Pre-Existing Injuries and Workers’ Comp Claims

Medical concept of workers' compensation: Benefits for medical personnel for injuries, accidents, and illnesses.

You may be more prone to accidents and injuries depending on your line of work. Additionally, if you’ve suffered an injury in the past, your occupation may contribute to worsening that injury. So, what do you do when your job aggravates a pre-existing injury? You may have the opportunity to file a workers’ compensation claim.

Workers’ comp claims can provide a clear avenue toward benefits to ensure you get medical coverage and minimize financial hardships. However, workers’ compensation claims for pre-existing injuries can be a bit more challenging to handle. For this reason, it’s best to seek legal assistance from a seasoned workers’ compensation attorney in your area.

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Understanding Workers’ Compensation Insurance

Workers’ compensation, also called workers’ comp, is a special, government-mandated insurance many employers must offer for their employees. When an employee suffers injuries in the workplace, they can file a workers’ compensation claim to receive benefits.

Workers’ comp is also a type of no-fault insurance. This means that by offering insurance protection to employees, employers save themselves from potential liability under most circumstances. Employees also have an easier path to obtain benefits and compensation without having to prove fault or file suit against their employer.

Who is Eligible for Workers’ Comp Coverage?

Many employees, including full-time, part-time, and seasonal employees, get workers’ compensation protection. Still, every state’s workers’ comp laws are different. Some of the workers not often protected by the workers’ compensation system include:

The text "Independent Contractor" is written on a notebook surrounded by colored felt-tip pens, representing a business concept idea.

  • Independent contractors
  • Farmers and farmhands
  • Real estate agents
  • Volunteers
  • Casual workers
  • Railroad employees

Certain states only require employers to obtain workers’ comp insurance if they have more than a set number of employees. Other states don’t require workers’ compensation insurance for some kinds of workers, including sole proprietors and corporate officers, but these employers can choose to purchase insurance protection. Because state law varies, knowing what your state requires is important.

For employees to qualify to file an insurance claim, there are specific requirements they must meet. First and foremost, you must have workers’ comp insurance protection. The injury or condition must arise out of or be related to your occupation. Additionally, you must understand your state’s rules concerning filing a claim, as some states have deadlines for notifying employers and filing the claim with the insurance company.

If you’re unsure whether you’re covered by workers’ compensation, discuss it with your employer. Should you have any concerns regarding insurance coverage, eligibility, and local laws, seek assistance from a local workers’ compensation attorney.

Workers’ Comp Benefits

Workers’ compensation benefits can cover certain expenses and losses related to your work-related injury. Benefits vary by state, but usually include:

  • Medical expenses: Treatment for a workplace injury can be costly. Workers’ compensation helps cover medical bills, allowing you to receive the treatment you need most.
  • Income replacement: Many occupational injuries require time off from work to heal. Workers’ comp helps replace some of your lost earnings while you’re away from your job, alleviating some financial stress.
  • Disability benefits: Work injuries regularly result in disabilities, whether permanent or temporary. Workers’ comp insurance provides special benefits based on the severity of your disability.
  • Death benefits: In the most unfortunate cases, work injuries result in death. Workers’ compensation offers employees’ loved ones certain death benefits, including funeral and burial costs and lost earnings, to help with the undue financial burdens that often come after someone’s passing.

The compensation an employee is entitled to depends on several factors, including the severity of the injury, the amount of time off from work, and state law. Do not hesitate to discuss your situation with a workers’ compensation lawyer to ensure you get full benefits.

Injuries and Illnesses Covered by Workers’ Compensation

Workers’ compensation insurance covers a wide variety of injuries and medical conditions. The most important detail is that the injury or illness must have arisen from your occupation.

A construction worker experiencing back pain from building, home renovation, or handyman work. The image suggests the need for massage therapy and highlights the risks of accidents for workers or contractors.

Some of the injuries employees often seek compensation for include:

  • Head and neck injuries
  • Traumatic brain injuries
  • Back injuries
  • Spinal cord injuries
  • Soft tissue injuries
  • Internal injuries
  • Crush injuries

Work-related injuries are frequently the result of workplace accidents. Common workplace accidents involve falls, being struck by objects, and getting caught in or between equipment. Additionally, some work injuries result from repetitive motions and overexertion, leading to certain injuries like carpal tunnel, sprains, and strains.

Workers’ comp also offers benefits for occupational conditions. An occupational condition is an illness or disease caused by your job, such as cancer, asbestosis, or asthma.

When filing a workers’ comp claim for a work injury or condition, providing sufficient medical documentation to support your claim is critical. Medical records can help you get a claim approval and adequate benefits.

What is a Pre-Existing Injury or Condition?

For purposes of workers’ comp, a pre-existing condition is a previous medical condition or the worsening of an existing condition. Simply put, the term refers to an injury or condition that pre-dates the one you’re not filing a claim for. In other words, it is not a new injury.

Pre-existing injuries and conditions include, but are not limited to:

  • Joint issues
  • Arthritis
  • Neck or back injuries, including those affecting discs
  • COPD
  • Mental health issues, like anxiety and depression
  • Skin issues, such as dermatitis or eczema

Sometimes, existing medical conditions and injuries worsen due to your job. This can cause financial burdens as you seek treatment to heal and prevent further worsening of the condition.

Does Workers’ Comp Provide Compensation for Pre-Existing Injuries?

Workers’ compensation does offer benefits when your occupation worsens a pre-existing injury or illness or leads to a new, related medical condition. Benefits can include medical coverage, income replacement, and disability benefits. The specifics of your injury or condition determine the benefits you’re entitled to receive.

