Can I get workers’ compensation if I had a pre-existing medical condition when I was injured?
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UPDATED: Jun 19, 2018
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In general, having a pre-existing condition will not prevent you from receiving workers comp. However, proving the cause of your injury – or re-injury, as it were – will be even more important than it is for other types of workers comp claims. Workers compensation insurance is only available for injuries that are sustained on the job and/or in the performance of one’s job-related duties. You will need to gather all the evidence you can – and as quickly as you can – that tends to show that the cause of your injury was work-related, rather than condition-related.
Workers Comp Claims and Re-Injury
In many ways, workers compensation insurance is just like your auto accident insurance. If an accident occurs, and the accident meets certain requirements, then you are entitled to have the insurance company pay out for the costs of that accident. While one payout “requirement” for car insurance is that the vehicle must not have been stolen, one payout requirement for workers comp insurance is that the cause of your injury must be job-related. If you have a preexisting condition, you can count on the workers comp carrier claiming that the cause of your re-injury was that condition instead. You have to be ready to demonstrate your side of things.
You can increase the likelihood of your side prevailing if you have witnesses to the accident, take detailed notes of what happened (if you can), and report the work-related injury to your employer as soon as possible after it occurs.
Importance of the Medical Exam
As you can imagine, both you and the insurance carrier will want a doctor’s opinion on your side. In fact, you may want several doctors’ opinions. If your doctor and your employer’s doctor disagree, then you or, more likely, the workers comp insurance carrier, will probably request an independent medical exam (IME) in order to have a 3rd-party doctor add his or her opinion. IMEs are rarely binding, but the written reports that come from them are often the deciding factor in convincing a workers comp board of the true cause of a re-injury. The laws of your particular state will have more information on the role of an IME.
Remember, none of this is to say that your pre-existing medical condition cannot play any role. In fact, if a pre-existing medical condition becomes aggravated, accelerated or exacerbated due to a work-related injury, then the workers’ compensation carrier is usually responsible for the cost of the increased disability, including medical treatment.
Pre-Existing Conditions, Re-Injuries, and the Law
If you sustain a work-related injury to a part of your body that was previously injured, then you will not be automatically barred from recovery under any state’s workers’ compensation system. This is true regardless of whether the previous injury was work-related or not. Similarly, if you are in an accident which aggravates or accelerates a pre-existing physical condition, such as arthritis, a back condition or a prior surgery, you are still entitled to all the rights and benefits provided by the workers’ comp law in your state.