The Impact of Pre-Existing Conditions on Workers' Compensation Claims

Workers’ compensation claims can be challenging to prove, especially those involving pre-existing conditions. Filing a claim after a workplace accident can be daunting for employees with a prior injury or chronic illness. Workers’ comp carriers often deny or reduce benefits because of pre-existing conditions. Understanding the treatment of pre-existing conditions under workers’ compensation law is vital to obtaining fair compensation.

Suppose you have a pre-existing condition and have suffered a workplace injury or illness. In that case, a workers’ compensation lawyer can explain your rights.

Understanding Pre-Existing Conditions

Workers’ comp is employer-paid insurance that protects workers injured on the job. You can get lost wages, medical care, and rehabilitation training as part of your compensation. You report the accident to your employer and seek medical attention. The insurance company reviews your claim and determines your eligibility for benefits.

A pre-existing condition is a medical condition that existed before your workplace accident. It affects the same part of your body as your workplace injury. Pre-existing conditions aren’t unusual. Many people have some type of pre-existing condition when they’re injured on the job.

Impact of a Pre-Existing Condition on Your Workers’ Comp Claim

You shouldn’t be refused workers’ comp because of a condition you had when you started the job. If the work-related injury worsens the pre-existing condition, then insurers must pay workers’ compensation benefits. Still, a pre-existing condition adds complexity to your claim.

Several states specifically require that employers provide workers’ compensation benefits to employees with pre-existing injuries if the work-related accident aggravates or accelerates a pre-existing condition. However, some insurers automatically deny claims that show a pre-existing condition.

If you have a pre-existing condition that is worsened by a work-related injury or illness, you’re entitled to workers’ compensation benefits. But workers’ compensation insurance doesn’t pay for a pre-existing condition separate from the work-related injury or illness.

Common Pre-Existing Conditions

Pre-existing conditions cover a range of disorders. They encompass physical injuries, medical health conditions, and mental health disorders. Common pre-existing conditions include:

• Arthritis
• Back injuries
• Broken bones
• Carpal tunnel syndrome
• Chronic illness
• Knee injuries
• Mental health conditions
• Neck injuries
• Torn ligaments

When you have a pre-existing condition, one of the biggest challenges in winning your case is proving that your work accident or illness aggravated your health.

Proving a Work-Related Injury Is Separate From a Pre-Existing Condition

If you have a pre-existing condition, showing a difference in health between the pre-existing condition and the new injury is essential.

Medical evidence is crucial. Your medical history, medical reports, and medical treatment can demonstrate that your condition worsened because of the workplace injury. Your medical providers should clarify the difference in symptoms, pain, and limitations that you’re experiencing because of the new injury.

You should also keep a journal of your health differences from the new workplace injury.

Tips for Supporting Your Workers’ Comp Claim

You can do many things to improve your chances of a favorable decision.

• Report your injury as soon as possible: File your claim as soon as you become aware of your injury. Waiting too long to notify your employer can increase your chances of a denial. Some states require that you file your claim within 90 days of the accident.
• Seek immediate medical attention: Thiscreates a medical record of your injury, which is important evidence for your claim. Let your doctor know about the difference in your health between your previous injury and the new injury. For example, describe changes in the intensity and location of pain since the new work-related injury.
• Follow medical advice: Failure to attend medical appointments or follow treatment plans can harm your claim. Your lack of cooperation can be viewed as a sign that your injury isn’t severe enough to qualify for benefits.
• Document everything: Keep copies of the documents related to your injury and claim. This includes the accident report, medical records, and communications with the insurance company, your employer, and medical professionals.
• Cooperate with the insurance company’s medical requests: The insurer may ask for an examination by a doctor of their choosing. This is called an independent medical examination (IME). You may hesitate to respond to requests from your workers’ comp carrier for medical information. But you must allow them to have access to your medical records.

An Experienced Attorney on Your Case

Pre-existing medical conditions can make proving your workers’ comp case more difficult. Insurance companies often look for reasons to deny disability benefits. An experienced workers’ compensation attorney can help you navigate workers’ compensation law and get fair compensation.