If you have a pre-existing condition, you may be wondering, “Will My Pre-Existing Conditions Hurt My Workers Compensation Case?” The good news is that in California, pre-existing conditions cannot be used to reduce most of the benefits you are entitled to receive. The bad news is that employers and their insurance adjusters try to deny claims on the basis of pre-existing condition. This is why it's so vital to know your legal rights and what to do if you aggravate a pre-existing condition at work.
In this blog article, you will learn what happens with pre-existing conditions, workers' compensation claims, and how to protect your rights after a work-related aggravation to a pre-existing condition.
What is a pre-existing condition?
A pre-existing condition is an injury or illness that you had before you were injured at work. Examples of pre-existing conditions include:
- carpal tunnel syndrome;
- degenerative disc disease;
- herniated discs;
- previous back injuries; or
- prior surgery areas
- prior broken bones
- prior head trauma
These are just a few examples. If you have any condition that is not work-related, it may be considered a pre-existing condition.
What if I aggravate a pre-existing condition at work?
If you aggravate a pre-existing condition at work, you may still be eligible for workers' compensation benefits. This is because workers' compensation is designed to cover all work-related injuries, even those that aggravate pre-existing conditions. This rule applies whether your pre-existing condition is major or minor.
For example, let's say you have arthritis in your knee. If you slip and fall at work and injure your knee further, you would be eligible for workers' compensation benefits, even though the arthritis was a pre-existing condition.
One Percent Causation Requirement Under California Law
Most of those who experience an injury at work and who have a preexisting condition have trouble receiving workers compensation benefits. When the injured worker applies to the workers compensation carrier, the claim is swiftly denied. This can happen when a preexisting condition to the same body part exists as the result of any type of prior accident. Maybe it was a prior work related injury, or possibly an injury from an earlier auto accident or slip and fall at the workers home.
For the injured worker with a preexisting condition, it is absolutely vital to seek a fair medical evaluation so that a respected medical professional can determine the relative apportionment of the injuries. Even if the injury was 99% preexisting and 1% due to the present work related injury, the workers compensation insurance carrier is required to provide all medical treatment necessary to cure and relieve that condition, regardless of whether there was preexisting injury. This is the rule in California workers compensation law: medical treatment and care is not able to be apportioned among injuries. Therefore, any accident at work that makes a preexisting condition worse will entitle the injured worker to full medical treatment for that condition despite the preexisting problem.
What if my employer says my injury is not work-related because of a pre-existing condition?
For example, if you have a degenerative disc disease and you injure your back at work, your employer may try to say that the injury is not work-related because it is due to the degenerative disc disease. If your employer denies your workers' compensation claim on the basis of a pre-existing condition, you should speak to a workers' compensation attorney. Your attorney can help you gather evidence to prove that your injury is work-related, even if you have a pre-existing condition.
Injured workers' have the burden to prove their claim. Having the burden of proof means that you are required to show the judge that you are entitled to benefits. All kinds of evidence can be gathered to help prove an aggravation to a pre-existing medical condition. This evidence may include:
Medical Records Showing The Condition Was Made Worse By Work
Your medical records can show that your injury is work-related. For example, if you went to the doctor for an injured knee and the doctor wrote that the injury was caused by a slip and fall at work, this would be strong evidence that your injury is work-related.
Witness Statements Before And After The Work-Related Incident
If there are witnesses to your accident, they can provide testimony that your injury is work-related. For example, if you slipped and fell at work and a co-worker saw it happen, they can provide testimony that the fall was indeed work-related.
Accident Reports Showing What Happened In the Work Accident
If you filed an accident report with your employer, this can also be used as evidence that your injury is work-related. The accident report should describe what happened and how you were injured.
There may be other types of evidence that can be used to prove that your injury is work-related. Your attorney will know what type of evidence is needed in your case.
What benefits am I entitled to if I have a work-related aggravation of a pre-existing condition?
