Author: Joseph Smith

If you’ve been injured at work but also have a pre-existing condition (PEC), you may be wondering how that will impact your workers’ compensation claim. Can you still get benefits if your current injury is related to an old injury or health issue? The answer is not always clear-cut, but understanding the rules surrounding pre-existing conditions and workers’ compensation can help you navigate your claim successfully.

In this blog post, we’ll explain:

• How pre-existing conditions are handled in workers’ compensation cases
• When you’re eligible for benefits
• The steps you should take if you find yourself in this situation

What is a pre-existing condition (PEC)?

A pre-existing condition (PEC) refers to a medical issue or injury that existed before your new work-related injury occurred. These conditions can vary widely and can include:

• Previous injuries (e.g., a back or knee injury)
• Ongoing health issues (e.g., arthritis, carpal tunnel syndrome)
• Old injuries that were never fully healed (e.g., a previously-sprained ankle or broken bone)

Injuries related to pre-existing conditions

One of the most common questions we receive is whether a workers’ compensation claim can be made if your injury is related to a pre-existing condition. While there are some nuances, here are some general rules:

1. New Injuries to a pre-existing condition and aggravation of a pre-existing condition: If your work accident causes a new injury to the same body part as your pre-existing condition (for example, if you already had back problems and lifting a heavy object at work caused further damage), or your work accident aggravates your pre-existing condition, your claim could still be covered. Workers’ compensation only pays for injuries that are sustained at work, and the injury must be directly related to your work duties. You will also need medical evidence to prove that the work accident caused or contributed to your current symptoms despite the pre-existing condition, or caused a new injury to the same body part.
2. Aggravation of a pre-existing condition: If your pre-existing condition is made worse by a workplace injury, you may still be eligible for benefits. This is especially true if the original injury was also work-related. For example, if you had a previous back injury from a different job, and a new fall at work aggravates that condition, you could be eligible for workers’ compensation benefits for the additional damage caused by the work injury.
3. Conditions not related to work: If your pre-existing condition is not related to your job but contributes to your current injury, the situation becomes more complex. Workers’ compensation usually only covers injuries that occur on the job, and proving that your work was a major factor in aggravating or causing the injury can be a challenge.

Example: If you have a pre-existing knee injury from a sports accident, and then a slip on the job worsens your knee pain, the employer’s insurance may argue that your knee issue existed prior to the injury, making your workers’ compensation claim more difficult.

How is coverage determined for pre-existing conditions in workers’ compensation claims?

The type of coverage and benefits you can receive for a pre-existing condition varies heavily on whether the condition was caused by a work injury. Here’s how it works:

• Pre-existing condition due to a previous work injury: If the condition was caused by a work-related injury, you may be entitled to additional workers’ compensation benefits, as it’s considered a work injury that was aggravated or worsened by a new workplace incident.
• Pre-existing condition not related to work: If the pre-existing injury wasn’t caused by a work injury, but has contributed to your current injury, it complicates the situation. In these cases, the employer and their insurance company will likely try to argue that the work-related injury is minimal, and any existing conditions are not their responsibility. This makes it more difficult to prove your case and receive full benefits.

What should I do if I have a pre-existing condition and get injured at work?

Even if you have a pre-existing condition, it’s essential to take the right steps to protect your workers’ compensation claim:

• Seek medical attention immediately: It’s important to see a doctor right away after any workplace injury. Be upfront with the doctor about your pre-existing condition so that they can properly assess how it may have been aggravated or worsened by the work injury. A doctor who is experienced in handling workers’ compensation cases will know what to look for and will document your condition using the correct terminology.
• Report the injury to your employer: Report the injury to your employer as soon as possible, even if you think your pre-existing condition is playing a role in your injury. Failure to report the injury within the required time frame can result in a denied claim. Please note that there are statutes of limitation that apply to lawsuits and claims, and the longer you wait, the more difficult it can be to plead your case.
• Maintain documentation: Keep all medical records, treatments, and communications related to both your pre-existing condition and your work injury. This includes any physical therapy, diagnostic tests, or doctor visits. This documentation will be crucial if your claim is challenged or if you need to prove that your pre-existing condition was aggravated by the work injury.
• Work with an experienced attorney: Dealing with workers’ compensation claims involving pre-existing conditions can be complex. An experienced workers’ compensation lawyer can help you navigate the system, ensure that your rights are protected, and help you get the compensation you deserve, all while being mindful of the statute of limitations on your claim.

Reinhardt | Harper | Davis has secured the seven largest workers’ compensation settlements in Virginia history, with 185 law firms referring their workers’ compensation claims to us. If you’ve been injured at work and have a pre-existing condition, don’t hesitate to reach out to an attorney for guidance. Reinhardt | Harper | Davis is here to help you understand your rights and fight for the compensation you deserve. For a free case evaluation, call us today at 1-800-359-5500. Or reach out to us online. We are here to help.[/vc_column_text][/vc_column][/vc_row]