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Workers Compensation: Pre-Existing Conditions

At Bader Scott Injury Lawyers, we routinely get calls from injured workers who’ve been denied Georgia workers’ compensation based on a pre-existing condition. It’s a relatively common excuse some insurers use to deny injured employees their benefits. Here’s an important fact that all injured employees need to know: Having a pre-existing condition does not disqualify you for workers’ compensation benefits.

How Workers’ Compensation Views Pre-existing Conditions

You may claim workers’ compensation benefits on the basis that your work conditions or a work accident aggravated a pre-existing condition.
For instance, let’s say years ago you suffered a back injury in a car accident. You received treatment and the injury healed. But then you get a job in a warehouse where you’re required to lift heavy boxes. If you aggravate your pre-existing condition because of your work tasks – lifting heavy boxes – then you may qualify for workers’ compensation even though you suffered a back injury in the past.

When a Pre-existing Condition  CanPrevent You from Receiving Workers’ Compensation

There is a scenario where a pre-existing condition can prevent you from receiving workers’ compensation benefits. Let’s say your employer asked about any previous injuries when you were hired. If you were truthful about your previous back injury, then you may still be entitled to workers’ compensation benefits.
But if you intentionally misrepresented your previous injury – you said, “No, I have not suffered any previous back injuries” – then the employer may deny your claim. That’s why it’s important to be truthful if a potential employer asks you about any pre-existing conditions when you’re hired.

Examples of Pre-Existing Conditions

Having a pre-existing condition can be tough – you’ve already gone through the pain of that pre-existing injury, and pain from the injury may even linger with you still. When a pre-existing injury or illness is exacerbated, aggravated, or re-injured by performing your job duties, or by a workplace accident, you may be entitled to workers’ compensation benefits. A few examples of common pre-existing conditions that become aggravated or re-injured by work include:

  • Back injuries;
  • Degenerative disc disease;
  • Arthritis;
  • Joint injuries; and
  • Old sports injuries.

A pre-existing condition could also cause a worker to suffer a workplace injury, and workers’ compensation claims based on these types of pre-existing conditions cannot be denied arbitrarily either. A few examples of pre-existing conditions that could cause workplace injuries include:

  • A worker who has the pre-existing condition of epilepsy could suffer a seizure while at work. The worker could fall to the ground and injure him or herself, or could knock something over that causes injury. Injuries resulting from a seizure are covered by workers’ compensation insurance.

 

  • A worker could have diabetes or another health condition that could trigger serious harm to the worker if the worker becomes overheated, dehydrated, or suffers through a period of low blood sugar, as a result of their job. Injuries that are the byproduct of the worker’s pre-existing condition and a work-related trigger for that condition could make a worker eligible for workers’ compensation benefits.

When a Preexisting Condition Matters

Any preexisting condition is cause for concern. It is therefore extremely important that you make sure to inform doctors and medical professionals about the old and new injuries at the time of treatment. You certainly don’t want to have a claim denied because you failed to properly handle a claim. For this reason it is advisable to have an Atlanta workers’ compensation attorney represent you throughout the claim process.
A preexisting condition is only considered part of a workers’ compensation case for as long as the condition continues to be impacted by the new injury. If the new injury is no longer an aggravating factor for the condition it will no longer be covered as part of a workers’ compensation claim. The medical examinations and reports will be of utmost importance for the purpose of determining whether an injury is covered by the claim.

 

When Can a Workers’ Compensation Claim Be Denied Based on a Pre-existing Condition?

There are certain situations where a worker’s workers’ compensation might be denied, based on the pre-existing condition, but these denials have to do with the worker, rather than the employer. For instance, a worker who lies or is misleading about a pre-existing condition could be denied workers’ compensation benefits. Many employers ask workers at the time of hiring if the worker has any injuries or conditions that the employer should know about. Since the worker had an opportunity to disclose to their employer any pre-existing conditions, and the worker either refrained from disclosure, lied or mislead the employer, any workers’ compensation claim that might arise from the worker’s undisclosed pre-existing condition, could be denied.

Similarly, a worker who works despite their doctor’s orders and becomes injured on the job may be rendered ineligible as well. For instance, if a worker suffers a knee injury (either on their own time or work time) and the doctor instructs the worker to stay away from work, and to not put undue stress on the knee, the worker could be ineligible for workers’ compensation benefits if he or she is injured on the job. Worker’s cannot disregard their doctor’s orders.

When Do Benefits Stop?

When an injured worker is recovering from a re-injury or aggravation of a pre-existing condition, the worker will receive workers’ compensation benefits until the worker recovers to the state they were in before the re-injury or aggravation occurred. The worker will not receive benefits if they are trying to further recover from the pre-existing condition or injury. To think of this another way, the worker is only eligible for workers’ compensation benefits until he or she returns to their pre-existing condition baseline from before the reinjury, or aggravation of the pre-existing condition.

Need Help With Your Workers’ Compensation Claim? Call Bader Scott Injury Lawyers

If you filed your claim and the insurer wrongly denied it on the basis of a pre-existing condition, you have the right to fight the decision. However, these cases are complicated. So, it would be in your best interest to discuss the details of your claim with an experienced workers’ compensation attorney in Atlanta. Contact Bader Scott Injury Lawyers, today at 678-562-5595. We can help you gather supportive documents so that you can get the benefits you deserve.

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