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The Impact Of Pre-existing Conditions On Workers’ Comp Claims

  • Jan 29 2024

Workers’ compensation claims can become trickier when pre-existing medical conditions are involved. Many individuals wonder how their prior health issues may influence their eligibility for benefits. If you’re having difficulty proving that your current health condition is a result of a workplace injury or occupational disease, then a work accident attorney can help you appeal any denial or minimization of your claim. Our friends from Rispoli & Borneo P.C. are taking a deeper look a the impact of pre-existing conditions on your workers’ comp claims.

Understanding Pre-existing Conditions

A pre-existing condition refers to any health issue or injury that an individual had before the workplace accident occurred. It could range from chronic illnesses and previous injuries to ongoing medical treatments. In workers’ compensation cases, the presence of pre-existing conditions can make the evaluation of injuries and the determination of benefits more difficult.

How Pre-existing Conditions Affect Workers’ Compensation Claims

Pre-existing conditions can affect your claim in the following ways:

  • Aggravation of Pre-existing Conditions: If a workplace accident exacerbates a pre-existing condition or injury, the injured worker may still be eligible for workers’ compensation benefits. The key is establishing a clear link between the current workplace injury and the worsening of the pre-existing condition.
  • Determining Compensability: Whether the worker receives compensation hinges on whether the workplace accident is a substantial contributing factor to the injury or condition. If the work-related incident is the primary cause of the current health issues, the claim is likely to be deemed compensable.
  • Apportionment of Benefits: In cases where a pre-existing condition is a contributing factor to the overall disability, the workers’ compensation benefits may be apportioned. This means that the benefits awarded will reflect the extent to which the workplace injury is responsible for the disability.

Proving Causation

Successfully navigating a workers’ compensation claim involving pre-existing conditions often relies on establishing a clear cause-and-effect relationship between the workplace accident and the current injuries. Here are essential steps to consider:

  • Prompt Reporting: Report the workplace accident promptly, providing detailed information about the incident and any pre-existing conditions to your employer.
  • Medical Documentation: Seek immediate medical attention and ensure that healthcare providers thoroughly document the connection between the workplace incident and the exacerbation of pre-existing conditions.
  • Expert Medical Opinions: Consulting with medical experts who can testify to the causation and extent of the injuries can strengthen your case. Their professional opinions carry weight in demonstrating the impact of the workplace accident on pre-existing conditions.

Seeking Legal Counsel

Given the nuanced nature of workers’ compensation claims involving pre-existing conditions, seeking the guidance of an experienced workers’ compensation attorney is crucial. An attorney can help:

  • Interpret Laws and Regulations: Workers’ compensation laws vary by jurisdiction. An attorney can help interpret the specific regulations that apply to your case.
  • Build a Strong Case: Your attorney can assist in gathering evidence, obtaining medical records, and presenting a compelling case that demonstrates the link between the workplace accident and the aggravation of pre-existing conditions.
  • Negotiate with Insurers: If necessary, your attorney can negotiate with insurers to ensure fair compensation and advocate for your rights throughout the claims process.

While pre-existing conditions can complicate workers’ compensation claims, they do not automatically disqualify individuals from receiving benefits. It’s crucial to navigate these cases carefully, with thorough documentation and legal guidance, to ensure that workers receive the compensation they deserve for injuries sustained on the job.

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