Yes, you can get workers’ compensation benefits for injuries, even with a pre-existing condition. Here’s what the insurance companies won’t tell you.
Workers’ compensation insurance companies are quick to flatly deny claims made by workers who have old workers’ comp injuries, unrelated prior injuries, or age-related health conditions.
But in most states, an injured worker is eligible for workers’ compensation benefits even when their on-the-job injury is a worsening of a pre-existing injury or condition.
Don’t take “No” for an answer. Learn how to get the workers’ compensation medical benefits and wage replacement you are legally entitled to receive.
Common Conditions Used to Deny Claims
Pre-existing injuries can include herniated disks, broken bones, torn ligaments, and other relatively obvious injuries.
Other conditions may be more closely related to general physical health, such as age-related spine degeneration or arthritis.
It’s not uncommon for an insurance company to wrongfully deny a legitimate claim because of a pre-existing medical condition.
Many times, an injured worker simply gives up on the claim; however, insurance companies cannot legally deny an on-the-job injury claim based solely on a pre-existing condition.
Old Injuries can be anything from old workers’ comp injuries to car accident or sports injuries from years ago.
If you’ve previously been awarded workers’ compensation benefits for an injury and are now suffering an aggravation or worsening of the original injury, you may not be eligible to file a new workers’ comp claim, but you may be able to re-open your prior case.
Re-opening a workers’ compensation case for a prior work injury has special challenges. You’ll need an
experienced personal injury attorney
for the best chance of success.
Arthritis is a potentially disabling condition that affects more than 54 million people in the United States. But it’s not a condition limited to the elderly.
Two-thirds of American adults with arthritis are working age. That’s up to 36 million workers with just one kind of pre-existing condition.
Degenerative Disk Disease isn’t a true disease, it’s normal wear and tear to the cushioning disks in your spine. As we age, those disks can break down.
If worn-out disks start hurting, it’s called degenerative disk disease.
You may not know you’ve got degenerative disk disease until you get hurt on the job and have X-Rays or a CT scan.
Nearly every working adult, especially older workers, will show up with some level of disk degeneration on scans, making it a pretty handy excuse for workers’ compensation insurance companies to deny their back injury claims.
Example: Back Injury Caused by Lifting Boxes
A worker is loading boxes onto his delivery van when his pre-existing back injury flares up.
He didn’t have any problems with his back when he woke up that morning. In fact, he’s been fine since he recovered from his prior injury two years ago.
Therefore, the act of loading the boxes is the cause of the worker’s pain and discomfort, not the prior back injury.
But for the loading of the boxes, the worker’s back would not be hurting him or restricting his activities. Performance of the worker’s duties loading boxes onto the van is the sole cause of his new injury.
In most states, employers hire employees “as is.” When you buy a used car, and the sign on the window says, “Sold As Is,” that means you are responsible for paying the cost of any repairs it might need.
While human beings aren’t cars, the “as is” principle is similar.
Stay a Step Ahead of the Insurance Company
Insurance companies look for any reason to deny your injury claim. The insurance adjuster assigned to your claim will thoroughly investigate your medical background and look for any evidence of pre-existing conditions.
Build your workers’ comp claim with that in mind.
File your workers’ comp claim right away. Don’t wait to see if the pain eases up, or for your supervisor to tell you to file a claim.
Report the injury to your employer and file a workers’ compensation claim as soon as possible after an injury.
Never try to hide your pre-existing condition. Neglecting to disclose a pre-existing condition can be grounds for denial of your claim.
On the other hand, don’t make excuses for your symptoms. If you immediately felt a sharp pain in your back after lifting a case of copier paper, don’t remark to the doctor, “I guess back troubles are to be expected at my age.”
Be detailed and specific. When you make your claim, write down exactly what happened. Be specific about the pain you felt, and how the work incident gave you pain unlike any you’ve ever had before.
Repeat those same details at every medical exam, and to every new medical provider, you may see. You must consistently make it clear that you would not be having your current pain and limitations but for the injury you suffered at work.
