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How could a pre-existing condition impact compensation?

| Jan 4, 2021 | Workers' Compensation

After suffering an injury on the job, most workers know that they can file for workers’ compensation benefits to help support them while they recover in such a stressful time.

However, the Centers for Medicare and Medicaid Services suggests that roughly one in two Americans deals with pre-existing conditions. It is understandable that many injured workers might worry about how their pre-existing conditions might affect their claim.

They can impact a worker’s claim – but what does that entail?

First, it is critical to note that workers are often still entitled to collect workers’ compensation if they meet the requirements that make them eligible (Maryland Code, Labor & Employment §9-501). This generally applies regardless of a worker’s health conditions before suffering an injury on the job.

If a pre-existing condition is aggravated or made worse by a work injury or work exposure, the injured worker is entitled to Worker’s Compensation benefits. So long as an injury is partially related to the work accident, the Employer/Insurer is responsible for the entirety of the treatment. By law, the payment of medical care cannot be apportioned, or split up, between the Employer/Insurer and the injured worker.

  1. Examples of pre-existing conditions aggravated at work include: Injured worker is of advanced age and has arthritis in their knee. However, after lifting a heavy object on the job, feels a pop, and is diagnosed with a torn ligament. A need for surgery may be the responsibility of the Employer/Insurer.
  2. Injured previously suffered a back injury and required surgery. While working for the employer, the worker falls off of a ladder and experiences worsening back pain. The fact that the worker has developed new symptoms likely indicates the claim would be compensable and the employer and its insurer would be responsible for additional medical care.

An employer’s insurance company often challenges claims involving pre-existing conditions arguing that any need for medical care is solely related to the pre-existing condition. Such conditions might complicate the process, but that does not mean injured workers should not recover the compensation they deserve.

Can workers avoid these issues?

Obtaining workers’ compensation benefits can already seem like a complex process. Additional challenges from a pre-existing condition might be frustrating. However, workers can take steps to reduce these issues.

It can help if workers keep detailed documentation of:

  • Their pre-existing condition, including their medical records and past treatments
  • A copy of the report to their employer about the incident or work injury
  • A record of their pain and symptoms from the new work injury

Having a record on hand can provide critical information for an injured worker to clarify how the new accident aggravated their pre-existing condition. However, even with clarification, it is always beneficial to obtain counsel to ensure the worker’s rights are protected.

  • AABA