Can You Get Workers Comp for a Pre-Existing Injury?
If you have a pre-existing injury and suffer a workplace accident, you may wonder: Can you get workers’ comp for a pre-existing injury? Many employees believe that a prior injury automatically disqualifies them from receiving workers’ compensation benefits. However, this is not always the case.
Workers’ compensation does cover pre-existing injuries, but only if the new injury or workplace conditions aggravate the serious previous injury or condition. This process, however, can be complicated since insurance companies often dispute these claims. Understanding your rights, gathering strong medical evidence, and seeking legal help when necessary can improve your chances of receiving benefits.
This guide explains how workers’ compensation applies to pre-existing injuries, how to prove your claim, common challenges, and legal options to ensure you receive the benefits you deserve.
Understanding Workers’ Comp and Pre-Existing Conditions
What is a Pre-Existing Condition in Workers’ Comp?
A pre-existing condition is any injury, illness, or medical issue that existed before your current workplace accident or work-related injury. These conditions can stem from prior work injuries, sports injuries, car accidents, or general health issues.
Common pre-existing conditions include:
- Back injuries: Herniated discs, spinal fractures, chronic lower back pain
- Joint problems: Knee injuries, arthritis, ligament damage
- Repetitive strain injuries: Carpal tunnel syndrome, tendonitis
- Fractures and broken bones: Prior injuries that have weakened certain areas
- Previous workplace accidents: Injuries from prior workers’ comp claims
Can You Get Workers’ Compensation for a Pre-existing Condition?
Yes, workers’ compensation does cover aggravated pre-existing conditions, but only under specific circumstances. If your work-related tasks or a new accident worsens your existing injury, you may qualify for benefits.
To be eligible, you must prove:
- The pre-existing injury was stable or under control before the workplace accident.
- Your job duties or work accident caused significant aggravation to the injury.
- Medical documentation confirms that the current injury is worse than the previous condition.
Some insurance companies may attempt to take a medical history to deny benefits, arguing that your symptoms are related to your previous condition, not a work-related injury. This is why strong medical evidence is crucial.
Proving That Work Aggravated a Pre-Existing Condition
Medical Evidence Required for Workers’ Comp Claims
To receive workers’ compensation permanent disability benefits for a pre-existing injury aggravation, you need medical evidence proving the condition worsened due to your work duties.
Key medical records that strengthen your case include:
- Before-and-after medical reports showing the difference in severity.
- Doctor’s statements linking the workplace accident to the aggravated injury.
- Independent Medical Examination (IME) reports (if requested by an insurance company).
- Diagnostic test results (X-rays, MRIs, CT scans) prove worsening of the condition.
How to Strengthen Your Claim
Aside from using medical bills as evidence, providing workplace documentation can help prove your claim. Employers and insurance companies often require detailed records to establish a clear link between the injury and workplace conditions. Additionally, maintaining a timeline of workplace incidents and medical treatments can further strengthen your case.
Additional supporting evidence:
- Incident reports from the employer documenting the accident.
- Witness statements from coworkers who saw the accident.
- Work restrictions issued by a doctor after the injury.
- Proof of prior stability, showing you had no recent issues before the new work accident.
Seeking legal help from an experienced workers’ compensation attorney can also improve your chances of winning your claim.
Challenges in Getting Workers’ Comp for a Pre-Existing Condition
Common Reasons for Denial
Insurance companies frequently deny claims involving pre-existing injuries. Common reasons include:
- “Your condition was not caused by work” – Insurers may argue that the worsening of your injury is due to natural progression, not work-related factors.
- “You failed to disclose your prior injury” – If you did not disclose a pre-existing condition during hiring, your employer may try to deny benefits.
- “Insufficient medical evidence” – Lack of documentation proving the injury aggravation can lead to claim denial.
- “You filed a claim too late” – Many states have strict deadlines for filing workers’ comp claims.
How to Appeal a Denied Workers’ Comp Claim
If your claim is denied, you have the right to appeal. The process generally involves:
- Filing a formal appeal with the workers’ compensation board in your state.
- Submitting additional medical evidence proving work-related aggravation.
- Attending a hearing where a judge will review your case.
- Getting legal representation to challenge the insurance company’s arguments.
Legal Options & Next Steps
When to Hire a Workers’ Compensation Lawyer
If your workers’ compensation case involves a pre-existing condition or permanent disability, it’s often best to consult an attorney. A workers’ compensation lawyer can help:
- Gather strong medical documentation to prove work-related aggravation.
- Fight insurance company denials and delays.
- Represent you in appeals hearings and negotiations.
Winning a Workers’ Comp Claim for a Pre-Existing Condition
A warehouse worker with a prior back injury suffered a fall at work, worsening his pre-existing herniated disc. Initially, his workers’ compensation claim was denied because the insurance company claimed his pain was due to his prior injury. However, with medical records showing no recent issues before the work accident, plus testimony from the injured worker and his doctor, he successfully won benefits on appeal.
Final Thoughts: Can You Get Workers Comp for a Pre-Existing Injury
Workers’ compensation does not automatically disqualify employees with pre-existing conditions. However, proving work-related aggravation requires strong medical documentation, legal knowledge, and persistence. If you are facing challenges, consulting an experienced workers’ compensation attorney can help secure the benefits workers’ compensation system you deserve.
If you’ve been injured at work and require skilled legal representation, Tomack Law, PLLC is ready to advocate for your rights. Our dedicated team focuses on workers’ compensation cases, ensuring that injured employees secure the full benefits they deserve. Don’t leave your case to chance, reach out to us today for a free consultation at (914) 500-2060 or email dtomack@tomacklaw.com.
FAQs: Can You Get Workers Comp for a Pre-Existing Injury
What qualifies as an aggravation of a pre-existing condition for workers’ comp?
An aggravation occurs when a work-related accident or repetitive job duties make a prior injury significantly worse. Medical evidence must show that the condition was stable before the serious workplace injury accident.
How do I prove my job made my pre-existing injury worse?
You need medical records, doctor statements, and workplace reports that demonstrate how your work conditions aggravated your pre-existing medical condition. An attorney can also help gather expert opinions to support your claim.
Can my employer deny my claim because of a pre-existing condition?
Employers or their workers’ compensation insurance companies may try to deny claims involving pre-existing injuries. However, if your job aggravated the condition, you still have legal rights to benefits and medical care. If your claim is denied, you may need additional medical documentation and legal assistance to challenge the decision effectively.
How long do I have to file a workers’ comp claim for an aggravated injury?
Each state has different statutes of limitations for filing a claim. In many cases, you must report the injury immediately and file a claim within a few weeks or months. Missing the deadline for a previous claim can jeopardize your ability to receive benefits, so timely action is crucial.
What should I do if my workers’ comp claim is denied due to a pre-existing condition?
If denied, file an appeal, gather more medical evidence, and consult a workers’ compensation lawyer to improve your chances of winning benefits. Additionally, consider seeking a second medical opinion to provide further support for your case.
