Workplace injuries are, unfortunately, fairly commonplace and can occur in a variety of industries for a variety of reasons. Even occupations that are not inherently physical can result in debilitating physical issues, such as back injuries or carpal tunnel syndrome. When an employee is injured in the scope and course of their job, the workers’ compensation program exists to provide assistance. However, when a worker has a pre-existing condition at the time of injury, the process of filing for and assessing potential benefits can be a bit more complicated.
Pre-Existing Conditions
For workers’ compensation purposes, a pre-existing condition is defined as an injury or medical condition that pre-dates the current condition or injury that is prompting the employee’s claim. Some examples of pre-existing conditions include the following:
- Arthritis
- Degeneration of the spine
- Fractures
- Herniated disks
- Knee injuries
- Strains and/or sprains
How To File a Claim With Pre-Existing Conditions
While a pre-existing injury could impact the workers’ comp claim, it does not preclude an employee from receiving benefits. There are a number of steps that employees can take to strengthen their workers’ comp claim when a pre-existing condition is an issue.
Prompt Claim Filing
The first hours and days following a workplace injury are important for the employee to notify the employer, complete the relevant paperwork, and file it appropriately. Most states require that claims be filed within 90 days of the occurrence. Insurance companies tend to view hesitancy in reporting as a signal that the injury may not be serious.
Physician Consultation
Employees should contact their medical provider immediately after the occurrence of a workplace injury, providing specifics about the impacted bodily areas and details about how the injury has aggravated any pre-existing condition. Providing the doctor with a description of differences between the current injury and previous injury will help to differentiate between the two conditions and highlight the effects of the more recent incident. This description should include any discomfort, pain, or limitations that exist due to the previous injury and any changes in duration, intensity, frequency, or location of pain as a reuslt of the workplace injury.
Compliance With Medical Requests
The workers’ comp process will likely include a number of requests by the insurance company that employees are required to complete. Insurers may ask an employee to undergo an independent medical examination as part of a workers’ comp claim. They may also request additional medical documentation relating to the pre-existing condition. Employees are also expected to comply with any medical prescriptions, including physical therapy and follow-up appointments.
State laws in regard to workplace injuries that worsen pre-existing conditions vary throughout the country. While some allow recovery of benefits when a job-related injury aggravates an existing injury, others deny claims if the existing condition was not incurred as a part of the job.
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