Have A Pre-Existing Condition? What You Need To Know About Workers Comp

5 August 2016
 Categories: Law, Articles


Workplace injuries are stressful. You're coping with the pain and limitations of the injuries and you're unable to work, so you would hope that the process of getting compensation and getting your medical bills paid by workers comp would be a simple one. Many times it is simple, but if you had a pre-existing condition before your workplace injury occurred, you could face additional hurdles. Take a look at a few things you should know about claiming workers compensation when you have a pre-existing condition.

Medical Bills

When it comes to getting your medical bills paid, you should be aware that workers comp will only pay for the treatment of the new injury. That's not a problem if your pre-existing condition is a shoulder injury and the new workplace injury is a foot injury. Your workers comp will pay for the foot injury and you'll pay for any shoulder treatments you need with your regular health insurance or out of your pocket. However, if you have a pre-existing shoulder injury and you injure that same shoulder at work, it can get complicated.

Your new injury might worsen the pre-existing injury, and if so, your workers compensation will pay for the medical care that you need to treat that. However, if you still also need treatments that relate only to the pre-existing condition, those would not be covered by workers compensation. Your doctor will need to indicate whether the worsening of your condition is temporary or permanent, and which treatments pertain to the new injury as opposed to the old one. It's a good idea to choose a doctor who is experienced with treating work-related injuries – they'll understand the workers compensation rules and know the specific terminology to use to ensure that your claim gets paid.

Permanent Partial Disability

In addition to covering medical bills, workers compensation may also pay a lump sum or structured settlement if you sustain what's called a permanent partial disability. A permanent partial disability is what you have when your on-the-job injury does not leave you completely disabled or unable to work, but does prevent you from returning to your former position. Because you can no longer perform the same job, you may have to accept a job that pays less. Permanent partial disability payments are compensation for that diminished earning capacity.

Permanent partial disabilities are rated on a scale of one to 99 (100 would be total disability). The award you receive is based at least in part on that rating – for example, an injury that leaves you with a permanent partial disability that's rated a 10 would be worth less than a partial disability that's rated an 80. However, if your pre-existing condition has already left you with a permanent partial disability, then your award will be adjusted based on that. For instance, if a previous injury left you with a permanent partial disability that was rated 25, then your new on-the-job injury worsened your condition, bringing your permanent partial disability rating to 50, you won't receive a permanent partial disability award based on the 50 rating – instead, you'll receive an award that reflects the 25-point change in your permanent partial disability status.

How To Handle Your Claim

Most of the workers compensation claim process isn't that much different for a person with a pre-existing condition than it is for a person without a pre-existing condition. You should still alert your employer to your injury immediately, or as soon as is reasonable possible. You should still put the notification of your injury in writing. Your employer should provide you with the forms you need to file a workers compensation claim as soon as you report an injury – if they do not offer these forms, be sure to ask.

One difference for workers with pre-existing conditions is that it's very important that you give your doctor all the relevant information about your pre-existing condition. Depending the workers compensation rules in your state, you may have to choose from a list of doctors provided by your employer – if your regular physician isn't among the choices, you'll need to make sure that they get a copy of your medical records relating to the pre-existing condition.

If the new condition and the pre-existing condition both require treatments, you may need to see two different doctors. This can happen if your original doctor is covered by your regular health insurance, but not by workers compensation, and the doctor you're seeing for your workplace injury is covered by workers compensation, but not your regular health insurance. This can be frustrating, but it will also ensure that you pay as little out of pocket for your medical care as possible. Just make sure that all the physicians you see are kept in the loop about treatments and medications prescribed by other doctors.

Because new injuries to workers with serious pre-existing conditions can become complicated workers compensation cases, you should consider hiring an experienced workers compensation attorney from a law firm like Prediletto, Halpin, Scharnikow & Nelson, P.S. to guide you through the claims process. Working with an attorney is the best way to make sure that your rights are protected and you get the benefits you deserve.