Having a preexisting medical condition does not necessarily prevent you from receiving workers' compensation benefits in California. Employees bring their medical histories with them to work, and a workplace injury can aggravate, accelerate, or otherwise affect an existing condition.
The difficult part is often determining how much of the worker's current condition is connected to the job and how much existed beforehand. Employers and insurance companies may closely examine prior injuries and medical records when a workers' compensation claim involves the same part of the body.
At Nantha & Associates, we help California workers understand how prior medical conditions can affect a claim and what evidence may be necessary when an insurer disputes the connection between a workplace injury and a worker's current symptoms.
Can You Get Workers' Comp if You Already Had an Injury?
A prior injury does not automatically disqualify someone from workers' compensation. The important question is what happened at work and whether the employment caused a new injury or contributed to a worsening of an existing condition.
Consider an employee who already has a history of lower back problems. If a workplace incident significantly worsens the employee's symptoms or causes additional injury, the existence of previous back pain does not necessarily mean the new condition is unrelated to work.
Preexisting conditions that may become relevant in a California workers' compensation case can include:
- Previous back or neck injuries
- Arthritis and degenerative joint conditions
- Prior knee or shoulder injuries
- Previous surgeries
- Carpal tunnel syndrome
- Degenerative disc conditions
- Old fractures
- Chronic pain conditions
- Previous workplace injuries
The medical history matters, but it is only part of the analysis. What changed because of the worker's employment can be equally important.
What Does It Mean to Aggravate a Preexisting Condition?
An aggravation occurs when workplace activity or an accident makes an existing medical condition worse. This can happen through one sudden incident or through repeated physical demands over time.
For example, an employee with an existing knee condition might slip at work and suffer additional damage to the same knee. Another worker with a degenerative back condition might experience increasingly severe symptoms after months or years of repetitive lifting.
An aggravation can involve more than a temporary increase in discomfort. Depending on the circumstances, work may cause additional impairment, create a need for new treatment, or accelerate a condition that previously caused relatively minor limitations.
Our California workers' compensation attorneys can review the medical and employment evidence when an insurer argues that an employee's symptoms are solely the result of a preexisting condition.
How Do Doctors Determine Whether Work Made a Condition Worse?
Medical evidence is particularly important when a workers' compensation claim involves a preexisting condition. A doctor may need to determine the employee's condition before the workplace injury, what happened at work, and how the worker's health changed afterward.
This can require more than simply reviewing the employee's current symptoms. A physician may compare previous medical records with current examinations, imaging, diagnostic testing, and the worker's description of the workplace incident.
Information that may be relevant includes:
- Medical records from before the work injury
- X-rays, MRIs, and other diagnostic tests
- Records documenting symptoms before and after the incident
- The worker's job duties
- The physical demands of the job
- Prior surgeries or treatment
- Current physical limitations
- Medical opinions regarding causation
Workers should provide accurate information about prior injuries. Attempting to conceal a previous condition can damage credibility and create additional problems if the insurance company later discovers the records.
What Is Apportionment in California Workers' Compensation?
Preexisting conditions can become particularly important when determining permanent disability. California workers' compensation law uses the concept of apportionment when evaluating the causes of permanent disability.
In general, the analysis may consider what portion of the permanent disability resulted from the work injury and what portion resulted from other factors. Those other factors can include certain preexisting conditions or prior injuries.
This means a worker may establish that a workplace accident caused an injury but still encounter a dispute over the extent to which the resulting permanent disability should be attributed to that accident.
Apportionment can become medically and legally complicated. The existence of a degenerative condition on an MRI, for example, does not by itself answer every question about what caused the worker's current disability. Medical evidence must address the relevant factors and explain the basis for the conclusions reached.
Can an Insurance Company Deny a Claim Because of a Preexisting Condition?
An insurance carrier may dispute a claim by arguing that the employee's symptoms are caused by an old injury, age-related degeneration, or another condition rather than work.
That argument does not necessarily mean the claim is invalid.
Disputes involving preexisting conditions commonly focus on questions such as:
- Did a workplace incident cause a new injury?
- Did work aggravate an existing condition?
- Were the worker's symptoms significantly different before the incident?
- Did the employee require new treatment after the workplace injury?
- Did the worker develop new physical restrictions?
- What do the medical records show about the change in condition?
A denial should be evaluated based on the medical evidence and the circumstances of the injury. Workers should not assume that an insurance company's initial decision necessarily resolves the issue.
What if You Had No Symptoms Before the Workplace Injury?
Some workers have underlying medical conditions that caused few or no noticeable symptoms before a workplace accident.
For example, diagnostic imaging after an injury might reveal degenerative changes in the spine. An insurer may point to those findings as evidence that the employee's condition existed before the accident.
However, the presence of an underlying condition and the cause of the worker's current symptoms are not necessarily the same question. A person may have had degenerative changes without significant pain or work limitations until a workplace incident occurred.
Evidence showing that the employee was performing regular duties without significant problems before the injury can provide important context. Medical records documenting a sudden change in symptoms, treatment needs, or physical limitations can also be relevant.
Do You Have to Disclose Previous Injuries?
Workers should be truthful about their medical history when pursuing a workers' compensation claim.
Doctors evaluating the injury may ask about previous symptoms, accidents, surgeries, and treatment involving the same body part. Insurance companies may also obtain relevant medical records during the claims process.
Workers should be prepared to provide accurate information about:
- Previous workplace injuries
- Prior car or recreational accidents
- Earlier surgeries
- Chronic medical conditions
- Treatment involving the injured body part
- Previous periods of disability or work restrictions
Disclosing a prior injury does not mean admitting that the current condition is unrelated to work. Accurate information allows doctors to compare the employee's condition before and after the workplace incident.
What if You Previously Filed a Workers' Compensation Claim?
A previous workers' compensation claim can add another layer to the case, particularly if it involved the same part of the body.
The insurance company may review records from the earlier claim to determine the employee's previous diagnosis, treatment, work restrictions, and permanent disability. Those records may also show whether the worker recovered and returned to regular duties before the new injury occurred.
A prior claim does not automatically prevent a worker from pursuing benefits for a later workplace injury. Employees can experience multiple legitimate injuries during their careers.
The challenge is determining which condition or incident is responsible for the worker's current treatment needs and disability.
What Can Strengthen a Claim Involving a Preexisting Condition?
Documentation is particularly valuable when an insurance company disputes whether work aggravated an existing condition.
Workers should report workplace injuries promptly and explain accurately how their symptoms changed. They should also attend medical appointments and follow treatment recommendations so there is a clear record of the condition's progression.
Helpful documentation may include medical records, diagnostic testing, written work restrictions, incident reports, witness information, and records showing the employee's duties before and after the injury.
Workers should also keep track of significant changes in their abilities. If someone could regularly lift, stand, walk, or perform other job functions before an accident but can no longer do so afterward, that change may be important to the medical and legal analysis.
Talk to Our California Workers' Compensation Attorneys
If you are dealing with a workplace injury that aggravated a preexisting condition, our attorneys are here to help. We can review your medical and employment history, explain how California workers' compensation law may apply, and help you pursue the benefits available for a work-related injury. Call us today or connect with us online to schedule a consultation.
