Pre-Existing Conditions in a Workers’ Compensation Claim

Pennsylvania workers’ compensation laws exist to protect employees with work-related injuries. But what if your injury is connected to a pre-existing injury or condition?

While your employer or their insurance company may suggest you aren’t eligible for workers’ compensation, that is not the case. You have rights under Pennsylvania and federal law.

If you have questions about your eligibility or need help fighting for the compensation you deserve, schedule a free consultation with a workers’ compensation attorney at Munley Law. We can help you understand your legal options and will fight for your rights.

Understanding Pre-Existing Conditions in Workers’ Comp Cases

For workers’ compensation purposes, a pre-existing condition is any prior medical condition that an employee has experienced before beginning work with your organization.

Common pre-existing conditions of  injured workers include:

• Back and spine injuries
• Arthritis and joint problems
• Knee injuries
• Carpal tunnel syndrome
• Heart conditions
• Asthma and respiratory issues
• Mental health conditions
• Genetic predispositions

For workers’ compensation purposes, pre-existing conditions fall into two categories: aggravation and continuation. Aggravation happens when a work-related incident or exposure worsens a pre-existing condition, creating a new or worse level of disability. Conversely, continuation refers to a pre-existing condition that persists without significant worsening due to work activities.

The distinction is important because you are unlikely to qualify for workers’ compensation benefits if you have a continuation injury. Don’t let your pre-existing condition prevent you from seeking benefits. Contact Munley Law for a free consultation about your workers’ compensation claim.

Your Legal Rights with Pre-Existing Conditions

Pennsylvania workers’ compensation laws protect employees who have a pre-existing condition. Employees have the right to compensation for work-aggravated injuries.

Anti-discrimination laws, such as the Americans with Disabilities Act, prohibit your employer from discriminating against you for any pre-existing condition. Know your rights. Contact Munley Law for a free legal consultation about your workers’ compensation claim.

Common Challenges and How to Overcome Them

Likely, your employer’s insurer will create a number of challenges to prevent injured workers with pre-existing conditions from receiving workers’ compensation benefits. They don’t like to pay out, so they employ a series of tactics, like:

• Delaying payments
• Minimizing the severity of your injuries
• Requesting excessive documentation
• Denying claims

When the insurance company denies your claim, they will give you some general excuse, such as:

• Paperwork is missing
• The filing was late
• There was no injury causation

You shouldn’t accept a denial when you may be entitled to obtaining workers’ compensation benefits. You need to appeal. Don’t face insurance company tactics alone. Let our experienced team fight for your rights.

How Your Pre-Existing Condition Impacts Your Workers’ Comp Claim

Workers’ compensation covers pre-existing conditions in Pennsylvania if work activities directly aggravate them. To receive workers’ compensation, you must prove that your job duties worsened your condition beyond its natural progression – this is the aggravation mentioned above. The key to success is providing thorough documentation, including:

• Medical records demonstrating diagnosis and medical treatment
• Doctor’s statement
• Any additional evidence detailing how job tasks impact your condition

Uncertain how your pre-existing condition affects your claim? Let our experienced attorneys evaluate your case at no cost.

Building a Strong Case with a Pre-Existing Condition

Building a strong workers’ compensation case with a pre-existing condition requires a few things. Medical evidence is a huge component. While it can be inconvenient to seek medical treatment, it can prove aggravation in your case.

When you notice your condition worsening, get treatment and notify your employer. Continue to document the progression of your symptoms over time. You should also share information with your coworkers so they can support your claim down the line if needed. If necessary, your workers’ compensation attorney will bring in medical expert witnesses to support your claim.

Working with Medical Professionals to Support Your Claim

Because medical documentation plays such a big role in a successful claim, you want to choose the right doctor or doctors. You want a doctor who will maintain thorough treatment records, conduct detailed exams, and give you specialist referrals who can better assess and document your injury. If possible, continue working with doctors you have seen before and can provide your complete medical history.

Key Steps to Protect Your Workers’ Comp Rights

To file a workers’ compensation claim in Pennsylvania, you must report your injury to your employer within 120 days.  However,  for claim purposes, the sooner, the better. When filing a claim, you will need to submit the following documentation:

• Detailed medical records
• The report of injury to your employer
• Accident reports and witness statements

Unfortunately, injured workers often make a few mistakes when filing their claim; these include:

• Filing late
• Providing inconsistent medical reports
• Failing to notify their employer

Don’t risk losing your benefits. Contact Munley Law today for experienced guidance on your workers’ compensation claim.

Apportionment in Pre-Existing Condition Claims

In pre-existing condition claims, workers’ compensation benefits are calculated using apportionment, which divides responsibility between pre-existing conditions and work-related injuries.

Your employer’s insurer might suggest an unfair apportionment.  Still, you should challenge it with the help of a workers’ compensation lawyer. 

Settlement Options for Pre-Existing Condition Claims

Settlements in workers’ compensation claims involving pre-existing conditions include lump-sum settlements (paid all at once) and structured settlements (ones with periodic payments). Factors that are assessed when calculating settlement include:

• Severity of the aggravated condition
• Future medical expenses
• Impact on earning potential

Your workers’ compensation attorney will use a few negotiation strategies to maximize your settlement, such as:

• Presenting strong medical documentation
• Emphasizing the work-related aggravation
• Countering insurer tactics

Get the settlement you deserve. Schedule a free consultation with our workers’ compensation attorneys.