Can You Get Workers' Comp for a Pre-Existing Injury?

What Is a Pre-Existing Injury?

A pre-existing condition is any injury you had before your workplace accident that is in the same part of your body and may have some lingering effect on it. Sources of pre-existing injuries include past accidents, sports injuries, and congenital disabilities. Common examples of pre-existing conditions include:

Back injuries

Tendonitis

Broken bones

Torn ligaments

Degenerative joint disease

Cartilage damage

Slipped discs

Joint disease

Diabetes

Respiratory conditions

Cardiovascular disease

An injury doesn’t have to exist for a specific timeframe to count as a pre-existing injury. As long as the injury existed before the specific workplace accident that is the subject of your current claim, it is a pre-existing injury for the purposes of workers’ compensation insurance.

Will Workers’ Comp Cover a Pre-Existing Injury?

“[W]hen an employee afflicted with a pre-existing disease or infirmity suffers a personal injury by accident arising out of and in the course of his employment, and such injury materially accelerates or aggravates the pre-existing disease or infirmity and thus proximately contributes to the death or disability of the employee, the injury is compensable, even though it would not have caused death or disability to a normal person.” Anderson v. Northwestern Motor Co., 233 N.C. 372, 374, 64 S.E.2d 265, 267 (1951). “When a pre-existing, nondisabling, non-job-related condition is aggravated or accelerated by an accidental injury arising out of and in the course of employment or by an occupational disease so that disability results, then the employer must compensate the employee for the entire resulting disability even though it would not have disabled a normal person to that extent.” Goforth v. K-Mart Corp., 167 N.C. App. 618, 622, 505 S.E.2d 709, 712 (2004) (citing, Morrison v. Burlington Industries, 304 N.C. 1, 18, 282 S.E.2d 458, 470 (1981). So if a workplace accident makes your pre-existing condition worse, you could still access medical and income replacement benefits through workers’ compensation (Ruffin v. Compass Group USA, 150 N.C. App. 480, 481, 563 S.E.2d 633, 635 (2002)).

For example, imagine you have been previously diagnosed with arthritis of the knee, but it doesn’t currently limit your ability to work. During a slip-and-fall accident at work, you suffer a meniscus tear in your knee. The tear from this accident creates new symptoms, requiring surgery and leaving you unable to perform your job duties. In this case, workers’ compensation should cover your aggravated arthritis. Even though the workplace accident didn’t cause the arthritis, it made it significantly worse than it would have been otherwise. The accident exacerbated the condition, converting a non-disabling condition into a disabling condition.

How a Pre-Existing Condition May Affect Your Workers’ Comp Claim

One of the most challenging parts of making a workers’ comp claim when you have a pre-existing condition is proving that the work accident aggravated it. This means demonstrating that your pre-existing condition is now worse than it would have been if the recent work-related injury had not occurred.

Medical documentation and expert medical testimony are crucial pieces of evidence to prove your claim. For example:

Documentation, such as imaging results or lab reports, can show differences in your pre-existing condition before and after the workplace accident.

Medical records showing that you reported new or more intense symptoms to your doctor after the injury can support an aggravation of a pre-existing condition.

Your medical provider can testify about how the workplace accident worsened the progression of your pre-existing condition.

However, even with sufficient evidence, you may struggle to get your employer’s workers’ comp insurer to accept your claim. They will look for any way to deny your rightful benefits, and a pre-existing condition is a common excuse. Having an experienced workers’ compensation attorney on your side is crucial to protect your rights and make a solid case.

Examples of Pre-Existing Conditions That Might Qualify for Workers' Comp Benefits

Here are some examples of pre-existing conditions that may qualify for workers’ compensation coverage, depending on the circumstances:

Arthritis – Arthritis can take many years to develop and may not start showing symptoms until much later. When a workplace accident significantly aggravates existing arthritis, it may be eligible for workers’ compensation benefits.
Back injuries – Many adults suffer from chronic back pain, and it is very easy to aggravate a previously existing back injury in an accident. For instance, a lifting accident at work can severely worsen a degenerative spine and require back surgery.
Joint problems – Injuries to the knees, shoulders, elbows, and ankles can cause joint problems and long-term mobility issues. They can easily become exacerbated in a workplace accident, such as slipping and spraining an ankle that had previously been broken.

How to Protect Your Right to Workers’ Comp Benefits with a Pre-Existing Condition

Despite the fact that pre-existing injuries can qualify for workers’ compensation, the insurance company will likely try to deny your claim. Insurance companies always aim to maximize profits, so there is a good chance they will issue a denial – even if your pre-existing injury was aggravated by a work accident. Here are some tips on how to minimize the chances of receiving a claim denial:

Report the injury as soon as possible. The longer you delay reporting, the more likely it is that the insurance company will dispute your claim. They may use the delay to dispute timelines and downplay the severity of the injury.
Get as much medical documentation from your doctor as possible. You need evidence that the work accident aggravated your previous injury. Relevant documentation includes imaging results, lab reports, doctor’s notes, and intake/discharge paperwork.
Be honest about your pre-existing injuries and limitations. Concealing pre-existing conditions or faking your symptoms to obtain benefits will only hurt your case and get you in legal trouble.
Follow any treatment plans, including medications and rehabilitative exercises. If you fail to follow medical advice, the insurance company could claim your workplace injury is not as serious as you say it is.
Respond promptly to any requests from the insurance company. They may ask you to submit additional medical documentation. If you fail to respond, they could deny your claim.
Avoid talking about your case. That includes making public social media posts about your injuries. Even a seemingly harmless statement can be twisted into evidence against the claimed extent of your injuries and conditions.
Contact a workers’ compensation lawyer. An attorney can help you gather proof and communicate with insurers on your behalf during the claims process. They can also help you appeal claim denials and represent you in hearings.

Was Your Workers’ Comp Claim Denied Due to a Pre-Existing Injury?

If your workers’ compensation claim was denied, it’s important to not panic and assess the situation rationally. An attorney can help you appeal the claim and fight for a reconsideration.

When the insurance company denies your claim, they will send a letter explaining their reasons for denial. Review this letter to see what other documentation you need, which could include additional medical records or expert testimony.

The next step for your attorney is filing a formal appeal. In North Carolina, you can file a request for an evidentiary hearing with the North Carolina Industrial Commission (NCIC) using Form 33. The Commission may order the parties to attend mediation to attempt to resolve the claim before the hearing. When you file an appeal, the NCIC schedules a hearing with a deputy commissioner, where your attorney will present evidence and arguments supporting your claim. If your claim is still denied at the hearing, your attorney can escalate the appeal to the Full Commission and then the NC Court of Appeals.

Call Our Raleigh Workers’ Comp Attorneys for Assistance

If you are currently in a workers’ comp injury dispute or would like assistance filing a workers’ comp claim, contact the attorneys at Younce, Vtipil, Baznik & Banks, P.A. We have over 90 years of collective experience helping injured workers access the benefits necessary to recover from their injuries and manage their lives. Although each case is different and past results cannot guarantee a future outcome, we have secured compensation for electrical workers, transportation workers, office employees, and more, including a $2.625 million workers’ compensation settlement. Here is what one satisfied client had to say about our work:

“Excellent communication and was very effective in analyzing the situation and working diligently to resolve the issues. I was very pleased with the professionalism and expertise of the staff and highly recommend them.” – Theodocia Shabazz

With our legal knowledge and state-of-the-art case tracking system, we can pursue your claim efficiently and protect your rights throughout the process. Contact our offices online or call (919) 661-9000 for a free case consultation with a Raleigh workers’ compensation attorney.