Types of Prior or Aggravated Conditions Covered by Workers' Compensation
Workers’ compensation is intended to cover an employee’s lost income and treatment costs for injuries suffered in the workplace. In general, a work injury is compensable as long as it is the primary cause of the employee’s medical bills and lost time from work.
Injuries That Might Be Compensated
- A re-injury. Re-injury occurs when an employee was previously hurt while performing their job duties and is later hurt a second time with the same injury. For example, if you received benefits for a back injury two years ago, you can collect workers’ compensation if you hurt your back at work again. However, the amount of benefits may be adjusted depending on the details of your previous claim.
- Aggravation of an old injury. Aggravation injuries occur when an employee’s work activities cause more significant pain or disability to a pre-existing condition. Coverage would likely depend on whether treatment costs are related to the new or old injury. For example, say you dislocated your shoulder several years ago, weakening the arm and contributing to a lifting injury at work. In that case, workers’ compensation may pay to repair a torn ligament, but it will likely not cover surgery to prevent future dislocation.
- Pre-existing conditions that worsen on the job. Some employees are at greater risk of occupational diseases due to their medical histories or past illnesses. For example, someone with asthma may need breathing treatments or hospitalization after exposure to certain chemicals. Workers’ compensation should cover any conditions the employee’s workplace accelerates or aggravates.
- Injuries resulting from work-related stress. Employees who develop PTSD symptoms or disabling mental conditions due to job demands, workplace harassment, or increased work duties could collect workers’ compensation.
Previous Injuries Can Complicate Your Workers’ Compensation Claim
While collecting workers’ compensation benefits for a pre-existing injury is possible, your claim is more likely to be challenged by the insurance company. Insurers only keep their profits if they pay as little as possible on all claims, and they definitely don’t want to pay for injuries unrelated to the workplace.
Insurance Company Arguments Involving Pre-Existing Conditions
- The work accident wasn’t the only cause of your symptoms
- The injury was caused by gradual wear and tear on your body or lifestyle choices (such as smoking)
- You are partly responsible for increased medical costs
- Your failure to follow doctor’s orders or keep medical appointments led to the second injury
Insurance companies have deep pockets and will use any information to their advantage when investigating workers’ compensation cases. For this reason, gathering as much evidence as possible to support your claim is vital. Medical records detailing your initial injury and current condition, notes from any doctors who treated both injuries, pay stubs showing any wages lost as a result, and other relevant documents increase the chances of a swift resolution. Additionally, if there were witnesses present at the time you were injured, it would be beneficial if they could provide testimony in support of your claim.
Let Us Help You Recover After a Work Injury
If you were injured at work and have a pre-existing condition, contact the workers’ compensation attorneys of Mahaney & Pappas, LLP at 508-879-3500, or reach out to us online. We will explain your options at no cost to you, and you will not pay any legal fees unless we secure your benefits.