Can I Recover Workers' Comp With a Pre-Existing Condition?

Having a pre-existing condition could complicate your workers’ compensation claim if you are injured while on the job. While a pre-existing condition doesn’t make you ineligible, your employer and insurance company will likely try to leverage your pre-existing condition against you to protect their bottom line. There are three types of pre-existing conditions in workers’ compensation claims, and on this blog we’ll take a look at how each type of condition could impact your case and the compensation you are entitled to.

Unrelated Pre-Existing Condition

If your pre-existing condition is mostly or entirely unrelated to your accident and workers’ compensation claim, then your case will likely proceed as normal. Your employer will be required to pay your medical bills that relate to the injury, and your private insurance will continue to pay for your pre-existing condition. This may require you to see multiple treatment providers, and while this may be a hassle to do, it’s the best way to go in order to ensure your medical bills and other treatments continue to be paid in full. This is the ideal scenario as your claim will most likely not be impacted at all.

For example, say you have arthritis in your left hand and one day you slip on an unmarked spill and twist your right ankle. In this injury, your pre-existing condition (arthritic hand) had no influence whatsoever on your new injury, so the two will remain as separate injuries with no bearing on each other. Your claim should proceed as normal.

Related Pre-Existing Condition from Non Workers-Comp Injury

If you have a pre-existing condition that you obtained from an injury that was not sustained at work, then your claim could be considerably impacted. In these instances, your employer is only responsible for the worsening of your previous injury, and will likely challenge your claim regarding the extent to which your condition has been impacted. In these instances, it’s strongly advised that you seek treatment from a doctor who is experienced with workplace injuries, as they will likely be the most familiar with phrases and terminology that are effective in workers’ compensation cases.

Let’s look at another example. Say you recently twisted your ankle in an accident at home. While you’ve been wearing a brace for a few days at work to keep the pain in check, you slip on a hidden spill and fully sprain it. Your employer is only responsible for the treatment that emerges from the sprain in these instances, meaning you will likely have your benefits reduced appropriately. It’s important that you have an attorney on your side to fight for your rights in these cases, otherwise your claim could be rejected outright entirely.

Pre-Existing Condition Related from a Prior Workers’ Compensation Claim

If you have been previously injured on the job, and then further injure or re-aggravate that same condition, your employer will still be responsible for the worsening of your condition, but will seek to reduce it slightly as a result of the condition existing previously. They will still be required to pay all of your medical bills and treatment costs related to your injury, including the costs for new treatment as a result of it being worsened.

However, you could see any disability benefits you are awarded reduced. If you are currently on disability as a result of your previous injury, whether permanent or temporary, your new condition will likely change these benefits. However, you will most likely not receive the same amount of benefits that you would were the injury new or unrelated to your previous condition.

Let’s go back to the previous example for a moment. Say your initial ankle twist occurred during a previous workplace accident, and your subsequent injury to the same ankle wound up tearing a ligament in your ankle and your doctor says that you will be in pain for the rest of your life, even with surgery to correct the issue. Say you are now eligible for an impairment award of $10,000 as a result of your injury, but your previous injury, which partially disabled you, awarded you a $5,000 impairment award. Your new award would now be $10,000, meaning your old impairment would reduce your new one by the same amount.

If you are injured on the job with a pre-existing condition, you should not hesitate to contact a Sacramento workers’ compensation attorney for assistance with your claim. The experienced team at Smolich and Smolich can help you protect your rights and claim the compensation you deserve to help you recover and live your life comfortably after you have been hurt on the job. We have strived to fearlessly protect workers in Northern California since opening our doors in 1969, and have fought tirelessly to help each of them pursue the justice their claim deserves.