A workplace accident can turn a manageable pre-existing condition into a serious disabling problem. When that happens, many employees assume that their prior medical history will disqualify them from collecting workers’ comp benefits. North Carolina workers’ compensation law says otherwise.
If a work accident aggravated your pre-existing condition, you could be entitled to benefits for the worsening of that condition, regardless of your health history before the accident. However, the exact details depend on the case, and not all injuries that affect pre-existing medical conditions are eligible for workers’ compensation coverage.
Here’s what you need to know about how the North Carolina Industrial Commission (NCIC) handles these cases, the kinds of evidence that could support your workers’ compensation claim, and what benefits may be available.
How North Carolina Determines Whether an Aggravated Pre-Existing Condition Is Compensable
Unlike the typical workers’ comp case, aggravation of a pre-existing condition injury claims involve a non-job-related prior condition. The key to determining whether the aggravated condition is compensable is whether it was worsened to the point of disability because of a work accident or occupational disease.
In Anderson v. Northwestern Motor Co., the North Carolina Supreme Court held: “[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.”
The North Carolina Court of Appeals reaffirmed this standard in Goforth v. K-Mart Corp. and in Ruffin v. Compass Group USA, “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.”
Medical causation is what ties these pieces together. To have a valid claim, a physician must connect the accident to your worsened condition.
How Do You Prove a Work Injury Aggravated a Pre-Existing Condition?
When it comes to pre-existing conditions and workers’ compensation, these cases typically require more documentation than straightforward work injury claims. Insurance companies frequently argue that claimants’ current pain and limitations stem entirely from prior conditions rather than the workplace accidents at issue.
Strong medical evidence can make all the difference in proving otherwise, including:
- Medical records from before the accident that establish the nature and extent of your condition prior to the workplace incident
- Medical records from after the injury showing that your condition significantly worsened
- Diagnostic testing results that show a measurable change in the severity of your condition
- Physicians’ opinions that the accident more likely than not significantly aggravated your condition
- Proof of work restrictions you have experienced since the accident that did not exist before
- Proof of functional changes, such as any decline in your ability to perform routine daily activities or job duties compared to before the accident
What Benefits May Be Available If Your Claim Is Approved?
If a workers’ compensation claim involving the aggravation of a pre-existing condition is approved, several types of benefits may be available, including:
- Any reasonable medical expenses should be covered if they’re related to the worsening of the condition or any other injuries the accident directly caused. This includes the costs of treatments, medications, therapy, and any related care tied to the workplace injury.
- Wage-replacement benefits may also be available if the aggravation of your condition prevents you from earning your usual wages. These benefits typically cover a portion of your average weekly wages, subject to statutory limits and eligibility rules. The duration of wage-replacement benefits depends on whether your disability is temporary or permanent and total or partial.
Every claim is unique, and the workers’ compensation benefits available to you will depend heavily on the specific medical findings in your case and the requirements of your job.
What Should You Do If a Work Injury Makes an Existing Condition Worse?
A claim for a workplace accident that aggravates an old injury can be far more complicated than a standard workers’ compensation claim. The good news is that you can take certain steps to strengthen your claim and protect your access to benefits from day one.
Here’s what you should do:
- Report the accident to your employer as soon as possible (ideally no later than 30 days post-accident).
- Seek medical treatment from an employer-approved provider.
- Tell your provider about your prior condition and how the accident changed it.
- Follow all treatment recommendations and attend every follow-up appointment.
- Keep copies of all medical records and bills relating to the incident.
- Contact a North Carolina workers’ compensation attorney before you speak with any insurer.
Call Our Workers’ Compensation Lawyers in Raleigh, NC to Get Help Today
The attorneys at Younce, Vtipil, Baznik & Banks have more than 100 years of combined experience helping injured workers throughout North Carolina pursue the compensation they deserve, even in complex cases involving pre-existing conditions. We have secured millions of dollars for injured employees to date, including:
- A $2,625,000 settlement in a workers’ compensation claim tied to a construction accident
- A $700,000 workers’ comp settlement for a construction accident that resulted in a traumatic brain injury
- A $600,000 settlement in a previously denied workers’ comp case involving a worker who suffered paraplegia after an on-the-job fall*
Our team knows how to build a strong record of medical causation and stand up to insurance companies that try to avoid paying what claimants are owed. The people we represent notice the difference. As one former client of ours put it:
“Mr. Vtipil was great! Very kind, calm, knowledgeable, and actually cares about you as a person! This law firm is very organized as well. Highly recommend!”– Lanie Luck
If a workplace accident has made your existing condition worse, let our experienced workers’ compensation attorneys fight for the compensation you deserve. Contact us today for a free case evaluation to get started.
*Each case is unique, and past results do not guarantee future outcomes.
