Does Workers' Compensation Cover Pre-Existing Conditions?
In general, if you have a pre-existing condition, workers' compensation will not cover those ailments. However, in some cases where a workplace injury aggravates a pre-existing condition, an employee may be able to receive workers' compensation benefits. These claims can often be met with resistance.
If you're wondering, “Does Workers' Compensation Cover Pre-Existing Conditions?” we can help. Learn more about what you need to know about pre-existing conditions and workers' compensation benefits.
Pre-Existing Conditions and Workplace Injuries
If you are injured in a workplace accident and have a pre-existing condition, you must make note of that condition at the time of your workers' compensation claim. While the pre-existing condition will not give you more money in a pay out, it helps protect you from being denied compensation should the employer later find out.
Further, if your pre-existing condition was worsened because of the accident, this needs to be documented.
Aggravation of a Pre-Existing Condition: Workers' Comp
Under the Pennsylvania Workers' Compensation Act, a work-related injury can include the aggravation of a pre-existing condition. Because of this, an employee with a pre-existing condition is not exempt from workers' comp benefits–but is not entitled to additional funds that exceed what any other employee may receive.
For example, if an employee had a history of back injuries like a herniated disc, and a fall at work causes that injury to worsen or become aggravated, they can seek workers' compensation. The employee must just show that the activities they engaged in at their place of employment caused the pre-existing condition to worsen.
In addition, the pre-existing condition need not be related to the employee's position. If an employee had been injured in a car accident, those chronic injuries would still be categorized as a pre-existing condition and if aggravated by the workplace accident, would qualify under workers' comp.
The bottom line is that the new injury or worsened condition must be related to the employee's job in order to have a successful workers' compensation claim.
Can an Employer Challenge a Workers' Comp Claim Because of a Pre-Existing Condition?
While they may not be successful, an employee should not be surprised if the employer or the insurance company tries to challenge the workers' compensation claim because of a pre-existing condition.
The employer may try to make the argument that the injury is not employment related and would have occurred regardless of the workplace activity.
To avoid this, the employee should seek medical attention and be diligent in making sure it is documented appropriately and supplies the medical provider and their lawyer as much detail as possible as to how the employment activity worsened the condition.
Note, this can be a double-edged sword if the employee knows that they should not have been engaging in the workplace activity but did so anyway. This does not mean you should withhold information but rather, be upfront about this with your lawyer.
Can Munley Law Personal Injury Attorneys Help Me Seek Workers Comp For My Worsened Pre-Existing Condition?
If you have been denied workers' compensation because of your pre-existing condition, let the workers' comp lawyers at Munley Law Personal Injury Attorneys help you.
Our lawyers can help you navigate the Pennsylvania workers' compensation process through the following avenues.
Representation
Only five percent of workers' comp claims end up going to court, however, if yours does, you may need legal representation.
A personal injury lawyer who focuses on workers' comp claims can help you negotiate a settlement out of court, or can take it to the courtroom to get a larger verdict.
Your workers' compensation attorney can help calculate what compensation is needed for your post-accident recovery as well as help determine who is liable for your losses. This allows you to focus on recovery while they take on communicating with your employer and the insurance companies.
Should your case be more complex and a larger fight need to be taken on to get the compensation you deserve, a workers' comp lawyer will be prepared to represent you.
Workers' Compensation Claim Hearings
It is estimated that nearly 25 percent of workers' compensation claims are denied in the first round. If this has happened to you, know that you can file an appeal, especially in cases where you have reason to believe your pre-existing condition was the reason for the denial.
In Pennsylvania, the appeal process begins when it has been filed with the Workers' Compensation Appeal Board. Then, the oral arguments are heard on both sides. This occurs within one to two month of the appeal being filed.
Then, within six to 12 months, the board will either reverse or affirm the initial claim. If denied again, you can appeal to the Commonwealth Court. This can take an additional six months to a year. Typically, cases are decided here, however, there is the option to go to the Pennsylvania Supreme Court if the case is legally compelling.
Compensation for Specific Losses
Some workplace injuries result in permanent scarring and/or disfigurement, the loss of a limb, or impaired use of a body part. In these instances, you may be eligible for “specific loss” payments. These payments are different from regular workers' compensation because you can still collect specific loss payments even if you can continue working.
How much you can receive depends on the body part that is injured or lost as a result of the accident. Also, know that employment-related illnesses may also be covered under specific losses.
Third Party Liability
A workers' comp claim usually means that you were injured at work and seeking compensation for those losses. However, there are some cases where the injury may be caused by the negligence of someone other than your employer.
This may be a mechanical failure by a manufacturer or a vendor who is negligent. Even with workers' compensation benefits, you can still seek a third party claim.
If you are seeking compensation from a third party, it will be imperative that you seek legal representation right away to gather evidence and begin the legal process.
Contingency Fee Basis
Workers' compensation claims can be difficult to process and costly to your family as you will likely be out of work far before the payments come to you. That's why Munley Law Personal Injury Attorneys works on a contingency fee basis. This means that you can seek legal representation from us, without an upfront cost.
It is once we secure a settlement or verdict for you that we are paid. This allows you to focus on recovery while also securing the maximum compensation for your losses.
Let Munley Law Personal Injury Attorneys Help in Your Workers' Comp Claim if You Have a Pre-Existing Condition
Workers' compensation claims are difficult enough. But when you or a loved one have a pre-existing condition, you may feel like the system is designed against you. If you're asking “Does Workers' Compensation Cover Pre-Existing Conditions?” we can help. Know that you may be able to recover compensation regardless of your pre-existing condition and Munley Law Personal Injury Attorneys can help.
The workers' comp attorneys at Munley Law Personal Injury Attorneys have helped Pennsylvania workers recover millions of dollars in workers' compensation claims. Our team will explore every avenue to make sure you are awarded the maximum recovery possible for your workplace injury or aggravated pre-existing condition.
For a no-obligation, free consultation, contact the workers' compensation lawyers at Munley Law Personal Injury Attorneys by calling us or completing our online contact form.
