Workers’ compensation is designed to protect employees who suffer injuries or illnesses due to their job. However, when it comes to claims involving pre-existing conditions, things can get complicated. Many workers worry about how past health issues might affect their ability to receive compensation after a new work-related injury. Understanding how pre-existing conditions influence workers’ comp claims is essential for anyone navigating this process.
As Francis Pommett, attorney, often explains, the presence of a pre-existing condition does not automatically disqualify you from receiving benefits. Instead, the key issue is how much your work injury worsened or aggravated that condition.
What Is a Pre-Existing Condition?
A pre-existing condition refers to any injury, illness, or medical problem that existed before your current workplace injury. This can range from chronic back pain, arthritis, or a previous injury that never fully healed, to any ongoing health issue unrelated to work.
When you file a workers’ compensation claim, insurance companies will look into your medical history to see if any pre-existing conditions might affect your case. This is where confusion often arises — many assume their claim will be denied if they had previous health problems. That’s not always the case.
The Legal Concept of Aggravation
The main question in workers’ comp claims involving pre-existing conditions is whether the workplace injury aggravated, accelerated, or worsened the pre-existing problem. If the injury you suffered at work made your condition worse or triggered new symptoms, you may still be entitled to compensation.
For example, imagine you had a mild back injury years ago that caused occasional pain. Then, while lifting heavy equipment at work, you re-injure your back and experience severe pain and limited mobility. Even though the injury involves a pre-existing condition, the new work accident aggravated it, making it a valid workers’ comp claim.
Francis Pommett, attorney, stresses that proving aggravation is critical. Your medical records, doctor’s opinions, and diagnostic tests will be key evidence in showing how the work injury impacted your condition.
How Insurance Companies Approach Pre-Existing Conditions
Insurance companies tend to scrutinize claims involving pre-existing conditions very carefully. Their goal is often to limit payouts, so they may argue that your current injury or disability is due mainly to your prior condition rather than your workplace incident.
They might say things like:
- “Your symptoms are from an old injury, not your recent accident.”
- “The pre-existing condition is the real cause of your disability.”
- “You wouldn’t need treatment if not for your prior medical issues.”
Because of these arguments, insurance adjusters may try to reduce your compensation or deny your claim altogether.
Importance of Medical Evidence
To successfully navigate a workers’ compensation claim with pre-existing conditions, medical evidence is essential. Your treating doctor needs to provide clear opinions on how the work injury worsened your condition. This may include:
- Comparing your condition before and after the injury
- Describing how the workplace accident contributed to new symptoms or disability
- Explaining why the aggravation requires additional treatment or time off work
Independent medical examinations (IMEs) may also be requested by insurance companies to challenge your doctor’s conclusions. Having an attorney who understands the medical and legal aspects can help you prepare for this and protect your interests.
Partial vs. Total Disability and Pre-Existing Conditions
Pre-existing conditions can impact the type and amount of disability benefits you receive. If your work injury worsened a prior condition but did not completely disable you, you might receive partial disability benefits. This means compensation for some loss of earning capacity.
In more severe cases, where the aggravation results in total disability, you may be entitled to full benefits until you recover or reach maximum medical improvement.
What to Do If You Have a Pre-Existing Condition
If you know you have a pre-existing condition, it’s important to be proactive:
- Disclose your medical history honestly. Don’t hide past injuries or illnesses during your workers’ comp claim.
- Seek prompt medical attention after your workplace injury. Document everything thoroughly.
- Work closely with your doctor. Make sure your medical records clearly state how your condition has changed due to the injury.
- Keep detailed records of symptoms, treatments, and work restrictions.
- Consult with a workers’ compensation attorney. Someone like Francis Pommett can help you understand your rights, gather evidence, and fight unfair denials.
Common Misconceptions About Pre-Existing Conditions
There are several myths surrounding pre-existing conditions in workers’ comp cases:
- Myth: Having a pre-existing condition means no benefits.
This is false. You can still receive benefits if your workplace injury aggravated the condition. - Myth: You only get compensation for the new injury, not the old one.
Actually, if the new injury worsens your overall disability, your claim can cover treatment and benefits related to that worsening. - Myth: Employers or insurers can deny your claim just because you had prior health problems.
They can try, but the law protects workers if the injury aggravated their condition.
Understanding these facts can empower you to advocate for yourself.
Pre-existing conditions add a layer of complexity to workers’ compensation claims, but they don’t automatically prevent you from receiving benefits. The law recognizes that workplace injuries can worsen existing problems, and you have the right to compensation for that aggravation.
If you’re dealing with a work injury and have a pre-existing condition, don’t get discouraged. Gather your medical records, work with your healthcare providers, and get legal help if needed. An experienced attorney can help navigate the system and ensure you receive the benefits you deserve.
Remember, your health and livelihood matter. Protecting your rights starts with understanding how pre-existing conditions impact your claim and taking the right steps to prove your case.