Learn about your right to workers’ comp benefits if you have a pre-existing condition
Having a pre-existing condition can have a serious impact on your workers’ compensation claim. This is especially true when the pre-existing condition is of a similar nature to the injury you are claiming. The employer can try to show that the injury was caused by your pre-existing condition.
Employers do this because in Alabama, if the work accident is a contributing cause to the injury, the injury and the resulting disability are compensable, meaning you’re entitled to workers’ comp benefits. Maclin v. Bamsi, Inc., 644 So.2d 1 (Ala.Civ.App. 1994).
An employee in these situations only needs to establish causation for a work accident or a workplace injury to show that the strain or exposure to employment conditions was a contributing cause of the injury. Page v. Cox & Cox, Inc., 892 So.2d 413 (Ala.Civ.App. 2004); Fort James Operating Co. v. Kirklewski, 893 So.2d 434 (Ala.Civ.App. 2004).
Thus, employers will try to show that your injury was not a result of the work-related injury at all but rather caused by a continuation of your pre-existing injury.
What’s a pre-existing condition or injury?
A pre-existing condition, in its simplest terms, just means that before the injured worker had an accident or became symptomatic with injuries or conditions from a workplace situation, they had some type of medical situation, medical care, surgery, physical therapy, or whatever it may be (before coming into the workplace or having that accident) that led to the injuries that are now at issue.
How employers try to use pre-existing conditions to deny claims
The pre-existing injury defense is used way too commonly by insurance companies to deny legitimate workers’ compensation claims.
Very commonly, the pre-existing defense or this issue deals with prior knee injuries, back injuries, shoulders, et cetera. An example would be if an employer denied a workers’ comp claim because it came out through the discovery (medical records, testimony, etc.) that the injured worker had had prior back surgeries in the past.
Fortunately, it doesn’t matter if there were prior back injuries, back surgeries, et cetera. If the person could do all of what was expected of them at work and had no limitations at the time they got re-injured in the workplace, then the pre-existing injury defense should fail, meaning it should be a compensable claim.
How to combat a pre-existing injury defense
Fortunately, a pre-existing injury defense can be defeated by showing that the prior injuries had nothing to do with the current injury claim.
Additionally, if the pre-existing injury has been aggravated or exacerbated by the accident at work, then the claim would still be compensable. However, all of these opinions must be supported by the treating physician.
In the state of Alabama, it’s not necessary that the employee show that the on-the-job incident was the sole reason for the injury, only that the injury was caused, in some part, by the work-related incident.
The main requirement for your claim is that the work-related injury contributed to the current condition of the injury. It’s important to note the difference between pre-existing conditions from outside work and work-related injuries. As long as your employment contributed to your injury, the employer will be responsible for your medical bills.
For example, when you have a pre-existing back injury and a work-related injury takes place that makes this injury worse, you can have a claim for the worsening of your pre-existing injury. If the work-related injury makes your pre-existing condition bad enough to keep you from continuing to work, you can make a disability claim for the new injury.
It’s crucial to discuss with your doctor the history of the injury and how the injury was made worse by the at-work injury.
What must be proven to get workers’ comp benefits for a pre-existing injury?
You do not have to have a “perfect back” just prior to having an on-the-job accident that injures your back in order to receive workers’ compensation benefits. If you’re able to perform the duties of your job in a normal manner prior to an on-the-job accident, then your workers’ compensation claim is compensable pursuant to Alabama law.
Typically, we have to take the doctor’s deposition or get a written opinion from the doctor to figure out whether or not the pre-existing injuries themselves caused or contributed to the current injuries that are going on. It could be a brand new injury, even if it is the same body part (or the same level on the back).
Additionally, even if you had a pre-existing medical condition at the time of the accident that caused the current issues that are going on in the claim, if the accident itself aggravated or exacerbated a pre-existing condition, then that too could be a compensable claim.
And again, a lot of these terms—exacerbated, aggravated, et cetera—are not common terms that everyone uses. They’re very specific to workers’ comp cases. Because of this, it’s essential to consult with a knowledgeable work injury attorney who can explain your rights and help you understand how your pre-existing condition could impact your workers’ comp claim.
Get help from an experienced Alabama workers’ compensation attorney
If you have questions or concerns about whether or not your pre-existing medical conditions are the cause or may be the reason for the denial of a workers’ comp claim, contact the experienced work injury attorneys at Nomberg Law Firm. We can evaluate your claim, help you gather evidence and file an appeal.
Get started today by scheduling your free consultation.