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Does Having a Pre-Existing Condition Affect My Workers’ Compensation Claim?

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If you suffer an injury or illness due to your job, you may be eligible for workers’ compensation. These benefits provide funding for medical expenses and lost income while you recover from your condition. However, you must satisfy a series of eligibility requirements to qualify for workers’ compensation. If you have a pre-existing illness or condition, receiving these benefits can become complicated.

Unrelated Pre-Existing Conditions

If your pre-existing condition is not related to the claim you are filing, you likely will not face any issues. Your pre-existing heart disease, for example, will not affect a claim for a knee injury. You may need to see multiple providers for the pre-existing condition and the workplace injury. While complicated, multiple insurance pathways will keep your out-of-pocket costs low.

However, if your job function aggravates your unrelated pre-existing condition, you could seek additional compensation. For example, if you suffered a back injury during an unrelated car accident, you could aggravate the condition by performing heavy lifting functions at work.

You will have to meet additional eligibility requirements depending on your state. In some areas, you can only receive workers’ compensation benefits related to the aggravation, not the pre-existing condition itself. You will need to visit a doctor to evaluate your injury and determine if your job caused aggravation, if the condition is worsening, and what treatment you will need to seek.

Workplace-Caused Pre-Existing Conditions

If a workplace accident caused a similar injury previously and you claimed workers’ compensation for that incident as well, you may see reduced benefits. Your employer will still pay your medical expenses for the new injury, but you may see a reduction in your permanent disability benefits. However, your employer will still pay temporary disability benefits if you cannot work.

You can only receive compensation for an increase in disability at the end of your claim. For example, if your doctor examines your injury and states that you could receive $15,000 in permanent disability benefits and you received a $7,000 permanent disability award in the past, you will only receive $8,000. If your doctor does not notice an increase in disability, you will not receive any award.

California-Specific Rules for Pre-Existing Conditions

According to the California requirements for workers’ compensation benefits, the state considers aggravated pre-existing conditions as separate injuries. As a result, California will not limit your potential benefits to the specific instance of aggravation.

Under California law, an aggravated pre-existing condition must satisfy one of the following factors.

  • The aggravated injury must cause a temporary or permanent disability increase.
  • The aggravated injury must create a need for additional medical treatment or a new treatment plan altogether.
  • The aggravated injury must change the existing course of treatment.

With a new workers’ compensation claim, you can seek funding for medical expenses related to your aggravated injury, as well as temporary and permanent disability benefits. You will need to visit a physician and receive a medical report to prove these claims.

However, flare-ups or recurrences for pre-existing conditions are not a new injury under California law. These are known as exacerbations. If your current employer did not cause the injury originally, you cannot seek benefits for a pre-existing condition exacerbation.

Discuss Your Workers’ Compensation Claim With a Lawyer

If you are unsure if your aggravated pre-existing condition qualifies for workers’ compensation benefits or if the condition will affect your claim, contact a workers’ compensation attorney in Orange County. These cases can be quite complex, and you want to ensure your employer honors your rights as an employee. Hiring an attorney early on will help facilitate your claim process.