Can I Get Workers’ Compensation with a Pre-Existing Condition?

A pre-existing condition has the potential to complicate, delay, or even dismiss a new workers’ compensation claim. According to statistics of the Department of Health and Human Services, up to 129 million people of working age have one type or another of a pre-existing health condition. This can be a chronic illness or some type of partial disability. If you are later hurt in a workplace accident, that pre-existing condition is a key factor in whether you receive workers’ compensation benefits or not. Knowing how to address this complicated process from the start is your number one way to ensure your rights are protected. Seek legal advice and a case review immediately from our confident workers’ compensation attorneys at Terry Katz & Associates, P.C. law firm by calling 888-488-7459 or reaching out through our online contact page.

What is Workers’ Compensation?

Workers’ compensation is specific insurance provided by your employer, paying out cash benefits, or providing medical care if you are injured or become ill due to your employment. In New York, the Workers’ Compensation Board is the one that processes claims and directs your employer’s insurance company in these matters. The insurance company, however, must agree that your injury or illness results from your job responsibilities. An important detail is that you only have 30 days to notify your employer that you sustained an injury on the job. However, our NYC workers’ comp lawyers will tell you to make sure that you report the injury as soon as possible.

In New York, workers’ compensation covers new injuries and the worsening or aggravation of a pre-existing condition while on the job or during a job-related accident. However, to be eligible for workers' comp benefits, injured workers will need to prove the new injury or illness is job-related or happened in the workplace. In addition, you must clearly identify the relationship between the injury or illness with your pre-existing condition. This is where our experienced workers’ compensation lawyers and injury claim attorneys can guide you and your claim through obtaining the benefits, including lost wages successfully, you need and deserve.

Did the Pre-Existing Injury Cause the Work Injury?

Often it is extremely difficult to determine if the pre-existing condition worsens due to a workplace injury or if it interferes with your overall job responsibilities. Undoubtedly, the employer will attempt to tie the pre-existing condition with the occurrence of the new injury or worsening condition, leading to a denial of your workers’ compensation claim.

It is no surprise that workers suffer physical injuries or illnesses unrelated to their work. Life is busy, and anything can happen. Say you are coaching your daughter’s soccer team and, in the process, injure your knee as you race down the sideline during a game. While this will not keep you from working, it can cause questionable conditions down the road.

For instance, if your job requires hours on your feet and continuous climbing stairs, you can suffer additional injury to that knee. Or, what if your knee suddenly gives out while carrying a heavy box for your employer and you take a tumble down a flight of stairs, breaking an arm or leg?

If either of these occurs, expect the insurance company to ask about your previous injury. You can guarantee that they will strongly take into consideration the previous knee injury. As a result, the insurance company will do its best to deny coverage saying your employer is not responsible for the new injury due to your pre-existing condition.

How and When Did the Pre-Existing Condition Develop?

The workers’ compensation insurance carriers and employers will look at the timeline surrounding your injury and how your pre-existing condition developed.

How Did your Pre-Existing Condition Develop?

Identifying how your pre-existing condition developed will be paramount in determining whether you are eligible for workers’ compensation benefits for the new injury. If heavy lifting has been part of your previous employment, you may suffer from slight or severe degenerative discs in your back or a decrease in knee cartilage. You may never know about these developing conditions until a new workplace injury occurs.

Your medical provider and legal representation team are your only help at a time like this. Together, they must prove that your current pain and suffering result from your current job duties and would not have occurred otherwise, regardless of this unknown condition.

Another situation of how a pre-existing condition develops and affects a current claim is if the injury falls under a prior workers’ compensation claim. This claim can be with your current employer or a past employer.

In these instances, your case becomes even more difficult. The insurance company will pour over all the records from the previous claim, looking for anything that will disqualify the new one. You, the injured employee, will need to show the previously claimed injury is unrelated and has already been taken care of.

Differentiating Between Pre-Existing Conditions and Current Injury

Your first step in proving separation between the pre-existing condition and your most recent injury is to differentiate them as much as possible. The more you can show the level of pain and suffering experienced with the new injury, the less focus will concentrate on the pre-existing condition. However, there are steps you can take to ensure you are providing the most convincing evidence possible.

First, notify your employer of your new injury immediately. This is required, so don’t delay. Attend all doctor’s appointments, whether with your own doctor or those chosen by your employer’s insurance company. Don’t skip any medical treatments, or else you may significantly jeopardize your case.

Discuss your resulting pain and any discomfort during your medical examination, clearly differentiating it from any prior injury or condition. Detailing and documenting your symptoms fully will be beneficial in separating the before and after injuries. Be sure to include information on the intensity, frequency, and even the duration of pain and discomfort. Also, explain how the new injury affects your day to day living.

Common Medical Conditions that Workers' Comp Claims Denies

Claims denied by Workers’ Compensation insurers are often the result of a list of common medical conditions, including old injuries, herniated discs, broken bones, torn ligaments, degenerative disc disease, carpal tunnel syndrome, and other such common injuries. Just because you suffer from one of these, however, doesn’t mean there is no hope in obtaining benefits.

Life happens, and so do resulting injuries throughout your life. Old injuries may result from a car accident or from participating in a sport you love, even if a decade ago.

Broken bones are a common injury and often heal with time. Yet, they can cause lifelong pain and weakness in some cases. Other long-term impacts include nerve damage, weakness, and muscle, joint, or ligament issues.

Torn Ligaments can lead to severe arthritis later on in life. Arthritis can occur in anyone, not just older adults, and can often be disabling. Approximately 36 million present-day workers suffer from this pre-existing condition on a daily basis.

Degenerative disc disease, often associated with aging, is wear and tear of the discs in the spine, which causes pain. This is one of those pre-existing conditions, however, you may not even be aware of until injured. You can see why this is often used as a reason to deny a claim, particularly for a back injury, by the insurance companies.

Any time you have a pre-existing condition, whether you are aware of it or not, the insurance company will do their best to use it in some way to deny your workers’ compensation claim. Keep this in mind as you file and build upon your claim. Make notes including highly descriptive details of the events surrounding the injury and any specific pain and discomfort that results. Be consistent as well, to each and every doctor you see.

Speak to a Work-Related Injury Lawyer Today

When a workplace injury occurs, the last thing you want to think about is proving that it is not due to a pre-existing condition. That is where we come in, providing the legal advice and representation needed to obtain for you the most compensation available for a pre-existing illness. Don’t let the insurance company get the upper hand. Contact our dedicated personal injury and workers’ compensation lawyers today for a free consultation and a confidential attorney-client relationship. Terry Katz & Associates, law office serves clients throughout Long Island and New York City. Call today at 888-488-7459, or contact us through our website. We’re ready to get started working for you!

Terry Katz, Esq.
Terry Katz, Esq., the founding Member of the firm, handles all aspects of Workers’ Compensation and Social Security Disability cases.

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