How Do Pre-Existing Conditions Affect Workers Compensation Benefits?

 Posted on October 29,2021 in Workers' Compensation

Anyone who has made an insurance claim is most likely familiar with the ways that a pre-existing condition can affect a case. Insurance companies may attempt to deny coverage because a person has previous injuries or existing health issues. This issue can also play a role in cases involving workers’ compensation insurance. An employer or their insurer may attempt to deny a claim by stating that a person’s injuries were not work-related but caused by a pre-existing condition. Injured workers will want to understand how to address these types of issues, and when they can make a workers’ comp claim based on the aggravation of a pre-existing condition.

Determining Whether an Injury Is Work-Related

Employees can receive workers’ compensation benefits for any injuries or illnesses that occurred due to the work they performed for an employer. In some cases, an employer or their insurer may claim that an injury occurred because of a person’s existing injuries or health issues rather than anything related to the work they performed. However, an injury or illness can only be considered a pre-existing condition if it was solely caused by an event that was not work-related or if it occurred outside of the work environment. If an injury or illness was partially caused by a pre-existing condition, the workers’ comp benefits a person can receive may be reduced based on the percentage of the injury that was related to their existing health issues.

Is an Aggravation of a Pre-existing Condition a New Injury?

If a workplace accident, an occupational illness, or the work a person performs causes a person’s existing injuries or health issues to become worse, they may qualify for workers’ compensation benefits. Typically, benefits will be available if the aggravation of a pre-existing condition is considered to be a new injury that occurred because of the work a person has performed. In general, a new injury must have led to temporary or permanent disabilities that are more serious than what a person had previously experienced, or new forms of medical treatment or changes to a person’s current treatment plan must be necessary to address the aggravation of a person’s condition.

Contact Our Gilroy Workers’ Comp Lawyers for Pre-Existing Conditions

If you need to determine how existing health issues will affect your ability to receive workers’ comp benefits, Cramer + Martinez can review your case and help you understand your rights. We will work with you to file a workers’ compensation claim or address the denial of benefits by an employer or insurer. We will help you pursue benefits that address the aggravation of your health issues or other injuries you have suffered while working. Contact our Morgan Hill workers’ compensation benefits attorneys at 408-848-1113 to schedule a complimentary consultation today.

Sources:

https://www.calhr.ca.gov/Documents/workers-compensation-preview.pdf

https://www.dir.ca.gov/t8/14300_5.html