During the investigation of your claim, you may be diagnosed by two or even three doctors, and you may have to undergo an independent medical examination (IME).
Always give them the same detailed information about your symptoms, level of pain, and disability. Consistently reporting your condition greatly improves the chances of reaching a consensus among all the doctors.
Challenges to Pre-existing Conditions
Most working adults have been around long enough to have had some kind of physical injuries during their lifetime. The insurance company will take a hard look at your entire medical history with three questions in mind to challenge the validity of your claim.
Did the pre-existing condition cause the injury?
Back injuries are one of the most common reasons for workers’ compensation claims. If a construction worker blew out his back while lifting bags of concrete mix on the job, he’ll likely be eligible for workers’ compensation. But suppose that same worker had knee surgery years before due to an ATV wreck.
The insurance company will want to know if the two injuries are related. If the worker never had any trouble with his knee, probably not. But if his knee gave out while he was lifting, causing him to twist his back, it’s a different story.
The insurance company will fight to prove the employer is not responsible for the worker’s injured back.
When and how did the pre-existing condition develop?
This time let’s say the injured construction worker’s only pre-existing condition was wear and tear on his back from years of heavy lifting and hard work. Until he blew out his back lifting those bags of concrete mix, he never knew his spine was degenerating.
If the injured worker hadn’t been with this company for very long, the insurance company will jump at the chance to say the worker’s back injury was caused by previous employment.
It will be up to the worker’s doctors and lawyer to prove the worker wouldn’t be disabled with pain but for his lifting bags of concrete mix that day while performing his job duties.
Is this a pre-existing workers’ comp claim?
Workers’ compensation claims for new injuries can be very difficult to win if the worker has previously been paid by workers’ comp for a similar injury, even if the old claim was with a different employer.
All the records from the old claim are fair game for the insurance company. The challenge for the injured worker will be to prove the old injury was completely resolved and unrelated to the current injury.
Separating New Injuries from Pre-Existing Conditions
You want to place as much distance as possible between your prior condition and the new on-the-job injury.
The greater the percentage of pain, discomfort, and disability from your new injury, the less chance your claim will be reduced as a result of your pre-existing condition.
When discussing your current pain and discomfort with the doctors, be clear that it’s very different from any residual pain and discomfort you may have from a pre-existing injury. Let them know you didn’t have those symptoms before your current injury.
If you tell the doctors your current symptoms are no different than those you’ve been experiencing since your previous injury, your claim will likely be denied.
Giving detailed information during your medical exams is very important. Clearly explain that you weren’t having pain or discomfort from a prior injury when your new injury occurred.
Describe any changes in the type of pain you’re feeling, including its frequency, intensity, and duration. Tell the doctor how the new injury is affecting your daily activities in a way it hasn’t since your prior injury.
You’re Entitled to Medical and Wage Benefits
Whether your current workers’ comp claim is based on a re-injury, or aggravation of a medical condition sustained on a previous job, you’re entitled to the same medical and wage replacement benefits as anyone else injured on the job.
This is true whether your old injury was fully healed or not, and so long as you didn’t perform actions restricted by your doctor.
Ignoring your doctor’s orders might be grounds for a rightful denial of your new injury claim.
Example: Mechanic Ignores Doctor’s Orders
A mechanic working for a car dealership is injured when a portable hydraulic lift loses power and drops a car on him, severely breaking his leg. He files a workers’ compensation claim and receives full medical and lost wage benefits.
He’s released for work, but his doctor instructs him not to resume or accept any job duties where undue pressure might be exerted on his injured leg. The doctor specifically tells him not to work with hydraulic jacks because using them requires leg strength.
Several weeks later, he interviews for a job with a new dealership. The pay is higher, but the job duties include working with a hydraulic jack. He accepts the job anyway.
One day the hydraulic jack he’s operating begins to slip. He uses his leg strength to prevent it from falling, and the pressure causes his previously injured leg to fracture.
