How Pre-Existing Conditions Affect Workers’ Comp Claims
Many of us start our workday with minor aches and pains. Perhaps you spent the weekend on a DIY project that left your back sore. Maybe you went for a long bike ride with the kids, and your legs are aching. On some level, those could be considered a pre-existing condition, but they don’t prevent you from getting your work done.
There are other types of pre-existing conditions that don’t just happen over the weekend, and you’re still able to work. What happens if, during the course of your work, you injure yourself, which makes that pre-existing condition worse? Can you receive workers’ compensation for an injury that exacerbates a pre-existing condition?
Technically, you’re entitled to those benefits, but that doesn’t mean there won’t be challenges.
This might be a scenario where filing a workers’ compensation claim requires the support of an experienced attorney who understands the laws and can be your advocate to get the maximum benefits you are due.
What Are Common Examples of Pre-Existing Conditions?
A pre-existing condition is a health condition that existed before starting at your job. It could be an injury from a previous job or even from your childhood. These are the kinds of injuries that can be aggravated if you’re at work and take a fall or are struck by a falling object. Even if you had a pre-existing issue with your back and lifted something heavy, it could trigger a new injury.
Here are some common examples of potential pre-existing conditions:
- Herniated discs and pinched nerves in the back
- Spinal stenosis
- Sciatic nerve problems
- Arthritis
- Asthma
- Chronic obstructive pulmonary disorder (COPD)
- Cancer
- Multiple sclerosis
- Epilepsy
- Mental health conditions like anxiety or depression
- Carpal tunnel
If the injury that occurred on the job makes those conditions worse and prevents you from working at the same level as before, you could be entitled to the full range of workers’ compensation benefits.
How Does Apportionment Apply to Workers’ Comp?
Despite what you might hear from a coworker or even your supervisor, having a pre-existing condition should not prevent you from applying for and receiving workers’ compensation benefits if the current injury is the cause of the disability preventing you from working in the same capacity as before. That doesn’t mean you won’t be able to recover and get back to work, but it does mean workers’ compensation is still available.
The issue of apportionment arises if the workers’ compensation insurer seeks to apportion your benefits or shift the blame for your current injury to your pre-existing injury. For example, suppose you have a history of a herniated disc. While at work, you lift a heavy object and further rupture that disc, preventing you from working.
The insurer might claim that your herniated disc was the real problem. That makes your injury apportioned.
What supports your claim is the fact that you were able to carry out your duties before the current injury. In other words, your herniated disc wasn’t a problem until you were injured at work.
In that scenario, you are entitled to full benefits.
The exception would be if you were working, but suddenly a pre-existing condition prevents you from carrying out your responsibilities, and there was no current injury. In that case, you wouldn’t be entitled to workers’ compensation. There needs to be causation between the current injury and the pre-existing injury to get the benefits.
Using the herniated disc example: Suppose you showed up for work and dropped your car keys. When you bent over to pick them up, your disc ruptured. That would not be considered a work-related injury where workers’ comp benefits would apply.
How to Support Your Claim
If you are injured on the job and that injury exacerbates your pre-existing condition, you may face challenges with your workers’ compensation claim. An experienced workers’ compensation attorney can help you present a strong case to the workers’ compensation insurance carrier. You can support your claim with the following steps:
- Report the injury ASAP
- Seek immediate medical attention.
- Be honest with your doctor about any pre-existing condition.
- Follow your treatment plan.
- Keep copies of all your medical records.
Why Legal Representation Matters
Being honest about a pre-existing condition should not preclude you from receiving workers’ compensation benefits. Of course, insurance companies will work every angle to avoid making any payments. That is why legal representation matters. With the support of an experienced attorney, you’ll improve your chances of prevailing in your claim.
If the claim is denied because of your pre-existing condition, you can still file an appeal. That will provide you and your attorney with the opportunity to present your relevant evidence, including testimony from medical professionals about your injury.
Workers’ compensation was designed to support workers who are injured on the job.
At Work Injury Advisor, we can help get you started. Those are benefits you’ve earned and should take full advantage of in case of any workplace injury.
