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How Does a Pre-Existing Condition Affect Your Workers’ Comp Claim?

Posted on June 18, 2020
How Does a Pre-Existing Condition Affect Your Workers’ Comp Claim?

If an employee sustains a work-related injury, a pre-existing condition could make the worker’s comp claim more complex and impact benefits. Benefits will be particularly affected if a pre-existing condition is medically relevant to the claim. For instance, an employee with a history of a medical condition affecting the same part of the body that was injured may receive a smaller payment compared to someone who didn’t have the condition prior to the injury.

There are several ways a pre-existing condition could impact a claim, depending on the nature of the condition and the injury.

Pre-Existing Conditions Pertaining to Prior Claims

If an employee was involved in a previous work-related accident that resulted in an injury to the same body part, the benefits in another claim will see a slight reduction based on the previous claim. Employers will still need to cover all medical expenses for treating the new injury, and the employer will also be responsible for paying temporary disability benefits if the employee is unable to work while recovering.

Keep in mind that when it comes to permanent disability, once the claim is closed, the claimant will only recover compensation for an increased permanent impairment resulting from the new claim.

Examination with a medical professional can help determine if a work-related injury qualifies as either a continuation of a previous injury or a new yet related injury.

Pre-Existing Conditions Unrelated to a Previous Claim

In some cases, an employee may have a pre-existing condition that stemmed from a previous injury or aging that’s unrelated to work, which a work injury may worsen. For example, an employee may have previously fractured an arm bone in a car accident and then aggravated the injury when injuring the same arm in an unrelated work accident. Similar to a claim involving a previous work injury, the worker will likely only receive benefits that account for the aggravation of the condition resulting from the work injury.

Again, a medical professional can determine if the accident worsened the condition.

Pre-Existing Condition That’s Entirely Unrelated

If a worker has a pre-existing condition due to another accident that’s entirely unrelated to the current claim, the condition likely won’t have an impact on the claim. The employer will still need to pay for all medical expenses resulting from the work injury, and a private insurer will be able to continue covering treatment for the pre-existing condition.

Understanding how a pre-existing condition may affect a new work injury claim can help victims understand the type of compensation they can recover following a new injury.