Does Workers’ Compensation Cover Pre-Existing Conditions?

There are between 30,000 and 40,000 workers’ compensation claims filed every year in Georgia, according to KTVA. While some claims are filed for new conditions completely caused by a work accident, others result from the aggravation of pre-existing conditions. Having a pre-existing condition does not automatically disqualify you from receiving workers’ compensation benefits, but it can complicate things.

Injuries caused by pre-existing conditions—not the work accident—are typically not eligible for workers’ compensation. However, your claim might be accepted if the pre-existing condition was affected by but did not directly cause the injury.

The Definition of Pre-Existing Condition

You often hear about pre-existing conditions related to insurance coverage. A pre-existing condition is any health problem that an individual had before they began new health coverage.

In terms of workers’ compensation, a pre-existing condition is any health issue you had before your work injury occurred. Often, the condition happened years before employment began. Examples of pre-existing conditions may be a herniated disc, carpal tunnel syndrome, or even a heart condition.

Are Pre-Existing Conditions Covered By Workers’ Compensation?

Under Georgia Code § 34-9-1, the aggravation of a pre-existing condition through a work-related accident is covered by workers’ compensation—as long as the aggravation of the condition causes your disability. If aggravation of the pre-existing condition is no longer the cause of your disability, it will cease to be covered.

Under the above criteria, in Georgia, workers’ compensation does cover pre-existing conditions in many situations. However, this can vary per state and might be different in other locations.

Having Your Condition Examined

Whether you have a pre-existing condition or not, it’s vital that you receive a medical examination very soon after your work injury occurs. The doctor you see will evaluate your situation and determine how a pre-existing condition may be related to your injuries and disability.

If the doctor sees that your pre-existing condition was not related to your current work injuries or did not contribute to your disability, it will likely not be covered. This is when you should reach out to a Georgia workers’ compensation lawyer for help. Most of the time, you’ll have to see a doctor who is connected to the workers’ comp insurance company, which means they may not have your best interests at heart.

An experienced lawyer can make sure you receive a fair medical evaluation in relation to your work injuries and any pre-existing conditions. If you believe you are being treated unfairly, you could be right. Reach out to a lawyer who can fight for your rights. Call John Foy & Associates today for a FREE consultation.

Common Pre-Existing Conditions that Can Be Aggravated Through Employment

Just about any pre-existing condition can be aggravated by a work accident, thus qualifying for workers’ comp. Pre-existing conditions can encompass anything from work injuries you sustained years ago to chronic diseases. The condition does not need to result from a previous work injury as long as it is affected by your employment.

Examples of pre-existing conditions that are often aggravated by work include:

• Knee injuries
• Neck, back, or shoulder injuries
• Arthritis
• Degenerative disc disease

Depending on how your work accident occurred, any previous condition may potentially become aggravated during the injury. However, you may run into problems if there was evidence of your pre-existing condition causing issues for you before your accident happened. Unfortunately, insurance companies know how to use the gray areas in workers’ comp laws to reduce the benefits they provide.

Filing and Fighting for Your Claim

After your work accident occurs, you will need to file a workers’ compensation claim with the Georgia State Board of Workers’ Compensation (SBWC) by completing a Form WC-14. Then, you’ll send a copy of the completed form to your employer and the insurance company that provides your workers’ comp coverage.

Filing your claim is rarely the end of your case. Insurance adjusters are trained to look for ways to reduce the value of a claim. If you have a pre-existing condition, even if it was clearly aggravated by the work injury, they might seek ways to reduce or deny your claim based on your previous injury or condition.

A lawyer who is trained to handle these types of workers’ compensation cases can help you build a strong claim and prepare for any pushback from the insurance company (or your employer). You should not be punished just because you had a former condition that got worse during an accident while doing your job.

Appealing Your Claim

It’s too common for insurance companies to deny workers’ comp claims based on pre-existing conditions. Thankfully, you can request an appeal and attend a hearing before the SBWC. Again, it’s best to already have a Georgia workers’ compensation lawyer at this point.

Pre-Existing Conditions from Former Workplace Accidents

If you injured the same body part in a previous work-related accident and received benefits, it may affect your new workers’ comp claim. Your new claim will likely be slightly reduced based on the previous claim.

Don’t be surprised if your permanent disability benefits are lower than before. Any previous awards you received for a permanent impairment will be taken into account, and it may limit what you can get now. However, your employer and workers’ comp insurance will still have to cover your medical bills related to the injury and temporary total disability weekly benefits if your injury prevents you from working.

You will also need to understand the difference between the aggravation of a previous injury and a completely new injury, even if it involves the same body part. Your doctor should evaluate you in this way and go over your previous medical records. The distinction is crucial when filing a workers’ compensation claim, so contact a lawyer if you’re not sure how to proceed.

Talk to a Workers’ Compensation Lawyer in Georgia for Free Today

If you were injured at work and have a pre-existing condition, it’s best to contact a workers’ compensation lawyer right away. Your claim is already more complicated, simply because you have a pre-existing condition. A legal professional can make sure you are treated fairly and that your previous condition does not make you lose out on the benefits you deserve.

At John Foy & Associates, we have been helping injured workers (with and without pre-existing conditions) win the benefits they need for over 20 years. Let us help you too by starting with a FREE consultation. Call us today or contact us online to get started with your FREE consultation.