When everything runs smoothly, receiving workers’ compensation is easy. In the best-case scenarios, you file the paperwork, get your compensation, and move on. No big deal.
This situation, of course, is not always the case. As an insurance benefit, workers’ comp filters through an insurer who always protects its bottom line. You can be denied for the smallest, most technical of reasons. This forces you to endure an appeal process, which is like going to court.
The situation can be further complicated if you have a preexisting condition. Worker’s comp benefits depend on the nature of the injury, the nature of a preexisting condition, and the relationship between the two.
Your Original Condition is Unrelated to the Injury
People with prior illnesses get hurt on the job. A diabetic, for example, can throw out their back in the warehouse.
When the two conditions are unrelated, gaining workers’ comp should be no problem. Diabetes should, in theory, have no connection to a back injury. The injury is viewed as a separate problem and is assessed accordingly. As long as the insurance company believes your story and finds no reason to deny your claim, you should be able to collect your benefits.
The Injury Makes Your Original Problem Worse
When a workplace injury makes a prior injury worse, this is called “aggravating” the injury. Gaining workers’ comp in this scenario is complicated.
First off, the insurance company will compensate only the injury you sustained on the job. If you have a chronic condition that sometimes flares up or reoccurs, this does not qualify for workers’ comp. The insurance company labels this problem as “exacerbated,” and it expects your current treatments to handle it.
To prove that your worsening condition is the result of an on-the-job injury, you must meet certain requirements:
First, you must prove that the injury happened on the job, and it worsened the original problem. This worsening can be either temporary or permanent.
Second, your worsened condition must require new treatments. If it can be handled through your normal routine, it will not be considered an aggravated injury.
Third, there must be changes to your normal treatment. Otherwise, the injury will not be considered aggravated.
The Injury Worsens a Prior Workplace Injury
If you were already hurt on the job, you probably received workers’ comp for this injury. If you are injured the same way, this affects how much compensation you can receive.
You will likely receive reduced benefits. The insurance company normally subtracts your previous compensation from your new claim. This policy significantly impacts disability benefits.
For instance, let’s say you injured your ankle at work, and you received $5,000 in disability. If the same ankle is reinjured, your doctor may recommend that your disability be raised to $15,000. In this situation, you would probably receive only $10,000 in disability benefits, or $15,000 - $5,000.
Consult an Attorney
Insurance companies can easily claim that you were not injured on the job, wrongly denying your claim. If you have preexisting conditions and need to file a worker’s comp claim, make sure to run your application by an attorney first. They can look over your paperwork, helping you avoid pitfalls that could get your claim denied. Knowing about your prior illnesses, they can help you craft a good, credible request for benefits. They know how to use specific language that can satisfy an insurers’ skepticism. Your lawyer can also help you compile the correct records, helping prove that your current injury is genuine.
You can trust our firm to help with workers’ compensation claims, even if you have preexisting conditions. For help, call us today at (714) 909-2609, or contact us online.