Pre-Existing Conditions Affect Workers' Compensation Claims

Workers' compensation laws are designed to protect workers who are injured on the job. However, if you have a pre-existing condition, you may wonder how that will affect your workers' compensation claim. Can it prevent you from receiving benefits? Will it reduce the amount you receive? This blog post will explain how pre-existing conditions factor into workers' compensation claims in Raleigh, North Carolina.

What is a Pre-existing Condition?

A pre-existing condition is any injury, illness, or medical condition that existed before the workplace accident or injury. This could include anything from a prior back injury to a chronic condition like asthma.

Examples of Pre-Existing Conditions

A pre-existing condition refers to any medical condition that an individual had prior to a specific event, such as enrolling in a health insurance plan or suffering a work-related injury. These can range from chronic conditions to previous injuries that have healed. Here are some examples of pre-existing conditions:

Cardiovascular Diseases

These include heart disease, hypertension (high blood pressure), and a history of heart attacks or strokes.

Respiratory Conditions

Conditions like asthma, chronic obstructive pulmonary disease (COPD), or a history of pneumonia could be considered pre-existing conditions.

Musculoskeletal Conditions

This includes conditions like arthritis, previous fractures, back injuries, or joint problems.

Mental Health Conditions

Mental health conditions, such as depression, anxiety disorders, post-traumatic stress disorder (PTSD), or bipolar disorder, are also considered pre-existing conditions.

Chronic Illnesses

Conditions like diabetes, cancer, HIV/AIDS, kidney disease, or liver disease are considered pre-existing conditions.

Neurological Disorders

Neurological conditions such as epilepsy, Parkinson's disease, or a history of seizures or strokes can be considered pre-existing conditions.

Previous Injuries

If you've previously suffered from an injury like a sprained ankle, broken bone, or torn ligament that hasn't completely healed or continues to cause issues, this could be considered a pre-existing condition.

Autoimmune Diseases

Conditions like lupus, rheumatoid arthritis, or multiple sclerosis (MS) fall into this category.

Impact of Pre-existing Conditions on Your Claim

The general rule under North Carolina's workers' compensation laws is that workers' compensation only covers injuries "arising out of and in the course of employment". So, if your pre-existing condition was not caused or aggravated by your work, it would not typically be covered.

However, if your pre-existing condition is aggravated or exacerbated by a workplace injury, then you may be eligible for workers' compensation benefits. For example, if you have a prior knee injury that was manageable and didn't affect your ability to work, but a slip and fall at work further damages that knee and leaves you unable to work, you could be eligible for benefits for the exacerbation of your pre-existing condition.

Proving Work-Related Aggravation

One of the biggest challenges in these cases can be proving that your work actually aggravated the pre-existing condition. Medical evidence, including reports from your doctor or other healthcare providers, can be crucial. They can help demonstrate that your condition has worsened due to your work activities or a specific incident at work.

Impact on Benefit Amounts

The existence of a pre-existing condition will not necessarily reduce the amount of workers' compensation benefits you can receive. The key factor is the extent to which the workplace injury has increased your disability or limitations. If the work injury has significantly increased your disability or caused new restrictions, you may still be entitled to full benefits.

How to Improve Your Chances of Maximizing Your Workers' Comp Benefits

Workers' compensation benefits are designed to provide financial support and medical care for employees who suffer injuries on the job. However, obtaining the maximum benefits can sometimes be challenging. Here are some strategies that can help you improve your chances of maximizing your workers' compensation benefits:

Report the Injury Promptly

As soon as you are injured at work, report the incident to your supervisor or employer. Delays in reporting can give rise to questions about the validity of the claim.

Seek Immediate Medical Attention

Prompt medical attention not only ensures your health and safety but also creates a medical record of your injury, which is crucial for your claim. Follow all your doctor's advice and instructions.

Document Everything

Maintain detailed records of everything related to your injury and claim, including incident reports, medical records, and any communication with your employer, the insurance company, or medical professionals.

File a Claim Promptly

Make sure to file your workers' compensation claim as soon as possible. In North Carolina, you typically have two years from the date of injury to file a claim, but the sooner you file, the sooner you may start receiving benefits.

Understand Your Rights

It's crucial to understand the workers' compensation process and your rights within it. For example, know that you have the right to appeal if your claim is denied.

Be Honest and Consistent

Always be honest about your injuries, your limitations, and the incident that caused them. Inconsistencies in your statements can cast doubt on your claim and reduce your benefits.

Follow Medical Advice

Failure to follow prescribed treatment plans or to attend medical appointments can harm your claim. It might be seen as a sign that your injury is not as serious as claimed.

Hire a Workers' Compensation Attorney

Navigating the workers' compensation system can be complex. An experienced workers' compensation lawyer can guide you through the process, helping to ensure you receive all the benefits to which you are entitled.

Contact The Law Offices of John M. McCabe

At The Law Offices of John M. McCabe, we're committed to helping injured workers in Raleigh understand their rights and pursue their workers' compensation claims, even when pre-existing conditions are involved. If you have been injured at work and have a pre-existing condition, don't hesitate to reach out to us for a consultation.