Can I Get Workers Comp for a Pre-Existing Condition?

Having a pre-existing injury or medical condition doesn't automatically disqualify you from workers compensation benefits. Many people with prior health issues successfully receive workers comp when their job aggravates or worsens their condition.

Workers compensation is designed to cover work-related injuries and illnesses. A pre-existing condition becomes eligible for benefits when:

If you had mild back pain before, but heavy lifting at work caused a herniated disc, workers comp may cover the worsening.

A degenerative condition that would have taken years to become disabling but became disabling quickly due to your job duties may qualify.

If you had an old injury that wasn't causing problems, but your work reactivated it, you may be covered.

Even if your pre-existing condition contributed to a new injury at work, you may still receive benefits.

Degenerative disc disease, old back injuries, arthritis, or previous herniated discs are common pre-existing conditions. If your job duties worsen your back problems, you may qualify for benefits.

Arthritis, old fractures, or previous joint injuries can be aggravated by repetitive motions, heavy lifting, or physical job demands.

If you had mild carpal tunnel that became severe due to repetitive hand motions at work, workers comp may cover treatment.

Pre-existing heart disease can be aggravated by work stress, physical exertion, or occupational exposures.

Depression or anxiety that worsens due to workplace stress or trauma may qualify for benefits.

Asthma or other breathing problems made worse by workplace fumes, dust, or poor air quality can be covered.

Most states use an "aggravation" standard. You don't need your job to be the sole cause of your condition—you just need to show that work aggravated, accelerated, or worsened it.

You had a knee replacement five years ago. The knee was fine until your new job required climbing stairs 50 times per day. The repetitive stress causes pain and requires a second surgery. This may be covered by workers comp.

You have degenerative disc disease that was mild and managed with occasional medication. After starting a job requiring heavy lifting, you develop severe pain and a herniated disc. Workers comp may cover your treatment and wage replacement.

You had depression that was controlled with medication. A traumatic incident at work causes severe anxiety and PTSD. The worsening of your mental health condition may be work-related.

To receive workers comp benefits for a pre-existing condition, you typically need:

Records showing you had the condition before your current employment.

Documentation from your doctor showing that your work duties made the condition worse.

Your treating physician should state that your job aggravated, accelerated, or worsened your pre-existing condition.

Evidence of what your job required you to do that affected your condition.

Insurance companies often try to deny claims involving pre-existing conditions by arguing:

They claim work had nothing to do with your current problems.

They argue the natural progression of your condition, not work, caused your current state.

Failing to mention a pre-existing condition on employment paperwork doesn't disqualify you from benefits, though it can complicate things.

While you do need medical evidence, insurance companies sometimes demand unrealistic levels of proof.

Tell your employer as soon as you notice your condition worsening due to work.

Get medical documentation of your worsening symptoms and their connection to your work duties.

Hiding a pre-existing condition can hurt your credibility. Acknowledge it and focus on how work made it worse.

Ask your physician to document in writing that your work aggravated your pre-existing condition.

Keep records of what your job requires you to do physically, especially activities that stress your pre-existing condition.

Note when your symptoms worsened and what work activities triggered problems.

Sometimes you don't know you have a degenerative condition until a work injury brings it to light. For example:

• An MRI after a work accident reveals degenerative disc disease you didn't know you had
• A fall at work shows you have bone density issues
• Repetitive work motions reveal arthritis you weren't aware of

The fact that you didn't know about the condition beforehand doesn't disqualify your claim. What matters is that your work injury or work duties triggered the need for medical treatment.

Some states apply an "eggshell plaintiff" rule to workers comp. This means your employer takes you as they find you. If you're more susceptible to injury due to a pre-existing condition, the employer is still responsible when work causes harm.

If you have brittle bones and a minor workplace accident causes a serious fracture, workers comp should still cover your injury even though someone without your condition might not have been hurt.

Consider hiring a workers comp attorney if:

• Your claim is denied because of a pre-existing condition
• The insurance company argues your condition is entirely pre-existing
• You need help gathering medical evidence
• Your doctor isn't clearly linking work to your worsening condition
• You're being pressured to accept inadequate benefits
• The insurance company disputes your disability rating

Lawyers experienced with pre-existing condition cases know how to present medical evidence, challenge insurance company doctors, and prove work aggravation.

If your claim is approved, you're entitled to:

For the work-related aggravation of your condition, including doctor visits, medications, physical therapy, and surgery if needed.

If you can't work while recovering.

If the work-related aggravation causes lasting impairment.

If you can't return to your previous job.

You're not entitled to treatment for the underlying pre-existing condition itself, only for the work-related aggravation.

Pre-existing condition cases can be complex, and insurance companies often use prior injuries as reasons to deny valid claims. If you're facing this situation, having an experienced workers compensation attorney makes a significant difference.

Dear Legal specializes in connecting injured workers with attorneys who understand the nuances of pre-existing condition claims. Answer a few questions about your situation, and we'll match you with lawyers in your area who have successfully handled cases like yours. The service is free, and there's no obligation to hire anyone.

Don't let insurance companies use your medical history against you. Get the legal help you need to prove your work-related aggravation.