Can Your Medical History Effect A Workers Compensation Claim?

Have you ever asked Can Your Medical History Effect A Workers Compensation Claim? There are many things to consider when filing a Workers’ Compensation claim, but your medical history is a major one. An individual’s medical history can greatly affect the outcome of a claim, giving you insight into the severity of any injuries and the role of any pre existing conditions that may have worsened because of the workplace incident.

In this article, our workers comp lawyer at Tomack Law, PLLC, discuss how an employee’s medical history can affect a workers’ compensation claim and why it can sometimes be difficult to associate a workplace incident with an injury.

Understanding the “Eggshell Claimant” Doctrine

An “eggshell claimant” is the concept that individuals must be taken as they are, in whatever state of health, regardless of history. In New York, transparency about your medical history is vital. If you did not disclose a prior injury, you risk losing your case. For example, if you had a previous back injury, but don’t report it, when you are filing a claim for a new back injury, this could be used against you.

Relevant injuries need to be disclosed and only the relevant body parts be given a HIPAA release. Over disclosure can include signing an unsigned HIPAA release with your physician which can expose your entire medical history to insurers, who may be able to deny you benefits unconstitutionally.

The Importance of Disclosing Only Relevant Medical History

In case of workers’ compensation claim, only injuries related to your case should be focussed on. If your claim involves a back injury, you do not have to disclose that you have aching feet from a foot fracture that occurred years ago.

Key Tip: Limit HIPAA authorizations to specific body parts affected by your workplace injury. A blanket HIPAA release allows insurers to access irrelevant medical history, potentially leading to delays or denials based on unrelated past injuries.

Medications and Their Impact on Your Claim

In most cases, your current or past medications are not subject to disclosure unless your employer has reason to suspect substance use contributed to the workplace accident.

Returning to Work and Reduced Earnings

Returning to work, even part-time or light duty, can help preserve your benefits. For example:

If your average weekly wage was $900 and you return to a light-duty job earning $450, you may be eligible for reduced earnings benefits.
You would receive two-thirds of the difference between your prior wage and your current earnings, equating to $300 in this scenario.

Schedule Loss of Use (SLU) Awards

In New York, injuries resulting in permanent damage to limbs (arms, hands, legs, etc.) may qualify for a Schedule Loss of Use (SLU) award. Here’s how it works:

If you’re entitled to a $10,000 SLU award but were paid $5,000 in benefits while out of work, you would receive the remaining $5,000.
If your employer paid your salary during your recovery, they might be reimbursed, and you would receive any balance owed.

For non-limb injuries, compensation is based on Loss of Wage Earning Capacity (LWEC), which considers medical impairment, age, education, and work history.

Maintaining Workers’ Compensation Benefits

In cases of partial disability, injured workers must demonstrate labor market attachment by actively seeking employment within their medical restrictions. Failure to make reasonable efforts can result in termination of benefits, making it challenging to reinstate them.