Am I Still Entitled to Compensation If I Have a Pre-existing Condition

September 5, 2020

When you’re injured on the job, you may be entitled to receive workers’ compensation benefits. However, some employers or their workers’ compensation insurers may try to deny an injured worker benefits if he or she has a pre-existing condition. An injury caused by a pre-existing condition is generally ineligible for workers’ compensation benefits; however, if the pre-existing condition was not directly responsible for causing an employee’s injury, he or she may still be eligible to collect workers’ compensation benefits. Learn more below. 

Read more: What Is the Statute of Limitations on a Workplace Injury?

What Is a Pre-existing Condition?

A pre-existing condition includes any medical condition that a person has at the time of injury, or any aggravation of a previous injury or medical condition. In the realm of workers’ compensation, pre-existing conditions usually refer to old injuries that a worker suffered in the past, such as a rotator cuff tear or herniated disc.

The Effect of Pre-existing Conditions on Workers’ Compensation

Employees, particularly those at risk for suffering work-related injuries, must be aware of their pre-existing conditions, as the nature of the condition can affect whether an employee may be eligible for workers’ compensation for a future injury that occurs on the job.

A pre-existing condition caused by a prior work injury or occupational illness will typically not be a bar to a workers’ compensation claim for a future work injury, as the new injury will be considered an aggravation of a prior work injury or occupational illness.

However, if a preexisting condition is not work-related, it can complicate the process of seeking workers’ compensation benefits when the condition contributes to a new work-related injury. If your new injury on the job is deemed to merely be an aggravated of a non-work-related preexisting condition, you can generally expect to be denied workers’ compensation benefits. 

Claiming Workers’ Compensation with a Preexisting Condition

Fortunately, Pennsylvania has one of the more robust workers’ compensation systems for employees, paying more than the national average in workers’ compensation benefits. 

When you suffer an injury on the job and you have a preexisting condition, the process of filing a claim for workers’ compensation benefits begins the same as though you did not have a preexisting condition. Typically, you will notify your employer of your work accident and injury. Your employer will forward your claim to its workers’ compensation insurer (or process the claim in-house if your employer is self insured). 

The insurer will then investigate the claim, which may include a review of your medical records. If your records indicate that you have a preexisting condition that is not work-related and that your condition caused or contributed to your present injury, the insurer will likely deny your workers’ compensation claim. 

If your claim is denied, your next step would be to request a hearing before a workers’ compensation judge. You may likely need to obtain a medical expert who can testify as to the source of your preexisting condition — even if your preexisting condition was not caused by a prior traumatic injury at work, it may be related to wear-and-tear that you have suffered on the job, which could make your present workers’ comp claim compensable. However, you will need a physician to competently testify as to the causal link between your job and your preexisting condition. It’s important to note that if a new third party accident causes more damage to your injured body part, you can recover compensation for the increase in problems this new incident caused. At Goodrich & Geist, P.C., we can help. Contact our firm today for a consultation. 

Contact a Pittsburgh Workers’ Compensation Lawyer to Discuss Your Pennsylvania Workplace Injury Case

A workplace injury can be devastating, particularly if it prevents you from returning to work for an extended period of time. Although Pennsylvania Workers’ Compensation laws are supposed to provide you with reimbursement for medical expenses and replacement pay for missed time at work, it is not always easy to get the Workers’ Comp benefits you deserve. That is why you should speak with a knowledgeable Workers’ Compensation lawyer about your situation and get guidance throughout the claims process. The experienced Workers’ Compensation attorneys at Goodrich & Geist, P.C. represent clients in Pittsburgh and the surrounding Western PA counties. Call (412) 766-1455 or fill out our online contact form today to schedule a consultation about your work injury case. Our main office is located at 3634 California Ave., Pittsburgh, PA 15212.

The articles on this blog are for informative purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact our law firm directly.