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How to Handle Pre-Existing Conditions and Workers’ Compensation Claims?

The Downingtown Workers' Compensation Lawyers at Wusinich, Sweeney & Ryan, LLC Offer Free Consultations

A pre-existing condition is a health issue or medical problem that an individual had before starting a new job or filing a workers’ compensation claim. These conditions range from chronic illnesses like diabetes to previous injuries like back problems. How are they handled with workers’ compensation claims?

How Do Pre-Existing Conditions Affect Workers’ Compensation Claims?

Pre-existing conditions can impact workers’ compensation claims, but they do not automatically disqualify you from receiving benefits. The key is whether the work-related incident worsened the pre-existing condition.

If a workplace accident or occupational exposure negatively affects a pre-existing condition, you may be eligible for workers’ compensation benefits for the additional harm caused by the work-related event.

What Is the “Aggravation Rule” in Workers’ Compensation?

This legal principle allows employees to receive workers’ compensation benefits when a work-related incident worsens a pre-existing condition. Under this rule, if a workplace accident or occupational exposure aggravates or accelerates a pre-existing condition, making it symptomatic or more severe, the resulting disability may be compensable.

How Should Employees Disclose Pre-Existing Conditions?

Employees should be honest and upfront about their pre-existing conditions when filing workers’ compensation claims. Failing to disclose relevant medical history can harm the credibility of the claim and lead to a denial of benefits.

When reporting a work-related injury or illness, you should:

  • Provide a complete and accurate medical history.
  • Explain how the work incident affected your pre-existing condition.
  • Describe new symptoms and increased pain levels.
  • Submit all relevant medical records and documentation.

Transparency in this process helps establish a clear connection between the work-related incident and the aggravation of the pre-existing condition.

What Evidence Is Needed to Support a Claim Involving a Pre-Existing Condition?

Supporting a workers’ compensation claim involving a pre-existing condition requires strong medical evidence. The following pieces of evidence could be used to demonstrate that the work-related incident caused a measurable worsening of the pre-existing condition:

  • Medical records documenting the pre-existing condition before the work incident.
  • Diagnostic tests showing changes in the condition after the work-related event.
  • Expert medical opinions explaining how the work incident aggravated the condition.
  • Detailed descriptions of new symptoms or increased limitations.
  • Comparative analysis of the employee’s ability to work before and after the incident.

How Do Employers and Insurance Companies Evaluate These Claims?

Employers and workers’ compensation insurance carriers carefully scrutinize these claims and may request independent medical examinations or reviews of medical records. They often seek to determine whether the current symptoms and limitations are solely due to the natural progression of the pre-existing condition or if a work-related incident truly caused additional harm.

What Are the Challenges in Proving Aggravation of a Pre-Existing Condition?

Proving that a work-related incident aggravated a pre-existing condition can be challenging, with these common obstacles:

  • Distinguishing between natural progression and work-related aggravation.
  • Obtaining clear medical opinions on causation.
  • Overcoming skepticism from insurance adjusters.
  • Addressing gaps in medical treatment or documentation.
  • Demonstrating the extent of additional disability caused by the work incident.

Can an Employee Receive Benefits for Treatment of a Pre-Existing Condition?

An employee may receive workers’ compensation benefits for treatment of a pre-existing condition if it was aggravated by a work-related incident. However, the benefits typically cover only the treatment necessary to address the additional problems caused by the work event. The employer is not responsible for medical care related to the pre-existing condition that would have been necessary regardless of the work incident.

The Downingtown Workers’ Compensation Lawyers at Wusinich, Sweeney & Ryan, LLC Offer Free Consultations

Professional legal guidance can be beneficial if you are dealing with a workers’ compensation claim involving a pre-existing condition. Contact the Downingtown workers’ compensation lawyers at Wusinich, Sweeney & Ryan, LLC for a free consultation today. Simply complete our online form or call our Exton, Pennsylvania, office at 610-594-1600. Our coverage area includes Downingtown, West Chester, Exton, Coatesville, Phoenixville, Malvern, Lyndell, Wagontown, Uwchlan Township, Parkesburg, Chester Springs, Lancaster County, Reading, and Morgantown.