How Do Pre-existing Conditions Affect Your Workers’ Compensation Claim?

Posted on Friday, March 10th, 2017 at 2:00 pm    

Just because your employer or the insurance carrier for the employer says you have a pre-existing condition, does not mean you cannot file a claim. While a pre-existing medical condition may sometimes defeat your right to collect work injury benefits, there are exceptions and there are defenses. The best course of action is to review your case with an experienced North Carolina or Virginia workers’ compensation attorney who can make sure you get the correct legal and medical analysis.

In North Carolina and Virginia, even if the work injury was partially due to pre-existing causes, if it can be shown that the work injury aggravated the pre-existing condition, then the employer and carrier is 100% responsible for the medical bills and temporary total disability payments that the workplace accident actually causes. Often the employer will try everything it can to show that your pain and symptoms are conditions you experienced before the accident date. This is especially true if the worker has a permanent injury.

Watch a video from attorney Joe Miller about pre-existing conditions in Virginia Workers Comp Cases.

An attempt to deny you benefits

One of the key arguments our legal team makes in pre-existing condition cases—when the comp carrier is attempting to deny the claim— is to argue that the accident at least partially aggravated your medical condition. In Virginia, the standard is that the work accident must have caused a “mechanical change in the body.” We take it upon ourselves to make sure your doctors are educated that the standard for causation in Virginia is actually very, very low.

So long as your doctor can say that your current disability and treatment were caused, even to a slight degree, by the work accident, then 100% of the condition is compensable. That means the pre-existing condition really does not matter.

For example, the most common place where we see the pre-existing condition claims is on back injuries. Particularly if you have been employed in labor most of your life and you are over 50, even if you have not been hurt, an MRI of your lumbar spine is likely to reveal a basket of horrors such as bulging discs, osteophytes, foraminal stenosis, cord compression, and all sorts of other issues. Of course, you can have all kinds of things like this going on in your spine and feel perfectly fine, until………

When a trauma occurs, those asymptomatic conditions suddenly become very symptomatic, in some cases so much so that you may be unable to walk. Although it is true that many of these conditions took years to form and develop, so long as the treating physician can say that more likely than not the work accident caused a mechanical change in the body that worsened a condition that is now causing you disability and necessitates treatment, then that injury is 100% compensable. The fact that there were pre-existing conditions that were not causing you pain or interfering with your ability to work on a daily basis is irrelevant.

Prior injuries that have not healed

The real problems in proving your case may come when you have a condition that WAS causing you pain and you were treating for that is now aggravated by a work accident. The ability to prove such cases are really going to depend on the level of treatment you were engaged in leading up to the accident, the severity of your previous symptoms, whether you had already recovered from those issues prior to the accident, and whether you were continuing to lose time from work as a result of the prior accident.

If the prior pre-existing condition arose through another workers’ compensation claim, then sometimes it is appropriate to file more than one claim and sometimes it is appropriate to leave it alone and blame everything on the first accident, assuming the evidence supports that. This is really something that you must strategize together with experienced counsel, as every case is different.

Additional considerations

There are a few other considerations that you will need to review with an experienced North Carolina or Virginia (depending on where the accident happened) lawyer.

  • Multiple injuries. A more complicated scenario is if you have had multiple injuries to the same body part. Here, lost most other pre-existing cases, the medical evaluation is determinative. As with the worsening scenario, the workers’ compensation commission will review the status of your condition prior to the new workplace accident and what your status is now.
  • Prior awards. If you received a personal injury award for the accident that caused the pre-existing condition that generally should not affect your ability to collect new worker’s compensation benefits except that any statements you gave about the personal injury may be used by the employer’s insurance carrier to try to reduce your claim.

If you are receiving Social Security disability income or private disability income, those also should not affect your ability to get new worker’s compensation benefits. The key issue will still be how much did the new workplace accident contribute to and worsen your condition. Still, it is a good check to review any other payments with your work injury lawyer. Similarly, it’s wise to review any other benefits such as retirement benefits you get with your work comp lawyer.

  • Permanent vs. temporary injury. Another complicated area is how the pre-existing injury affects your right to have your new injury qualify as an additional permanent partial impairment. We work with your current medical doctors and other doctors we may direct you to – to determine if the new injuries worsened your condition so that your injuries are now so severe that you can’t work again or can’t do the same type of work anymore.

Get strong advocacy from a long-time workers’ compensation lawyer

Virginia and North Carolina workers’ compensation lawyer Joe Miller Esq. is ready for the arguments defense lawyers and insurance adjustors will try to make to reduce or deny your claim based on pre-existing conditions. He understands the counter-arguments that can help you get justice when you suffer a work-related injury. Attorney Joe Miller has helped thousands of injured workers get strong settlements and awards. To speak with an experienced workers’ compensation lawyer, please phone at (888) 694-1671. You may have a sizable recovery coming to you.