Pre-Existing Medical Conditions and Workers' Comp Claims

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If you have been injured at work or in the course of your employment, having a pre-existing illness can complicate your workers' comp claim. A condition that pre-dates your industrial injury may have an impact on the workers' comp benefits you receive. Your benefits will be impacted most significantly if your pre-existing condition is medically related to your workers’ compensation claim. For example, if you have a history of left knee arthritis and you have a left knee injury at work, your benefits will be more impacted than someone who previously had hip surgery and now has a left knee industrial injury.

The reason for this is that your employer, in most states, is responsible only for the worsening of your physical condition caused by the industrial injury. Your employer will try to gather evidence to show that any permanent impairment you have now is a result of your pre-existing condition, and not the industrial injury.

Pre-Existing Condition Related to Prior Workers’ Comp Claim

If you previously injured the same body part in another workplace accident, your benefits for your current workers' comp claim will be reduced slightly to account for the prior workers’ compensation claim. Your employer will still be required to pay all of your medical bills for treatment related to this new work-related injury. Similarly, if you are unable to work, your employer will pay you temporary disability benefits (a.k.a time loss compensation benefits).

However, at the time of claim closure, your permanent disability benefits will likely be different. Most likely, you will only receive compensation for the increase in permanent impairment, if any, that is attributable to the new workers’ compensation claim. For example, if your doctor determines that you are now permanently impaired to a degree that you are eligible for a $10,000 permanent impairment award, but you previously received an $8,000 permanent impairment award, you will receive only $2,000 as part of this most recent workers’ compensation claim.

Of course, if your condition did not permanently worsen due to the most recent industrial injury, you will not receive any permanent partial disability award.

It is important to note the distinction between an aggravation of a previous work-related injury and a new work-related injury involving the same body parts. Tell your doctor about your previous workplace injury, and if possible, provide your current doctor with a copy of all your medical records related to the previous workers’ compensation claim. Your doctor can evaluate your condition to determine if it is a continuation of your prior workplace injury, or a new, but related, injury. The difference is an important one in terms of worker's comp claim processing and the filing of a claim in many states. Your doctor, your employer, and your attorney can assist you in determining whether you need to complete the paperwork for an aggravation/worsening claim, or a new workers’ compensation claim. 

Pre-Existing Condition Not Related to Prior Workers’ Comp Claim

Often, a worker will have a pre-existing condition stemming from natural aging or a prior injury, unrelated to work, which is aggravated or worsened by a work-related injury. For instance, say you had previously dislocated your shoulder in a motorcycle accident, and you then injury it further at work due to repetitive lifting of heavy boxes. Just like with a prior workers’ compensation claim, you will likely receive workers’ compensation benefits only to account for the worsening of your condition attributable to the new work-related injury.

Your doctor will evaluate your condition to determine whether your industrial injury worsened your pre-existing condition. Your doctor will likely need to note in his records whether this worsening, if present, is temporary or permanent. If you have a pre-existing condition that you believe was worsened due to an industrial injury, you should strongly consider seeking a doctor that regularly treats injured workers. These doctors know the exact phrases and terminology necessary to describe your condition for purposes of your workers’ compensation claim. In some states, your employer can require you see a certain physician for treatment, in which case your doctor will be well versed in workers’ compensation rules.

Pre-Existing Unrelated Condition

If you have a pre-existing condition, either due to a previous workplace injury or not, your pre-existing condition may have little or no significance to your claim. Your employer will still pay for your medical bills for the industrial conditions. Your regular health insurance, if you have private insurance, will continue to pay for any treatment you need for the pre-existing condition. This may require you to see multiple providers – some for your pre-existing condition, and others for your workers’ compensation claim. While seeing multiple providers may be a burden, it will ensure you pay as little out of pocket costs as necessary.

One of the primary circumstances in which a pre-existing and unrelated condition is important is in the consideration of total and permanent disability. If you have a significant pre-existing condition, which, combined with your current industrial injuries, renders you unable to totally and permanently disabled, your employer may have options regarding your eligibility for a pension. If this describes your situation, talk to an attorney immediately to ensure that you receive any pension benefits you may be eligible for.

Getting Help

If you have a significant pre-existing condition when you are injured at work, you should talk to a workers’ compensation attorney immediately. This is not something you will be able to handle yourself, at least without losing some benefits and rights. Many claims involving pre-existing conditions end up in litigation due to the liability exposure involved for your employer. The earlier you hire an attorney, the more benefits you are likely to receive, and you may be able to avoid litigation.

Read more on Tips for Workers Compensation Claims.

by: , Contributing Author

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