The mechanic files a new workers’ comp claim.
After reviewing the medical records from his previous job injury, the insurance company justifiably denies his claim because he ignored his doctor’s orders.
A few states make a further distinction regarding prior injuries as they affect workers compensation benefits. In these states, if the pre-existing medical condition was from a non-work-related injury, the worker is not eligible for benefits.
Don’t rely on the worker’s comp insurance adjuster to interpret the labor and compensation laws in your state.
You have too much at stake and nothing to lose from a free consultation with a workers’ compensation attorney about your work injury case.
How Much is Your Injury Claim Worth?
Find out now with a FREE case review from an attorney…
Workers' Comp & Pre-existing Condition Questions & Answers
I recently injured my back lifting a pediatric patient (I am an RN.) An MRI last year showed minor lumbar osteoarthritis in all vertebrae and…
I am a union mason bricklayer and have been in this trade for over 25 years. A few years ago I hurt my back and…
I recently re-injured my back at work. I did have a previous injury at my workplace in Ohio which was a herniated disc in 2012….
I had a back injury 2 years ago at my job in New York City. The MRI at that time showed a disc prolapse. My…
On 11/13/17 a bone in my foot fractured. I was just walking through a public parking lot and not at work. However, I may have…
In 2004 I fell on a friend’s boat and injured my knee. They were using an empty cooler with a broken lid as a step…
In 2014, my husband was working at an appliance repair shop. He was moving a stove by himself and sustained 3 torn discs in his…
I fell originally on 12/31/2015 at work and ended up having rotator cuff surgery. I settled on this claim but then on 1/10/17 I fell…
I worked for a company as cashier manager for 7+yrs but was let go without notice when they closed the store in Nov 2016. I then…
During 9/11/2001, I was a Police Officer with the NYPD. Soon after I got sleep apnea, bronchitis, GERD, and the WTC cough. On 7/18/2003 I…
I have a pre-existing back condition: degenerative cervical spine with stenosis and multiple herniations of the lumbar spine. I was out on disability leave earlier…
I was injured on the job and was initially diagnosed with a shoulder strain, however, after two months of physical therapy my doc decided it…
I’m in the middle of a workers comp claim where I fell on the job and injured my back. I have a pre-existing back condition,…
I am currently involved in a workers’ compensation claim. I injured my back on the job, October 25th of this year (2014). However, today I…
I closed out a workers’ compensation claim receiving a settlement in 2010. It was re-injured in aggravation at a former employer when a hoist I…
I fell at work 4 months ago and hurt a pre-existing lower back injury, plus causing new injuries in my neck, upper back and hip….
I had a hernia repaired in January 2013. In May 2013 I injured the same hernia again while working. My employer said I needed to…
In November 2012 I hurt my right knee on the job. I tore my meniscus and had a partial tear of my ACL. My employer…
Approximately 12 years ago I had a 1 ton cheese press frame crush me to the ground, pinning me under it from my waist down….
I have 2 jobs, one full-time and one part-time. I fell at work at the part-time job. I broke my pinky finger and injured my…
I worked for a cola company for 36 years. I am 61 years old and have had three previous back surgeries due to my job…
I hurt one of my knees while working. I had surgery about 4 years ago. I’m still on workers compensation but working a light duty…
I injured my back after lifting roof decking while at work. I reported it to my supervisor that same day and continued to work. After…
I was injured in a car accident at work 6 years ago. I did not have a lawyer for my workmans comp claim, but I…
I slipped off a company van and sprained my hand. I did not know I had osteoarthritis in that hand. Ever since the fall my…
I was at work, doing a typical job task on my knees stocking cameras. Upon getting up, I had an intense pain, pull and pop…
I was at work lifting two different die sections, moving them from one cart to another cart. While setting the second die section down I…
I have a few workers comp questions that I hope you can help me with. I work on computer keyboards for 8 hours everyday, non-stop….
My husband was injured at his place of employment in February of this year. He was out of work from February ’till May of this…