How Preexisting Conditions Can Hurt Workers' Comp Claims

How Preexisting Conditions Can Hurt Workers’ Comp Claims

What happens if you have a work-related injury and also have a preexisting condition or prior, similar injury? Do preexisting conditions affect whether you can file a workers’ comp claim? Does having one decrease your workers’ comp payment or stop you from getting benefits? These questions get to the heart of our current reality. About half of Americans today either have a preexisting condition or live in a home with someone who does. Many of those people continue to work, and some will likely suffer injuries while on the job.

What then? Does having a preexisting condition stop you from getting workers’ comp benefits?

The answer is that every person’s situation is unique and complicated. But there’s good news, too. A qualified attorney can help you unravel your particular issues and determine if you have a case. If you do, that attorney can advocate on your behalf without charging you money up front.

What Counts as a Preexisting Health Condition?

Simply put, this is any health problem that existed before the accident that caused your current on-the-job injury. In workers’ compensation speak, it can be a previous injury or health problem you had before this job. Alternatively, it can also be a worsening of a prior injury or health issue.

For example, if you played high school football and injured your knee, that’s a preexisting condition. If you fall off a ladder at work and hurt that same knee, the fact that you had an injury there before can come into play.

Another example is that you can have a disease totally unrelated to a former injury, such as arthritis. If your job makes your arthritis pain worse, your employer’s insurer will count that as a preexisting condition when evaluating your workers’ comp claim.

How Common Are These Conditions?

Approximately half of all American households include someone with a preexisting health condition. This is important because it makes workers’ compensation evaluations a bit more complicated. If someone with a preexisting condition or injury has an on-the-job accident, it may affect their ability to claim workers’ compensation benefits.

Does Having a Preexisting Condition Disqualify Me From Workers’ Comp?

The Occupational Health and Safety Administration (OSHA) clearly stipulates that “an injury or illness must be considered to be work-related if an event or exposure in the work environment either caused or contributed to the resulting condition or significantly aggravated a pre-existing injury or illness.”

Let’s go back to the previous example where we talked about an old high school football knee injury. Based on the way OSHA worded this rule, if you fall and seriously injure that knee, it should qualify for workers’ comp. Why? Because a work-related fall “significantly aggravated” your previously injured knee.

Will Workers’ Comp Pay For A Preexisting Condition if Doing My Job Makes It Worse?

You cannot get workers’ comp for an injury or health condition that existed before your on-the-job accident. However, you can get workers’ comp for an injury that aggravates or worsens a preexisting condition if you were doing your job at the time. In fact, in most states, injured workers are eligible for workers’ comp when a workplace injury aggravates a preexisting condition.

Need another example that might make more sense? Let’s say you already suffer from carpal tunnel syndrome. If you break your wrist during a work accident, your carpal tunnel counts as a preexisting condition. So, workers’ comp won’t pay for you to have carpal tunnel surgery. However, you should receive workers’ compensation for your broken wrist. If the physical therapy for your broken wrist happens to improve your carpal tunnel symptoms, even better!

It can become even more complicated if you don’t understand all the legalese and regulations that dictate how and when you qualify for workers’ compensation. Laws continue to change, depending on the state you live in, and are difficult to track. In some cases, your employer may say that because you have a preexisting condition, you won’t qualify for workers’ compensation.

That’s why it’s vital to have a local workers’ compensation attorney review your case free of charge.

What Should I Do If I’m Hurt on the Job?

The most important thing you can do is to seek medical attention. You must document your injury (or illness) thoroughly, and you can’t get workers’ comp without medical treatment. Equally important is to decide if hiring a workers’ comp lawyer can help your case.

There’s no cost to have a workers’ compensation attorney who understands the relevant laws review your claim. If you’d like us to connect you with one for a free, no-obligation claim evaluation, click the button below now!

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Lisa Allen is a writer and editor who lives in suburban Kansas City. She holds MFAs in Creative Nonfiction and Poetry, both from the Solstice Low-Residency Program in Creative Writing at Pine Manor College. Prior to becoming a writer, Lisa worked as a paralegal, where she specialized in real estate in and around Chicago.