Do Pre-Existing Conditions Affect My Workers Comp Claim?

It’s common for a worker to have a pre-existing condition of some type when they’re injured in an accident at work. While a pre-existing condition doesn’t disqualify you or someone else from receiving worker’s compensation benefits, some insurers will deny a workers’ compensation claim if the person has a pre-existing condition.

Below, we’ll discuss what’s considered a pre-existing condition injury, how pre-existing conditions affect a claim, how to prove that an injury has aggravated a pre-existing condition, and what you can do to help your case.

What Is Considered a Pre-Existing Injury?

A pre-existing injury is an injury that you had before you have a new healthcare plan and is something you have previously received medical care or diagnosis for before entering into the new health plan. These injuries and conditions can be short-term, long-term, or chronic. Examples of pre-existing conditions and injuries include:

  • Arthritis
  • A knee injury or other joint injuries
  • Torn ligaments
  • Degeneration of the spine
  • Fractures

How Do Pre-Existing Health Conditions Affect a Claim?

There are two ways in which a pre-existing condition affects a claim for workers compensation benefits. One way is when a pre-existing medical condition aggravates an injury from work. The other way is if the work injury aggravates a pre-existing condition. The liability shifts depending on if the pre-existing condition happened with a current employer, a previous employer, or occurred in the worker’s personal life.

Before the Affordable Care Act went into effect, insurance companies could deny you coverage if they decided that you had a pre-existing condition. If they didn’t deny you for having a preexisting condition, then they would offer coverage at far higher rates. Once the Affordable Care Act passed, it became illegal for insurance companies to raise rates, offer coverage at inflated rates, or even deny coverage due to a pre-existing condition or injury.

How to Prove an Aggravation of a Pre-Existing Condition

When it comes to a work-related aggravating preexisting condition, the rules vary between states. Some states allow employees to receive benefits for aggravated preexisting injuries, while others deny benefits when they have an aggravated pre-existing injury.

What You Should Do to Help Your Injury Case

When you live with a pre-existing injury, there are a few steps you should take, regardless of the cause of the work-related injury, to help your case. This is because workers’ compensation insurance companies will use any opportunity they can to either deny your claim or reduce the amount of benefits you’ll receive.

Report Your Injury Immediately

The first thing you should do is inform your employer about your injury as soon as possible. The longer you delay reporting your injury, the more likely the insurance companies will believe that your injury isn’t as serious as you’re claiming. Some states have longer deadlines to notify your employee and file a claim, while others have short deadlines.

Consult a Doctor and Follow Medical Requests

When you see a doctor for medical treatment for your work-related injury, you should also give them the important details about your medical history. The insurance company you contact will make specific medical requests, and you must follow those requests.

Hire a Workers’ Comp Attorney

You may find that filing a workers’ compensation claim for a workplace injury when you also have a pre-existing condition is complex. It’s important to file in a way that insurance companies won’t automatically deny your claim based on your preexisting medical condition. That’s where a workers’ compensation attorney comes in handy.

If you’ve been in an accident at work and you have a pre-existing injury, don’t hesitate to reach out to someone who knows Colorado workers’ compensation law intimately and will fight for you. Contact us today to have someone on your side who will do whatever we can to maximize the benefits and compensation you receive.