepared: date of injury, immediate symptoms, key tests, treatments tried, and current limits. Sleep normally, hydrate, and avoid activities that would exaggerate or mute your baseline. If a particular movement sparks your typical pain, do not avoid it during the exam. Let the EMA see what your real life looks like.
What to Bring, and What to Leave at Home
Most EMAs get the records directly, but the packets can be incomplete. Your workers comp lawyer should confirm that the EMA received the authorized doctor’s notes, imaging, prior records relevant to pre-existing conditions, and any work restrictions. Bring your ID and a short medication list with exact dosages and frequencies. If you use a brace, TENS unit, or assistive device, bring it and explain how and why you use it.
Do not bring pages of internet research, social media printouts, or letters from family. EMAs deal in medical facts and their own exam findings. Flooding them with advocacy material can backfire. If you keep a pain diary, ask your lawyer whether to provide a succinct summary or simply use it to refresh your memory before the visit.
The Evaluation Room: How to Communicate Clearly
I coach clients to answer the question asked, then stop. If the EMA asks when shooting pain began, give the date or closest estimate and the activity you were doing. If they want a pain scale, give a range tied to specific tasks. If they ask about prior injuries, be candid and specific. Hiding prior issues invites credibility problems once the EMA reads your old records. The key is context: “I had occasional stiffness before, managed with stretching and ibuprofen, never missed work. Since the accident, I need prescription medication and can’t lift more than 15 pounds without numbness.”
Most EMAs assess effort. Do not exaggerate pain responses or quit too early on range-of-motion tests. Give honest effort without risking injury. If a movement triggers familiar symptoms, say so and describe where you feel it. The more precise your description, the more useful it becomes for mapping to nerve distributions or joint mechanics.
Beware of Small Talk That Isn’t Small
Casual conversation counts. Comments about weekend projects, gym workouts, or travel can become ammunition if they contradict your reported limitations. If you returned to bowling, gardening, or childcare, do not hide it. Explain what you attempted, how it went, and whether you paid for it afterward with increased symptoms. Judges do not expect perfection; they expect transparency. The worst outcomes I have seen involve seemingly minor inconsistencies that an EMA flags as symptom magnification.
Handling Common EMA Dynamics in Pre-Existing Cases
Spine degeneration: Many Floridians over 40 have disc desiccation, bulges, or facet arthropathy visible on MRI. EMAs know this. The central question is whether your work event produced a clinically significant change. A few anchoring facts help: a new dermatomal pattern, a new reflex change, or a new objective weakness. A record that shows repeated failed conservative care followed by short-lived relief from injections can also validate the seriousness of your aggravation.
Shoulder with prior repair: If you tore a different tendon or re-injured the same one, operative notes and imaging comparison matter. EMAs often look for new partial thickness tears, bursal-sided fraying, or labral pathologies. If you had full function pre-accident, make sure your work evaluations or task logs show the duties you performed without limitation.
Knee with arthritis: Crepitus and joint space narrowing alone are easy scapegoats. Show that your pre-injury daily steps, kneeling, or ladder work were well tolerated. If the incident produced swelling, buckling, or locking that had not occurred in years, highlight the onset date and objective findings like effusion or positive McMurray.
Diabetes, neuropathy, and wounds: Carriers often argue that delayed healing is unrelated to the accident. The better argument ties the wound or neuropathy flare to the specific trauma and shows how it altered your baseline. Endocrinology notes, A1C trends, and podiatry records become allies if they document stable control pre-accident and a clear setback afterward.
Psych overlay and pain management: Pre-existing anxiety or depression can complicate recovery. EMAs usually focus on physical causation first, but a clean behavioral health record that shows new or worsened symptoms tied to pain can bolster credibility. Keep your language factual and avoid dramatization.
The Role of the Workers Comp Lawyer Before, During, and After the EMA
A seasoned workers compensation attorney does more than schedule the appointment. Preparation involves curating the medical file, coordinating pre-EMA coaching, and arranging for any missing imaging comparisons or specialty consults. WorkInjuryRights.com Workers compensation attorney near me After the EMA, your lawyer will scrutinize the report for accuracy, internal consistency, and foundation. If the EMA mischaracterizes your history, omits key imaging, or ventures beyond the medical issues to legal conclusions, your attorney can challenge those points at hearing.
In rare situations, a deposition of the EMA may be necessary. Judges do not authorize EMA depositions lightly, but if the report presents glaring gaps or misstatements, a deposition can expose the weaknesses. This is where an experienced workers compensation lawyer near me search turns practical. You want a professional who has deposed EMAs before and understands how to navigate the statutory presumptions without alienating the judge who appointed the expert.
The Paper Trail: What Your File Should Contain Before the EMA
Think in layers. The EMA will have a packet, but your attorney should also assemble a clean, chronological reference set:
- Baseline records that define function pre-accident: PCP notes, prior ortho discharges, performance reviews. Immediate post-accident care: incident report, urgent care or ER notes, first imaging. Treatment chronology: therapy notes, injections, surgical consultations, medication logs. Objective comparisons: pre and post MRIs with radiologist addenda, EMG/NCS reports, operative photos if available. Work capacity and restrictions: light duty offers, refusal letters, compliance notes.
