Do Pre-Existing Conditions Affect Your Workers’ Comp Claim in New York

What is a Pre-existing Condition?

A pre-existing condition, in the context of a worker’s compensation claim, is any condition or injury that existed before the workplace injury.  For example, you may have had an injury from a car accident that happened several years before you were injured on the job.  The injury from the car accident is a pre-existing condition. 

A workplace accident may aggravate or worsen an existing condition or injury.  In cases like this, many insurance companies will attempt to point to the pre-existing condition as the cause of pain or injury rather than the workplace accident. 

Many people assume that they cannot succeed on a workers’ comp claim because of their pre-existing condition.  This is not the case, and rest assured your claim for workers’ compensation is not doomed because of a pre-existing injury or condition.

The Law on Pre-Existing Conditions in a New York Worker’s Comp Claim

Workers’ compensation benefits are benefits paid to employees who have been injured in a workplace accident. These benefits are typically paid out by insurance companies, and these workers’ compensation insurance companies will look for any reason to deny coverage, including pre-existing conditions.

The law in New York does not make a pre-existing condition a bar to a workers’ comp claim. Instead, if the workplace accident aggravates or worsens an existing condition, the employee is typically still entitled to coverage for any lost wages or medical expenses.

Potential Issues with Pre-Existing Medical Conditions in a Workers’ Compensation Claim

Although the law allows for employees to recover for a pre-existing injury or condition that is worsened or aggravated by a workplace injury, insurance companies are skilled at finding ways to deny a claim.  There are a few ways that insurance companies can still attempt to deny a claim because of a pre-existing injury.

• The pre-existing condition caused the injury. Insurance companies will look through your medical history and employment history to determine whether the injury was caused by the workplace accident, or whether the pain or injury you are experiencing is because of the condition or injury you already had.  They may use medical experts, your own medical records, and employment records detailing difficulty working because of the previous condition or injury.

• Your worsened pre-existing condition is unrelated to the workplace accident. A worsened or aggravated pre-existing condition or injury is only covered under a workers’ comp claim if it is related to the accident on the job.  If you had a pre-existing knee injury but you suffered a cut to your hand on the job, it is unlikely that the cut worsened your knee pain.  In this instance, even if your knee pain has worsened after the injury, the insurance company would likely deny the claim.

• The pre-existing injury or condition developed very closely to the time of the workplace accident. If you were injured or developed a condition a very short time before the accident, the insurance company may claim that the pain you are experiencing is because of the pre-existing condition and that your old injury has not fully healed.

• You were not medically cleared to work. If you suffered from an injury or condition, and you were working against doctor’s orders at the time of the workplace accident, the insurance company will likely deny your claim.

The Right Way to Process Workers’ Comp Claim with a Pre-existing Condition

If you have been injured on the job and a pre-existing condition has been worsened from the injury, there are a few things you can do to ensure the best results possible for your case.

• File your claim for workers’ compensation as soon as possible. It is important to report your injury and file a claim as soon as possible after the accident or injury. 

• Get medical attention. Getting medical attention for your injuries from an experienced workers comp doctor will help to document any injuries or conditions you have right after the accident, and will help to bolster your case. 

• Inform the doctor about any pre-existing conditions. Let your worker’s compensation doctor treating your injuries know about any pre-existing injuries or conditions you have, and make sure to let them know about any symptoms or injuries that have worsened or changed after the accident.

• Follow up with your pre-existing condition treatment provider. If possible, a follow-up visit to the person who treated your original condition or injuries is suggested.  This will help you have a record of any changes you have experienced in your symptoms or injuries since the accident.

Contact an Experienced Workers' Comp Attorney

Don’t rely on insurance companies without doing your research. A good workers compensation attorney in New York can interpret the laws to your benefit, and make sure your case is as successful as possible. If you have been injured in a workplace injury, don’t let an insurance company deny you for a pre-existing condition. An experienced workers’ comp attorney can walk you through the process, and make sure you get the right treatment and benefits that you are entitled to.