Will a Pre-existing Condition Affect my Workers’ Compensation Claim?

In Maryland, you are entitled to workers’ compensation for any injury arising out of and in the course of your employment. What happens though when you are told that your workplace injury is related to a pre-existing condition? Many insurance companies are quick to deny claims on the basis of a pre-existing condition. However, it is important to know your rights, because regardless of whether your workplace injury is a re-injury or an aggravation of a previous injury, you are entitled to coverage. Insurance companies often issue initial denials on the basis of a pre-existing condition in hopes that the employee will stop pursuing the claim. While these claims can be more complex, it is your right to pursue one and receive coverage, so don’t give up and retain experienced counsel if needed.

How Are injuries Related to Pre-existing Conditions Handled?

• Aggravation of a pre-existing condition. If a workplace injury aggravates a preexisting condition, the injury should be treated as a new claim. For instance, say an employee has been a construction worker, competently performing his job for his employer for several years when one day, in the course of his employment, there’s an accident at the site and he slips from a ledge several feet up, injuring his back. The employee had previously been in a car accident and completed physical therapy for an injury to his back seven years before. The insurance company may initially try to deny his claim on the basis that the pre-existing back injury was actually the cause of his injury, and not the accident at the construction site. However, Maryland precedent holds that an aggravation of a pre-existing condition is a covered claim for workers’ compensation purposes. For this specific example the aggravation resulting from the construction site accident will be treated as a brand new claim.
• Aggravation of a pre-existing condition unknown to the employee or related to their general health. This same logic above applies to pre-existing conditions that the employee is unaware of or that are related to age. For instance, if in the above example, the employee who slipped had no prior known injuries to his spine, but upon seeking treatment, learned that he had degenerative disk disease or arthritis due to years of hard labor for various employees. Although he accumulated this spinal damage working for various employers and likely from age, it will still not prevent him from collecting employees’ compensation from his current employer, since he sustained a new acute injury on the job. The fact that the employee was able to complete his work duties, even with the degenerative damage, until the new event happened is helpful to support a new claim.
• Re-Injury of an injury unrelated to work. Again, the same logic applies. If, in this instance, the employee herniated a disk in the previous car accident, and herniates the same disk 5 years later on the construction site due to the workplace injury, the relevant inquiry is whether, the new or increased symptoms were caused by the new work injury. If the ultimate medical determination is that the new event caused new symptoms, worsened the symptoms or aggravated already existing symptoms, the new injury should be considered as a new and separate claim.
• Re-injury of a previous workplace injury. If you have previously been injured at work, received workers’ compensation, and then suffered the same injury, you may be able to re-open your same case. For instance, if the employee mentioned above received workers’ compensation, healed his back, returned to competently performing his job, and then re-injured it while completing another job related task, such as lifting bags of cement, the injury may be treated by the insurance company as a continuation of the same claim. However, it is still not grounds to deny coverage. This type of scenario is the perfect type to discuss with a workers’ compensation lawyer as there may be more than one direction to take your case to best represent your interests.

How to Get Help

If you are being denied coverage for a workplace injury based on a pre-existing injury or other grounds, you are not out of options. The experienced Maryland workers’ compensation lawyers at Berman | Sobin | Gross LLP are prepared to advocate for you. Schedule a consultation today.

Resource:

wcc.state.md.us/gen_info/wcc_benefits.html