Aggravation of Pre-existing Conditions

One of the most common reasons an insurer will deny a claim for workers’ compensation in Boston is that an employee’s injury stems from a pre-existing condition, rather than a work-related injury. Workers’ compensation will not pay benefits for a solely pre-existing condition, but if the employee has an aggravation of a pre-existing condition due to his or her job, this can be the basis for filing a valid workers’ compensation claim.

To be covered by workers’ compensation, the injured worker must show that the work-related injury was a major cause of the medical condition for which the injured employee is asserting a claim for benefits. A pre-existing condition will not necessarily preclude an injured worker with a pre-existing condition from obtaining Boston workers’ compensation benefits. This is a fact-specific analysis so employees should speak with an experienced workers’ compensation attorney in their respective jurisdictions about their actual injuries or illness to determine whether they have a valid claim for a fair and appropriate award of workers’ compensation benefits.

Common pre-existing conditions include vision and hearing problems, repetitive stress injuries (RSIs) such as carpal tunnel syndrome, and neck and back injuries. The foregoing list of pre-existing conditions includes diagnoses that are often exacerbated by work. For example, someone that has served in the military may be at a high risk for hearing loss and it is not uncommon for them to leave the service with a significant loss of hearing. Later in life, a veteran with hearing loss might work in a factory that involves working with loud noises. This may result in the employee suffering an additional hearing loss. An employer might argue that the employee simply had a pre-existing condition and deny worker’s compensation benefits. While this would be an issue, it may not preclude an injured employee from obtaining a full and appropriate award of workers’ compensation benefits. The occupational exposure to loud noises will need to be a major cause of the employee’s hearing loss. This is situation would involve an aggravation of a pre-existing condition due to an occupational injury.

Insurers often argue that an employee’s ailment is only due to a pre-existing condition, and not an on-the-job accident or work-related illness. Our workers’ compensation attorneys know, having extensive medical documentation will be crucial in obtaining a successful outcome.

The first thing an injured employee should do is to make sure his or her treating physician, and any other specialists they treat with, prepare a detailed report of the injuries and the cause of said injuries. The documents should clearly state the current injury is work-related if that is the doctor’s opinion. If the employee’s medical records indicate a history of that type of medical condition, then an opinion that the current condition was a work-related worsening of that condition will also be extremely helpful. After obtaining this note, a claim can be filed to obtain workers’ compensation benefits.

The workers’ compensation insurer will have 15 to 30 days from the time a claim is submitted to either pay the requested benefits or to deny the claim. If the claim is denied, the employee will have to file a claim with the Massachusetts Department of Industrial Accidents (DIA).

The employee may submit prior medical records in order to show that the on the job accident is, in fact, a major cause of the present injury or illness.

Contact the Jeffrey Glassman Injury Lawyers today for a free and confidential consultation.