If you have a work-related aggravation of a pre-existing condition, you may be entitled to the same benefits as any other injured worker. These benefits include:
Medical treatment to cure or relieve the condition
You are entitled to all necessary medical treatment to cure or relieve your injury. This includes doctor's visits, surgeries, physical therapy, and any other type of treatment that is recommended by your doctor.
Temporary disability benefits while you are getting better
Temporary disability benefits: If you are unable to work due to your injury, you may be entitled to temporary disability benefits. These benefits replace a portion of your lost wages.
Permanent disability benefits for any permanent issues caused to the body part
Permanent disability benefits: If you have a permanent disability due to your injury, you may be entitled to permanent disability benefits. These benefits are based on the severity of your disability and your ability to return to work.
Your pre-existing condition may limit the amount of permanent disability money that you receive. This is the only benefits that may be “apportioned.” Apportionment means that the doctor may assign a portion of the disability to the pre-existing condition. For example, if the pre-existing degenerative back disease was permanently aggravated by a herniated disc, the doctor may assign 10% to the pre-existing condition.
On the other hand, if there is only a strain and their back is not made worse in the long run, then the pre-existing condition would be 100% responsible for the permanent issue and the work-injury would only be an exacerbation causing 0% long-term impairment.
What if I have a pre-existing condition that is not aggravated at work?
If you have a pre-existing condition that is not aggravated at work, you are not eligible for workers' compensation benefits. This is because workers' compensation only covers work-related injuries, not pre-existing conditions that are not aggravated at work.
For example, let's say you have arthritis in your knee. If you do not injure your knee further at work, you would not be eligible for workers' compensation benefits, because the arthritis is a pre-existing condition that was not aggravated at work.
Job Duties that Aggravate Could Arise to Cumulative Trauma Injury
Cumulative trauma injuries are work-related injuries that are caused by repetitive motions or activities. These types of injuries often occur over a long period of time, and can be difficult to prove that they are work-related.
If you have a cumulative trauma injury, you may be entitled to workers' compensation benefits if you can prove that your job duties aggravated your condition. To do this, you will need to show that:
- You have a condition that is typically caused by repetitive motions or activities;
- Your job duties involved repetitive motions or activities; and
- Your condition was aggravated by your job duties.
It can be difficult to prove that a cumulative trauma injury is work-related. If you have a cumulative trauma injury, it is important to speak with an experienced workers' compensation attorney who can help you build your case.
Always Consult With A Workers' Compensation Lawyer With Questions
Workers compensation insurance companies usually deny claims where preexisting injuries exist. When these claims are not denied, the insurance company will assert that the injury was largely due to the preexisting condition and tell the injured worker that the claim is worth very little. Other times, the insurance company doctor will quickly apportion the entire injury to the preexisting condition on the first doctors visit to the the industrial clinic even where a fair medical evaluation would find some apportionment to the current work related injury. It is important that the injured worker not be fooled and short changed on their benefits by this type of behavior by the insurance carrier. Instead, the injured worker should seek the advice of a workers compensation lawyer.
If you have any questions about whether you are eligible for workers' compensation benefits, you should speak to a workers' compensation attorney. An attorney can help you understand your rights and options under the law. California Workers Compensation Claims Apportionment Issues – California Attorney Advice from Alexander Napolin. Get the advice you need to know your rights and how to recover for your legitimate work related injury, regardless of a preexisting condition to the same body part or parts.
California Workers Compensation Claims Apportionment Issues – Attorney Advice From Alexander Napolin
Attorney Alexander Napolin knows about these types of apportionment issues and how California workers compensation law applies to them. When you hire Napolin Accident Injury Lawyer, you will no longer be pushed around by an insurance agent who cares nothing about you or your injury. Instead, you will have a lawyer who will fight for all the workers compensation benefits to which you are entitled. If you have been injured at work, Attorney Alexander Napolin will speak with you for free about your case. Call him at 866-NAPOLIN for your free consultation, or fill out a claim evaluation form at NapolinLaw.com and Attorney Alexander Napolin will call you within 24 hours to discuss your case for free.
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