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Pre-Existing Medical Conditions and Workers’ Comp

If you have a pre-existing medical condition, you might think it would be impossible to receive Workers’ Compensation for a related condition. However, depending on the nature of the injury or situation at work, you may be entitled to workers’ compensation regardless of whether you have a related pre-existing condition.

Disclosure and Coverage

The most important part of dealing with a pre-existing condition during the Workers’ Compensation process is disclosure. If you have a health concern related to a previous incident at work or a condition or injury that pre-dated your employment, it is vital that you share accurate information about the condition or injury while you are filing your current claim.

Workers’ compensation claims are designed to cover lost wages and medical expenses related to on-the-job injuries or exposures, but sometimes these injuries can overlap with health issues you may already suffer from.

For instance, if you have a previous knee injury related to sports or exercise outside of work but then injure the same knee on the job, your employer will only be liable for the expenses related to the most recent incident. However, if the new injury results in you being permanently unable to work, the benefits you are entitled to would be reduced by whatever treatment or compensation you received for the prior injury or condition. This makes processing the compensation case extremely tricky.

Obviously, the less your pre-existing condition impacts the current condition or injury; the less consideration needs to be given. For instance, if you have a pulmonary condition that makes breathing difficult, and your workers’ compensation claim is related to an ACL tear, there is little that needs to be taken into account when processing the new claim.

However, if you do NOT disclose a pre-existing condition, no matter how seemingly unrelated, this can seriously impact your ability to receive compensation on your current claim.

Rules Regarding Pre-existing Conditions

The rules governing pre-existing conditions that are aggravated by current workplace injuries and incidents vary from state to state, but most depend on an independent assessment of the extent to which your current disability is dependent on the most recent injury or the pre-existing condition. If there is a way for the claim to be reduced, the Workers’ Compensation program will work for that outcome. If it is determined that more than 50% of your current disability or required treatment is due to the pre-existing condition, your claim may be denied.

Therefore, disclosing the pre-existing condition and having a licensed and sanctioned professional determine the extent of the liability the current injury has versus the pre-existing condition is extremely important. If an outside agent is able to certify that the current disability is more due to the injury, regardless of the contribution of the pre-existing condition, then you can get the compensation you are entitled to receive.

It is important to note that workers’ compensation claims cannot cover “flare-ups” of pre-existing conditions such as carpal tunnel syndrome or arthritis. This is simply a case of “exacerbation” rather than “aggravation,” and as such, would not entitle you to compensation.

In all cases, it is vital that you receive guidance from people familiar with the processes and procedures and that you receive a proper examination from a physician who can determine the apportionment or percentage of responsibility that the current injury has for your disability or pain.

If you have a pre-existing medical condition and want to know more about workers’ compensation coverage, contact our office today and speak with one of our experts.

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