How Pre-existing Conditions Affect Workers’ Compensation Claims

When you’re injured on the job, workers’ compensation is designed to help you recover without the financial burden of medical bills and lost wages. However, the process can become more complex if you already have a health issue. Wondering how pre-existing conditions affect worker’s compensation claims?

Here’s what you need to know.

What Is a Pre-Existing Condition?

A pre-existing condition refers to any injury, illness, or medical issue that existed before your workplace injury occurred. This could include chronic conditions like arthritis, old injuries like a previously torn ligament, or health conditions such as diabetes.

Employers and their insurance companies often scrutinize claims involving pre-existing conditions because they want to ensure that the workplace injury—not a prior issue—is the cause of your current disability or medical need.

How Pre-Existing Conditions Affect Workers’ Compensation Claims

The good news is that having a pre-existing condition does not automatically disqualify you from receiving workers’ compensation benefits. In many cases, if a workplace injury aggravates or exacerbates a pre-existing condition, you may still be entitled to benefits. The key is proving that the work-related injury worsened the condition or caused new complications.

For example, if you have a history of back pain but injure your back lifting a heavy object at work, workers’ compensation may cover treatment for the new injury or the aggravation of your back pain. However, you may face challenges as the employer’s insurance company could argue that your current issues are solely related to the pre-existing condition and not the workplace injury.

What Should You Do if Your Claim Is Denied?

If your workers’ compensation claim is denied due to a pre-existing condition, don’t panic. There are steps you can take to fight back and protect your rights:

Understand the Reason for Denial

Carefully review the denial letter to understand why your claim was rejected. If the insurer claims your injury is linked to a pre-existing condition, it’s important to determine whether they believe your current issues are unrelated to your job or that your condition wasn’t aggravated by work activities.

Gather Medical Evidence

Medical evidence is crucial to proving that your workplace injury worsened or aggravated your pre-existing condition. Work with your doctor to document how your job-related activities caused new symptoms or worsened your existing condition. Ask for detailed medical records, test results, and written statements from your healthcare provider.

Consult a Workers’ Compensation Attorney

Navigating a workers’ compensation claim involving a pre-existing condition can be challenging. A knowledgeable attorney can help you gather evidence, appeal the denial, and advocate on your behalf during hearings or negotiations.

File an Appeal

Most states allow workers to appeal a denied claim. This process typically involves presenting your case to a workers’ compensation board or administrative law judge. Having strong evidence and legal support can significantly increase your chances of a successful appeal.

Final Thoughts

While pre-existing conditions can complicate workers’ compensation claims, they do not necessarily disqualify you from receiving benefits. If your claim is denied, take action by understanding the reasons, gathering evidence, and seeking legal support. With the right approach, you can fight for the compensation you deserve and focus on your recovery.

If you’re facing a denied claim in Maryland, consult an experienced workers’ compensation attorney who can guide you through the process and ensure your rights are protected. For more information or to discuss your case with an experienced personal injury attorney, contact Shugarman & Mehring today to schedule a consultation.