Does Workers’ Comp Cover Aggravation of a Pre-Existing Condition?

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Insurance companies look for any way that they can to deny workers’ compensation claims.

One of the most frequent reasons that they give for denying your claim is that the injury is not work-related.

However, insurance companies often try to use a stricter definition of what is work-related. If you have aggravated a pre-existing condition on the job, it would be considered a work-related injury. Nonetheless, you may need to fight for your benefits when the insurance company refuses to pay them.

Contact a trusted Philadelphia workers’ compensation lawyer at Gibbons & Crichton when you need legal help for a tough workers’ comp claim.

Pre-existing Conditions that Can be Aggravated on the Job

There are some times when doing your job could make an existing medical condition worse. If you have a physical job, there are many opportunities to injure yourself, especially when you may already be susceptible to getting hurt.

Perhaps the most common example of a pre-existing injury that can be aggravated by work is a degenerative disc condition in your back. The physical strain of standing and lifting heavy objects could cause a strain. The repetitive physical stress of your job alone could either reactivate your back injury or make it worse.

The same thing goes for joint pain. You may already have arthritis that is aggravated by the physical stress of your job. A mild condition can become far worse through the day-to-day wear-and-tear of your position.

You Should Qualify for Benefits if You Aggravated a Pre-Existing Injury

The legal requirement for you to receive workers’ compensation benefits is that you must have suffered a pre-existing injury. In general, the insurance company will not cover a pre-existing condition.

However, that is not the entire story. You could aggravate a prior condition or injury on the job, and you may still qualify for workers’ compensation benefits. The fact that you have a prior condition is not enough on its own to disqualify you without a closer look at the facts.

You have every right to try to earn a living, regardless of what your condition is beforehand. Your employer pays for workers’ compensation insurance that covers all of their employees. None are disqualified because of their prior physical condition. The general rule in a workers’ compensation claim is that employers “take their employee as they find them”.

If you are able to prove that you aggravated the pre-existing injury at work, you could qualify for the following benefits:

  • Temporary partial disability
  • Temporary total disability
  • Permanent partial disability
  • Permanent total disability

Workers’ Compensation Claims Can Be Difficult When Pre-Existing Conditions Are Involved

You can expect that you may have difficulty when your claim involves an injury that aggravated a pre-existing condition. The insurance company will closely review your medical records, and they are likely to deny the initial claim. You can and should anticipate a tougher road ahead of you.

The first thing that you should do is contact an attorney if your injury on the job has aggravated a pre-existing condition. Your lawyer can give you advice that can help you better document your claim. In these cases, your medical records will be key in how your initial claim is considered.

You should also seek medical help immediately after your injury. You should discuss your symptoms with your doctor and explain how your injury now is different from what you have previously encountered.

There is a key distinction to draw here. You are not entitled to coverage for the existing injury.

Your workers’ compensation benefits would only cover the treatment of the aggravation of your pre-existing condition.

For example, if you are suffering from arthritis and you injure the body part that was affected by the arthritis, the workers’ compensation benefits would cover the injury. Your treatment of the underlying condition would not be covered.

How to Protect Your Workers’ Compensation Claim If You Have From Pre-Existing Conditions

You can anticipate a difficult time with your claim. How you act and what you do could determine whether you receive the workers’ compensation benefits that you need. You can make mistakes that could cost you the chance at benefits.

One of the most crucial things that you can do is notify your employer as soon as you feel any type of symptom of your injury. In Pennsylvania, you have 120 days from the time of the injury to give notice to the employer. Otherwise, you would lose the right to receive benefits.

If you have not given notice within 21 days of the injury, you cannot receive benefits until you let your employer know. Make sure to notify your employer in writing so there are no questions.

The other way to protect their claim is to hire an experienced workers’ compensation attorney.

How you present your claim to the insurance company matters. You may want to consider an attorney at the claim filing stage in order to make the most effective case for benefits.

Finally, you should follow all of the treatment recommendations that your doctor makes. If they have prescribed physical therapy, you must go to all appointments and through the entire course of treatment. If not, the insurance company may claim that you are the reason for the injury.

If you’re claiming workers’ compensation with a related pre-existing condition, you can expect that the insurance company would deny your initial claim. You would then have two legal options:

  • You could negotiate a settlement agreement with the insurance company
  • You could appeal your denial to the Workers Compensation Appeals Board

In many cases, the settlement comes after you have filed an appeal. Our attorneys can help you get the highest possible amount of compensation in a settlement, standing up for you to the insurance company.

Contact a Philadelphia Workers’ Attorney to Discuss Your Pre-Existing Conditions

Gibbons & Crichton is here to fight for you when the insurance company makes your claim tougher.

You can discuss your case with us in a free initial consultation and get a complementary, personalized strategy. We can discuss your options and your path forward. To speak with an attorney, you can send us a message through our website or call us today at 215-274-0173.

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