A tidy record keeps the EMA from filling gaps with assumptions. I have seen cases turn on a single pre-accident MRI that showed no nerve root impingement, followed by a post-accident scan with a small but clinically significant extrusion. Without both films, that nuance would have been lost.
Apportionment Pitfalls and How to Address Them
Florida allows apportionment of permanent impairment when a portion is attributable to a pre-existing condition. Carriers sometimes stretch this into treatment or temporary benefits, which is not how the statute works while the accident remains the major contributing cause. If your EMA apportions impairment, your attorney should check whether the impairment guides were applied correctly and whether the doctor clearly differentiated underlying pathology from post-injury change.
A practical tip: concrete pre-injury metrics help limit apportionment. If you returned to full duty after a prior surgery and sustained that level for years, document it. Prior function matters more than abstract degeneration on a scan.
Surveillance, Social Media, and Credibility Around the EMA Window
Carriers sometimes time surveillance around independent exams and EMA visits. Assume you are being observed when traveling to or from the appointment. Live your restrictions, do not perform tasks you claim you cannot do, and avoid dramatic gestures that could be misinterpreted. On social media, avoid posting activity photos or “feeling great” messages that clash with your medical narrative. Judges understand that people have good days, but contradictory snapshots have derailed credible cases.
If the EMA Hurts Your Case, What Then?
Not every EMA goes your way. An unfavorable report is not the end, but it is a steep hill. Your lawyer will assess whether there is clear and convincing evidence to rebut the EMA or whether the better strategy is to narrow the issues. Sometimes the EMA supports causation but disputes the reasonableness of a proposed procedure. In that situation, a targeted second opinion on the procedure’s necessity or a trial of less invasive care can refill the record with supportive evidence.
If the EMA fundamentally rejects causation, look for factual errors. Did the EMA rely on an incorrect injury date or misread a prior MRI? Did the report ignore an operative finding that directly ties your pathology to acute trauma? When genuine mistakes exist, motion practice or deposition may be warranted. If not, settlement becomes a practical discussion. An experienced workers comp law firm can negotiate structured medical set-asides or settlements that account for ongoing care outside the comp system, especially when Medicare interests are involved.
A Short, Practical Checklist for Injured Workers Heading Into an EMA
- Review a one-page timeline and medication list prepared with your attorney, then put the papers away. Be precise about your pre-injury baseline, the moment of injury, and what changed after. Demonstrate honest effort during the exam. Describe symptoms with location, frequency, and triggers. Do not minimize prior conditions, but explain how they were managed or asymptomatic before the accident. Keep your day consistent with your stated limitations, including travel to and from the appointment.
Choosing the Right Advocate
Searching for a workers compensation lawyer near me or workers compensation attorney near me can feel like roulette. Focus less on billboards and more on experience with EMA-heavy litigation and pre-existing conditions. Ask pointed questions: How often have you prepared clients for EMAs? Have you deposed EMAs? What is your approach to apportionment? A best workers compensation lawyer for a pre-existing case understands how to anchor the medical story to objective facts without inflating claims. Look for an experienced workers compensation lawyer who collaborates closely with treating physicians, uses well-drafted timelines, and knows when to challenge or work within an EMA opinion.
A dedicated workers comp attorney aligns the medical and legal lanes. They will help you present the cleanest version of your real life: the job you did before the injury, the moment it changed, and the medically supported limitations you live with now. The right workers compensation law firm will also protect you from procedural missteps, from late authorization requests to incomplete record packets that could handicap your EMA.
A Real-World Example
A warehouse selector with a known L4-5 bulge had managed well for years. After a misstep with a loaded pallet, he developed left-sided radiculopathy he had never felt before. Early records were thin, and the carrier rushed him into a conservative track that made little progress. A defense IME said his issues were purely degenerative. We secured a comparison reading of prior and post-injury MRIs that highlighted a new extrusion contacting the L5 root. Therapy notes documented repeated positive slump and straight-leg tests on the left. A targeted injection provided short-lived but telling relief. At the EMA, the client described how he went from 12-hour shifts without numbness to a hard 30-minute sitting tolerance with predictable tingling. The EMA found the accident to be the major contributing cause and supported microdiscectomy after continued conservative measures failed. Without the comparison read and the precise functional story, the degenerative narrative might have won.
Timing, Patience, and Strategy
EMAs add months to the litigation timeline. Use that time wisely. Continue clinically appropriate care, comply with restrictions, and document. If an employer offers light duty within written restrictions, take it if you can. Refusals without solid reasons can undermine credibility with EMAs and judges alike. If you cannot perform a task safely, report it immediately and ask for adjustments. Good faith efforts at modified duty often strengthen the medical story by showing where the limits truly lie.
Final Thoughts for Workers With Pre-Existing Conditions
Pre-existing conditions do not doom a Florida workers’ compensation case. They do, however, demand rigor. The EMA process magnifies everything that is strong and everything that is sloppy in your file. Build a clean baseline, track a clear change, and speak with concrete detail. Partner early with a workers comp lawyer who lives in this world and knows how to prepare for these evaluations. Whether you call them a workers compensation attorney, work injury lawyer, or work accident attorney, the right advocate uses the law’s tools, including EMAs, to tell a credible medical story. That story, not volume or bravado, is what wins when pre-existing conditions meet Florida’s major contributing cause standard.