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What If I Had a Pre-Existing Condition?

Sometimes a workplace injury is not a brand new injury but rather an exacerbation of a previous injury. Workers’ compensation laws are clear: workplace injuries are to be compensated pursuant to the statute, and this includes injuries that aggravate a pre-existing condition. A worker who injured his knee years ago is still entitled to workers’ compensation benefits if he suffers an injury at work that causes additional pain and limitation in that knee. Likewise, a worker who had previously fallen at work and hurt her back can still recover workers’ compensation benefits if she later falls again and hurts her back.

Pre-existing conditions are no barrier to workers’ compensation benefits in California, except that workers’ compensation benefits are only available for the “work-related” portion of the injury. Workers who are injured while on the job and who have a pre-existing condition can expect to face some difficult hurdles in obtaining benefits.

How Do I Determine What Portion of My Injury is Work-Related?

When a work-related injury aggravates a pre-existing injury, it can be difficult to know precisely where to draw the line between what was suffered at work and what was suffered away from work.

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Workers’ compensation insurance companies will always want to highlight and emphasize the pre-existing condition and minimize the effects of the new injury as this is one of the most effective ways to avoid having to pay additional amounts in compensation. Naturally, the worker is interested in highlighting the effect of the work-related injury and downplaying the limitations the pre-existing condition created. But which side will win out?

Sometimes the limitations are obvious. A worker with a bad knee but who could work has obviously had a deterioration in his or her condition if one day after a workplace injury the worker simply can no longer walk. A worker with a back injury who could previously lift 75 lbs with a back support device and who can no longer lift anything over five pounds because of a workplace accident has obviously suffered a worsening of his or her condition. In these cases, there are few disagreements about the impact the workplace injury had on the worker’s abilities.

But suppose that the worker had significant back pain due to a pre-existing condition such that lifting 75 lbs would cause serious discomfort to the worker. Suppose further that the pre-existing condition was degenerative, and the worker’s back would eventually give out altogether. In this situation, what effect – if any – would a workplace injury have on the worker’s condition?

Battle of the Experts

Where a pre-existing condition is involved, the dispute often comes down to a battle of the expert witnesses. Whatever expert the fact-finding body finds more credible is the one who gets to say where the line is between the workplace injury and the pre-existing condition. The workers’ compensation insurer’s doctor and medical experts will attempt to establish that, according to your medical records, your pre-existing condition was so severe that the workplace injury likely had little to no effect on your limitations. Alternatively, the workers’ compensation insurer’s expert witnesses may try to establish that the nature of injury accident could not have produced the effects that the worker now complains of – as a result (the reasoning will go), the worker is not entitled to any workers’ compensation benefits because all of the pain and/or limitations stems from the pre-existing condition.

The worker will need to be prepared to combat this line of attack through the use of his or her own expert witnesses. The worker’s primary treating physician or the doctor who has been assisting the worker manage the symptoms of the pre-existing condition can be a powerful voice arguing that compensation is proper. This doctor or similar medical professional can provide testimony about the nature and cause of the pre-existing condition and how the condition affected the worker throughout the years. The medical professional or expert should be able to provide reasonably reliable testimony concerning what progression, if any, the pre-existing condition would have had. Taking all of this information together, the expert for the worker should be able to counter the workers’ compensation insurer’s expert to show that there was a distinct deterioration in the worker’s overall health as a result of the workplace injury.

Keep Your Medical Records Handy

If you have a pre-existing condition or injury, it is helpful to have copies of your medical records related to that injury in a safe but accessible place. These copies can be shown to doctors and other medical staff as well as to any experts that you may need to hire to help prove your case.

Persistence is the Key

If you have a pre-existing condition, do not be dismayed if your initial workers’ compensation claim is denied. Instead, you should seek out a highly qualified workers’ compensation attorney to look at your case and determine if an appeal is appropriate.

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