How Can a Pre-Existing Condition Affect My Workers’ Compensation Claim?

October 14, 2021 General

According to the United States Department of Labor, all businesses must carry workers’ compensation insurance. This insurance is used when a worker is injured due to the performance of their work activities.
Some of the benefits that workers’ compensation provides are medical care and treatment, replacement of lost wages, and vocational rehabilitation. Not having this insurance is illegal, and the penalties for the company can be very severe.

However, we know that insurance companies will do their best to deny a claim request and thus protect the money and interests of the company.
Some of these insurers may use the fact that the worker already had a pre-existing medical condition to justify denial.

What is a pre-existing medical condition? This refers to any injury or illness the worker has suffered prior to the injury for which the claim is generated. Even though the insurance may deny the application because of this, some pre-existing injuries or illnesses can be aggravated by specific actions that are carried out after.

For example, one of the most common pre-existing conditions is back pain and back problems. Let’s say a person suffered a back injury during a previous car accident or as a result of a fall. The person recovers from the injury and confidently returns to work or seeks a new job.
Now, let’s suppose that this same person finds a job where they constantly have to carry heavy objects. As there is already a previous injury, so much effort can likely re-injure the back, aggravating the injury.

In these cases, workers’ compensation claims must be accepted, and the worker must receive the corresponding benefits. This is on the basis that it was the work activity that caused the issue. If the re-injury can not be proven to have been caused by work activities, it will be more difficult for the claim to be accepted by the insurer.