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Preexisting Conditions and Workers’ Compensation: A Complicated Relationship

Preexisting conditions have long been a problem in the insurance industry, and are only starting to become widely accepted instead of viewed as grounds for coverage denial. People with conditions were being denied treatment that they needed, while the insurance companies wanted to avoid accepting policies that would knowingly include regular payouts. It was a battle in which no winner could be crowned.

Fortunately, insurance companies are learning how to handle preexisting conditions, so many people that were previously denied coverage can enjoy medical care. One insurance claim that remains rocky, however, is the relationship between preexisting conditions and workers’ compensation claims.

When Your Preexisting Condition and Workplace Injury Meet

When you are injured or not operating at 100 percent, the odds for further injuries are greatly increased. That is why it is not uncommon for old injuries to be reinjured and cause chronic problems. As insurers, it is easy to be wary of preexisting conditions as they relate to new workplace injuries—as the workers’ compensation coverage is only meant to cover injuries cause in the scope of employment.

Say that you broke your hip shoveling your driveway a few years ago. While you were able to return to work and perform your duties with no difficulty, you continued to experience some pain in your hip and back that causes you to return to the doctor once in a while. Last week, you slipped in the hallway at work and broke the same hip, which put you out of work for a few weeks and required minor surgery.

In this scenario, you are still likely to receive workers’ compensation benefits, but the benefits will only cover the amount of damage that the latest injury caused. This can be a difficult amount to determine, but a doctor that is experienced with workers’ compensation claims can provide a proper assessment.

If, instead, your old hip problems were the result of a previous workplace injury and workers’ compensation claim, you will also be able to receive workers’ compensation benefits. If you were awarded money based on permanent impairment previously, however, your new impairment award will be adjusted to include your previous award. This system prevents those who were previously awarded from “double dipping” their awards for the same injury.

For preexisting conditions that are totally unrelated to your new injury, your workers’ compensation claim should not be affected at all. Despite this common sense approach, however, the workers’ compensation insurance company may still give you grief.

Do Not Allow Your Workers’ Compensation Claim to Be Denied Based on a Preexisting Condition

If you have been injured at work and already cope with a preexisting condition, you may be in for an uphill battle with your workers’ compensation claim. To protect your rights and ensure that you receive the maximum compensation for your new injuries, you should consider hiring an attorney that is well-versed in Pennsylvania workers’ compensation laws.

If you would like to discuss your case with an attorney, schedule a free consultation with us today by calling one of our offices or clicking on the live chat feature.

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