Can A Workers’ Compensation Claim Be Filed For A Pre-Existing Condition?

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When you get hurt on the job you are entitled to workers compensation benefits that cover the cost of your medical care and provide income replacement while you’re out of work recovering. But what if you have a pre-existing condition that your job makes worse? Can you receive benefits for that too?

As a general rule you can only receive workers comp benefits in Virginia if you suffer an “injury by accident” at work. An “injury by accident” is defined as a sudden, specific event that causes an obvious structural or mechanical change to the body. The mechanical change can be anything from swelling to a broken bone.  But if the injury by accident aggravates, accelerates, or exacerbates a pre-existing condition like arthritis, you may be entitled to workers’ comp benefits.

Your Employer Must Take You As It Finds You

If you’ve worked in physical jobs for most of your life, have been involved in past motor vehicle accidents, undergone prior surgeries, or have reached the age of 40, then you likely have some degenerative disc disease or degenerative joint disease. This is also called arthritis.

Under Virginia workers compensation there is no distinction between employees who are 100% healthy when hired and employees who have pre-existing conditions. Your employer must accept your condition when it hires you. If you get hurt on the job your employer cannot avoid liability just because you have prior injuries. An aggravation or worsening of your preexisting condition is covered under workers comp if it is the result of an injury by accident arising out of and in the course of your employment. Worsening caused by repetitive motion, however, is not covered under Virginia workers’ comp.

For example, many construction workers have to undergo back surgery because of the nature of their jobs. If they return to work after surgery, but suffer a new injury by accident while lifting heavy materials or because of a fall from a ladder, they can receive workers comp benefits if the new injury aggravates their old condition. I’ve been able to obtain benefits for several construction workers in this situation over the past few years.   

If an aggravation of a pre-existing is covered, why is the insurance company denying my claim for benefits?

Though you may be entitled to workers’ comp for the aggravation of a pre-existing condition, the insurance company may still deny your claim. If your claim has been denied on this basis it is important that you contact an experienced Nassau County workers comp attorney. Your attorney can work with you and your treating physician to develop the evidence and build your case.

2017-11-28_10-56-04Thanks to our friends and contributors from Polsky, Shouldice & Rosen, P.C. for their insight into