“Help! Can I get workers’ comp with a pre-existing condition?”
Pre-existing conditions have long been a point of tension between employers and those seeking workers’ compensation benefits. As the name implies, a pre-existing condition is a medical condition that existed before the alleged workplace injury.
Strictly speaking, pre-existing conditions are not covered by a workers’ compensation policy because the workplace conduct did not cause the injury in question. Thus, employers are often quick to allege that an injury is a pre-existing condition.
Similarly, employees are often fearful that disclosing the complete nature of their injury will result in a denial of a rightful claim to workers’ compensation benefits.
What is considered a pre-existing condition?
A simple pre-existing injury definition is “any medical conditions that predated the workplace injury in question.” Often, these are fairly finite conditions. For example, broken bones, back injuries, torn ligaments or any other defined injury can constitute a pre-existing condition. However, they don’t need to be so concrete.
Pre-existing conditions can also be gradual or undefined symptoms such as arthritis, generalized joint pain or any other wear-related injuries. Pre-existing conditions are an exceptionally broad category. This is why denying a claim for workers’ compensation due to a pre-existing condition is such an appealing course of action for an employer or insurance company.
However, such a denial is not as clear cut as the insurer would hope.
Can you receive workers’ compensation benefits for a pre-existing condition in Arizona?
It is rare for an employer’s blanket denial of workers’ compensation benefits to be successful. In Arizona, workers’ compensation is a constitutionally protected right and there are measures in place to protect it. To receive these benefits, an injury must have been at least partially caused by the conditions of the workplace or the nature of the work.
As it relates to pre-existing conditions, the workplace situation in question
must have aggravated the pre-existing condition in order to qualify
for workers’ compensation benefits.
“Aggravation” is a fairly low standard. So long as it can be shown with reasonable certainty that a worker’s condition was made worse by some aspect of the workplace, compensation should be available.
For example, back pain is an extremely common claim and is often a pre-existing condition. But, if it can be shown that the working conditions resulted in a worsening of the back pain (by way of lifting a heavy object, repetitive motions or other factors), then a valid claim can be made.
Your medical records will often be examined in the course of a workers’ compensation claim. However, this should not be a cause of concern. When an employer hires a worker, they employ them subject to any conditions that the employee may have. Therefore, you should never try to hide a pre-existing condition. Nor should you ever be ashamed or embarrassed for having a pre-existing condition.
How does a pre-existing condition impact the amount of a claim?
The purpose of workers’ compensation benefits is to provide the worker with compensation for the injuries they sustained through the course of their work. However, pre-existing conditions can lower the amount of benefits paid out accordingly. An employer is only responsible for the damage that the job created.
In other words, the claim will be for the aggravation, not the underlying condition. It is often helpful to think of the analogy of a car accident. If another person runs into your car, they will be responsible for the damage caused by the collision. However, they will not be liable for any damage your car had before the accident.
Because of the way damages are calculated, workers are often tempted to conceal pre-existing conditions to secure a larger claim. While this makes sense on the surface, it is not advisable.
First, the insurance company that assesses your claim will have access to your medical history. Thus, any attempts to not disclose past conditions will likely be fruitless.
Further, failure to disclose a pre-existing condition can result in the denial of your claim due to not properly reporting the incident in question. In extreme cases, this can rise to the level of insurance fraud.
Questions and answers about compensation for a job-related accident, injury or illness in Arizona
How can you maximize your work injury claim?
There are 4 actions to follow to maximize your claim:
- Be honest.
- Be consistent.
- Be thorough.
- Be represented.
Resist the temptation to misreport a claim. While trying to maximize the severity of a claim may seem like a logical way to get a larger benefit, doing so can result in much greater complications.
Always be consistent when speaking to anyone related to the matter in question, whether this is your doctor, your employer or the claim investigator. State your condition honestly and unwaveringly.
Although you should never over-state your injury, you should nonetheless strive to be thorough. When speaking to a doctor or insurance adjuster, it is often easy to say you’re doing fine when asked. Remembering the specifics of your condition can be difficult, especially under pressure.
To avoid this, many employees find it helpful to maintain a record of their medical condition that includes any pain they feel, whether the symptoms have worsened and any lifestyle or activity limitations that are caused by the injury. Having a concrete list can ensure that you do not inadvertently under-report an injury.
Finally, never be afraid to seek representation. Workers’ compensation claims can be difficult to navigate, and having an advocate on your side can be immeasurably beneficial. If you’ve been hurt on the job and you live in Arizona, contact the Law Offices of Robert E. Wisniewski. Our team is ready to fight for your rights.