How Do Pre-Existing Conditions Impact Workers’ Compensation?

man operating machinery

In Pennsylvania, workers’ compensation is available to covered workers who are injured on the job or who suffer work-related medical conditions. But what happens if you have a pre-existing medical condition that worsens due to your work duties? What if your pre-existing condition gets so bad, you are unable to continue working? Can you receive benefits through your employer’s workers’ compensation insurance for a pre-existing condition?

The answer depends on several factors, including your ability to prove the relationship between your work activities and the worsening of your pre-existing condition. This is critical, as workers’ comp benefits are only available for injuries and medical conditions—including aggravated pre-existing conditions—that are related to your employment.

What Is a Pre-Existing Condition?

In the context of workers' compensation, a pre-existing condition refers to any health condition or injury that an employee had before they started working at their current job. This includes chronic illnesses like diabetes or asthma, as well as prior injuries, such as a back injury or a previous fracture. Importantly, for a condition to be considered pre-existing, it must have existed before the employee began working in their current job or before a work-related incident exacerbated it.

Some common examples of pre-existing conditions include:

While having a pre-existing condition can make it somewhat more challenging to recover workers’ compensation benefits after a new work-related injury or aggravated condition, you are not exempt from benefits simply because of your pre-existing condition. However, you’ll have to prove that your pre-existing condition was aggravated by your work activities, resulting in a new injury.

What Is Considered an Aggravated Pre-Existing Condition?

An aggravated pre-existing condition occurs when a pre-existing health condition or injury worsens or is exacerbated due to work-related activities. When this happens, you could be entitled to workers' compensation benefits if you can demonstrate that your job-related duties or work environment significantly contributed to the worsening of your condition.

For example, consider a construction worker with a history of lower back pain from a previous injury. While performing heavy lifting as part of their job responsibilities, they experience a sudden increase in pain and stiffness in their back. Upon medical evaluation, it is determined that the physical strain of lifting heavy materials at work has aggravated their pre-existing back injury, leading to a more severe condition than before. In this scenario, the aggravation of the pre-existing back injury due to work-related activities would likely qualify the worker for workers' compensation benefits in Pennsylvania.

Similarly, consider a chef who has a history of carpal tunnel syndrome from years of repetitive motions in the kitchen. Over time, the chef's symptoms worsen due to continuous chopping and slicing tasks required by their job. The repetitive nature of these activities exacerbates their pre-existing condition, causing increased pain, numbness, and reduced hand function. In Pennsylvania, if it can be shown through medical evidence that the repetitive motions at work have aggravated the chef's pre-existing carpal tunnel syndrome, they may be eligible for workers' compensation benefits to cover medical treatment and lost wages resulting from the aggravated condition.

Generally speaking, when a pre-existing condition is aggravated by an employee’s working conditions, activities, or environment, the employee is considered to have a “new” work-related injury. However, employers often push back on this. They may claim that, because the employee had a pre-existing condition, they do not have a new work-related injury that qualifies them for workers’ compensation benefits. Because of this, it’s important to work with an experienced workers’ compensation attorney who can help you understand your rights and work to recover the full benefits you are owed.

Proving That Your Work Activities Aggravated Your Pre-Existing Condition

To qualify for workers' compensation benefits under these circumstances, it is crucial that you establish a clear link between your job duties or work environment and the aggravation of your pre-existing condition. This typically requires thorough documentation from medical professionals detailing how the work-related activities directly contributed to the worsening of your condition. Legal guidance from an experienced workers' compensation attorney can also be instrumental in navigating the complexities of proving aggravation of pre-existing conditions under Pennsylvania law.

Compensation for Aggravated Pre-Existing Conditions

Under Pennsylvania workers' compensation law, the presence of a pre-existing condition does not necessarily disqualify an employee from receiving benefits if the condition is aggravated, accelerated, or made worse by a work-related incident or environment.

In such cases, the employee may be eligible for compensation to cover:

  • Medical treatment
  • Rehabilitation costs
  • Lost wages
  • Temporary or permanent partial or total disability

However, it is crucial for employees to provide clear documentation and medical evidence linking the aggravation of their pre-existing conditions to their work activities to substantiate their claim.

Navigating workers' compensation claims involving pre-existing conditions in Pennsylvania can be extremely complex. Employees facing such situations should consider seeking guidance from experienced legal professionals to better understand their rights and more effectively navigate the process. Understanding the nuances of pre-existing conditions and their implications under Pennsylvania workers’ compensation law is essential for ensuring that employees receive the appropriate support and benefits they are entitled to in case of a work-related injury or aggravation of a pre-existing condition.

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