22 Mar

Navigating Workers’ Compensation Claims Involving Pre-Existing Conditions

Written by admin
Category
Worker's Compensation

The primary purpose of the workers’ compensation system is to offer benefits to workers who sustain injuries while performing their job duties. Although some occupations may not be as physically demanding as others, they can still result in severe injuries such as back injuries and broken bones.

When an employee is injured on the job, they are entitled to receive workers' compensation benefits to cover their medical expenses and lost wages. However, pre-existing conditions can complicate matters when determining the extent of the injury and the benefits to which the employee is entitled.

What Are Pre-existing Conditions?

A pre-existing condition in cases of workers’ compensation constitutes a medical condition that existed before the employee's employment. Furthermore, it can be a physical or mental condition. For example, if an employee has a pre-existing back injury and then injures their back on the job, it can be difficult to determine whether the pre-existing condition or the work-related incident caused the damage.

Types of Pre-existing Injuries or Conditions:

Previously Broken Bones
Chronic Back or Neck Pain
Traumatic Brain Injury, Strain, and Sprains
History of Concussion
Herniated Disc

Arguing for Pre-existing Conditions in a Workers’ Compensation Claim

Insurance companies often use pre-existing conditions to deny claims or reduce benefits in workers’ compensation cases. Insurance companies may argue that the employee's pre-existing condition was the primary cause of the injury, and therefore, they are not responsible for covering the costs. However, it is essential to note that pre-existing conditions do not necessarily disqualify an employee from receiving workers' compensation benefits.

Employers and insurance companies must cover the full extent of the work-related injury, even if a pre-existing condition aggravated it. For example, if an employee had a pre-existing back injury and then injured their back on the job, the employer and insurance company would be responsible for covering the total cost of the injury, including any additional medical treatment needed as a result of the work-related incident.

If an employee has a pre-existing condition, it is also essential for them to seek medical treatment as soon as possible after a work-related injury occurs. This can help establish the extent of the damage and the role the pre-existing condition played in the injury. Employees must disclose all pre-existing conditions to their employer and doctor as soon as possible after a work-related injury occurs. Failure to disclose a pre-existing condition could result in denying a workers' compensation claim.

Employers can also take steps to protect themselves and their employees regarding pre-existing conditions. One way is to implement a pre-employment physical examination for all new employees. This helps to identify any pre-existing conditions that could complicate a workers' compensation claim.

Another way to protect against pre-existing conditions is to implement a safety program that addresses the specific needs of employees with pre-existing conditions. For example, suppose an employee has a pre-existing back injury. In that case, the employer could provide additional training on safe lifting techniques and ergonomic workstations to help prevent the aggravation of the injury.

What Happens if Pre-existing Conditions Aren’t Covered?

In some cases, workers who suffer work-related injuries that worsen a pre-existing condition may have their benefits denied by the workers' compensation insurance company. However, insurance companies cannot refuse to pay benefits based solely for this reason. Therefore, negotiations between the injured worker's attorney and the insurance company are typically necessary to resolve the issue and reach a settlement agreement for workers' compensation benefits. According to an article in Justia, despite the dispute, the insurance company is still obligated to provide compensation for the employee's medical expenses, treatment, and future medical care.

In situations where there is disagreement over the nature and severity of the injury, the insurance company can ask for a Qualified Medical Examination or Agreed Medical Examination. A neutral third-party medical provider will then assess the worker to determine the extent of the injury and the relationship between the worker's symptoms and the pre-existing condition.

Pre-existing conditions can complicate workers' compensation claims but do not necessarily disqualify an employee from receiving benefits. Employees need to disclose any pre-existing conditions and seek medical treatment as soon as possible after a work-related injury occurs. Employers can also protect themselves and their employees by implementing pre-employment physical examinations and safety programs tailored to the needs of employees with pre-existing conditions. By working together, employers and employees can ensure that workers' compensation claims are handled fairly and accurately, regardless of pre-existing conditions.

At Carrillo Injury Law, we work alongside you to determine the best legal options for your situation. Schedule a free consultation today by calling 352-371-4000 or emailing us at office@carrilloinjurylaw.com.