Aggravation vs. Exacerbation of a Pre-Existing Injury

When dealing with a workers’ comp claim for a pre-existing issue, it’s important to understand the difference between aggravation and exacerbation. While these terms are often used interchangeably, for purposes of workers’ comp, they mean different things, and they can impact the value of your claim.

Aggravation of an injury causes the existing injury to worsen, usually for the long term. Medical treatment for the aggravation of a condition may not result in much improvement. On the other hand, exacerbation usually worsens the existing condition, but only for a short period. Proper medical attention for an exacerbated injury can help you return to your physical condition beforehand.

It’s worth noting that a short-term exacerbation can sometimes lead to long-term aggravation. For example, an employee can exacerbate an existing knee injury with repetitive motion at work, like lifting heavy objects. The temporary worsening of the injury can cause the knee to eventually give out, causing the employee to fall and land on the knee, resulting in aggravation of the existing issue.

Pre-Existing Conditions and Workplace Injuries

An African American worker in a warehouse got injured while carrying a box, with a forklift truck operating nearby.

Regarding previous conditions and workers’ comp claims, it’s necessary to consider the origin of your pre-existing condition and how your workplace accident or injury has affected it.

Pre-Existing Conditions Related to a Past Workplace Injury

In physically demanding jobs, it’s not uncommon for employees to suffer re-injury or worsening of injuries sustained in the workplace. If you’re experiencing an exacerbation or aggravation of another work-related injury for which you’re already receiving workers’ comp benefits, your benefits for the new injury may be a bit less.

Pre-Existing Condition Aggravated by a Work-Related Injury

It’s common for employees to suffer from certain conditions unrelated to their occupations. For instance, perhaps you previously dealt with a shoulder injury you sustained playing football in college. While the injury is old and you may have recovered, your occupation can cause you to re-injure that same shoulder.

In a situation like this, the insurance company may claim you’ve suffered an aggravation of the injury. This can result in only receiving limited benefits to cover the “worsening” of the condition rather than the entire injury itself.

Pre-Existing Condition Unrelated to Your Current Work Injury

Everyone’s medical histories are different, and it’s normal for employees to suffer from various conditions. You may worry that an existing condition may impact your workers’ comp claim for a new injury, but that’s not necessarily the case.

For example, if you suffer from a herniated disc in your lower back and you injure your shoulder at work, the two are entirely unrelated. Therefore, if your pre-existing condition is independent of your new occupational injury, it’s unlikely to impact your workers’ compensation claim.

The Complication with Pre-Existing Injury Workers’ Comp Claims

Workers’ compensation claims can be challenging to navigate in general, but when your claim involves a pre-existing injury, you may have trouble obtaining fair benefits.

Insurance companies are not the easiest to deal with, especially because money is involved. When you’re requesting compensation for worsening a pre-existing injury, the workers’ comp insurance company may try to deny your claim, maintaining your condition is entirely unrelated to your job.

Strong evidence is key to pre-existing injury claims. With the help of supporting documentation, you’ll need to exhibit the relationship between the aggravation of your existing condition and your occupation.

During your claim, the insurance company may ask for more proof of your condition or an independent medical examination (IME). This can result in some setbacks with your claim and longer wait times.

Handling your workers’ comp claim promptly and properly is crucial, but even more so with a pre-existing condition. Taking proper steps and filing your claim on time can help you get the benefits you’re entitled to receive.

Filing a Workers’ Comp Claim for a Pre-Existing Injury

Workplace Injury Report Form.

Every state has varying requirements for filing workers’ comp claims. However, the steps involved are usually similar.

First, your health and well-being should always be your priority. Therefore, you should seek medical attention as soon as possible. Following an accident at work, get medical attention right away. If your situation does not necessarily involve one specific accident or incident, but you begin to show signs of injury or illness, visit an emergency room or make an appointment with your doctor whenever possible for a proper diagnosis.

Next, you must notify your employer of your condition. While orally reporting the issue is acceptable in most cases, you should provide a written report that is signed and dated, and maintain a copy for your records. In many states, failing to notify your employer can affect your ability to obtain workers’ comp benefits – this is a vital step.

States differ regarding procedures for filing workers’ compensation claims, so it’s critical to understand how claim filing is done in your state. In some states, your employer is responsible for filling out forms and submitting them to their insurance company. In other states, your employer may notify their insurer, but you may also need to file documentation.

Once your claim is filed, you’ll need to allow some time for the insurance company to investigate the matter and make their decision. Many states have deadlines for insurers to accept or deny your claim, so you should be mindful of that date. Based on the outcome of your claim, you may begin receiving your benefits shortly after receiving your acceptance, or you may need to take further action to pursue favorable compensation.

The Importance of Having a Workers’ Compensation Lawyer Support You Through the Claim Process

Pre-existing injury claims can be complicated and stressful. To give yourself the best chance of obtaining the benefits you deserve, consult with a workers’ compensation attorney as early as possible in the process.

A workers’ comp lawyer can provide much-needed guidance and advice throughout the claim process to give you peace of mind. Additionally, an attorney can handle any complications or obstacles you may encounter in a timely manner and appeal the insurance company’s decision if need be.

If your pre-existing injury or condition is exacerbated or aggravated, you shouldn’t have to bear the resulting financial burdens. Filing a workers’ compensation claim can give you a clear path toward benefits and compensation.

These are some of the most challenged claims, however, making legal representation imperative. A local workers’ comp attorney is ready to assist you.

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