When Pre-Existing Conditions Affect a Workers’ Comp Claim

What pre-existing condition hurt workers compensation?

When you have a pre-existing medical or health condition, filing for workers’ compensation can go from standard procedure too complicated very quickly. This is especially true if your pre-existing condition is related to your claim. For example, if your medical records show a herniated disk and you injure your back lifting something heavy at work, it will be more difficult for you to collect benefits than a worker who previously had knee surgery and now has a back injury.

This may sound backward, but it happens more often than it should. At the Law Offices of Gerald D. Brody & Associates, we’ve defended hundreds of workers with pre-existing conditions and helped them collect the benefits they’re entitled to.

What Qualifies as a Pre-Existing Medical Condition?

A pre-existing medical condition is any injury or illness that precedes a workplace accident. Pre-existing conditions can include obvious injuries like:

  • Herniated disks
  • Broken bones
  • Torn ligaments
  • Knee and lower body injuries
  • Shoulder and upper body injuries

Pre-existing health or medical conditions related to general physical and mental health may include: 

  • Age-related spine degeneration
  • Arthritis
  • Carpal tunnel
  • Anxiety and depression
  • Post-traumatic stress disorder

If you have any of these conditions and then re-injure yourself as a result of performing your job duties, you have sustained what is called an “aggravation.” An aggravation results in temporary or permanent disability, creates a new need for medical treatment, or requires a change in the existing course of treatment if you’re already under the care of a physician or specialist. 

Under California law, if you suffered an aggravation of a pre-existing condition, you have sustained a new injury. This is true whether your old injury was fully healed or not, so long as you weren’t disobeying your doctor’s order when the accident happened. Therefore, you’re entitled to all the same workers’ compensation benefits as anyone else injured on the job, including having your medical bills paid and receiving the same percentage of lost wages.

What could go wrong with workers' compensation for a pre-existing condition?

Up until this point, filing for workers’ compensation with a pre-existing condition has probably seemed fairly straightforward: You had an old injury, which was aggravated by an accident that happened while performing the work you’re paid to do. Your injury is new; therefore you qualify for all the same benefits as anyone else. However, proving that your job duties actually caused your new injury is where it gets tricky.

Insurance providers are notorious for using this argument to deny workers’ compensation benefits to injured workers. They’re under a lot of pressure from employers to keep their premiums low, and insurers don’t want to lose business. Therefore, insurers and employers work together to try to show that any impairment you have now is a result of your pre-existing condition and not the injury you suffered at work. 

If this seems unethical and dishonest, that’s because it is. The insurance adjuster assigned to your claim will go as far as thoroughly investigating your medical background to look for evidence that you’re being untruthful about your pre-existing condition. For this reason, it’s very important to be honest about your symptoms, level of pain, and disability with every doctor you see. Being consistent about reporting your pre-existing condition will greatly improve your chances of success.

When is it time to call a San Diego workers' compensation attorney?

A pre-existing condition is the number one reason workers’ compensation claims get denied. Whether you were denied for this reason and want to file an appeal or you are still preparing your case and seeking legal counsel, the attorneys at the Law Offices of Gerald D. Brody & Associates will defend your rights and help you get the benefits you deserve. 

Give us a call today to schedule your free initial consultation. Our team of professional attorneys will be happy to review your case and give you honest advice on the best way to proceed. Give us a call at (619) 528-9800.