A preexisting condition is not automatically a bar from recovery in a workers’ compensation claim, however it can seriously complicate the process. The major issue arises in proving that the workers’ compensation claim is for a re-injury of an existing one, rather than an attempt to claim an existing injury as having occurred at work.
Unfortunately, due to this legal caveat, many workers’ compensation insurance companies have begun to make a habit of aggressively claiming that re-injuries are in fact merely existing previous ones for the purposes of saving money on paying out claims. And, due to the fraud potential these sort of injuries bring with them, even good-actor insurance companies now very thoroughly research a claimant’s medical history for indications of any potential insurance frauds. Your employer is only responsible for the worsening of a preexisting condition, and thus both they and their insurance company also may try to claim that your re-injury did not actually increase the severity of the underlying problem.
Steps To Take
With any workplace accident it is in an employee’s best interest to report the incident as soon as possible, and in the event of a re-injury of an existing issue this becomes even more critical. It is illegal for an employer to retaliate against an employee for attempting to file a workers’ compensation claim, so you should not be penalized for this, and if you are it is potentially the grounds for additional legal action.
Document everything as quickly and thoroughly as possible. If there are witnesses to the accident, be sure to make note of them; this can be helpful if your case ends up in court, and will help prove that an injury actually occurred.
Be sure to point out to your doctor if any pain or other sensations you are experience differ from your baseline physical state. It is helpful to be clear that what you are feeling isn’t the typical aches and pains from an old injury, but is something new. Not only is this important to have on record, but it will also help them to diagnose and treat your injuries. There is a very good chance in these types of cases that you will be required to see multiple doctors; besides the one of your choosing you will also likely need to see one picked out by the workers’ compensation insurance company, and if their doctor disagrees with your doctor you will probably have to go for a third opinion from an impartial physician or specialist selected by the insurance company and your attorney.
Some jurisdictions also implement a legal theory called “apportionment”, where the costs of treating a re-injury of a preexisting condition is divided amongst additional parties. In these cases previous employers, government funds, or the patient themselves are responsible for part of the medical expenses based on the percentage of additional harm that the re-injury caused. When this occurs it is critical to have an experienced attorney represent you: the negotiations are complex, and often medically technical, and thus are best handled by someone who has professional experience in these matters in order to get a favorable outcome for the injured worker.
Workers’ Compensation Attorneys
Even in simple workers’ compensation claims it is often advisable to have experienced legal representation, and when a preexisting condition is a factor this becomes more important still. Quick action in retaining legal counsel is in your best interests, so if you have been hurt at work contact an experienced workers’ compensation attorney today.