Impact of Preexisting Ailments on Workers' Compensation Claims
Workers' Compensation Claims and Pre-Existing Conditions: What You Need to Know
When it comes to workers' compensation claims, having a pre-existing condition can complicate the process and potentially impact the outcome. Insurance companies often scrutinize medical records intensely to argue that the current injury is a natural progression of the pre-existing condition rather than a new work-related injury.
Heightened Insurance Scrutiny
Insurers search for past medical documentation referencing the same body part or condition to deny or minimize the claim. This heightened scrutiny can increase the risk of claim denial.
Independent Medical Examinations (IME)
Insurance carriers often require an Independent Medical Examination (IME), where doctors may attribute symptoms to the pre-existing condition, potentially jeopardizing benefits if the opinion goes unchallenged.
Apportionment of Disability
At permanent disability assessment, insurers may try to reduce workers’ compensation benefits by "apportioning" some impairment to the pre-existing condition rather than the workplace injury. For example, benefits may cover only the increase in impairment caused by the work injury.
Credibility Issues
The defense might claim the claimant concealed pre-existing injuries or conditions, affecting judges’ causation decisions during hearings.
However, some jurisdictions apply standards that prioritize the work-related injury even if a pre-existing condition exists. For example, Missouri's law requires employers to provide treatment reasonably necessary to cure or relieve the effects of the work injury regardless of pre-existing arthritis or other conditions.
The Importance of Documentation and Legal Advice
The outcome of the claim depends on how well the worker documents and presents their case. Seeking legal advice from a workers' comp lawyer can be beneficial when facing challenges with the claim. Providing clear evidence that the work injury impacted the pre-existing condition strengthens the workers' comp claim.
Documentation from the start and a detailed account of symptoms and treatments are crucial. Doctors' reports, medical records, and expert opinions can support the claim. Proving that a workplace injury worsened a pre-existing condition is crucial when filing a workers' comp claim.
If a work injury aggravates a pre-existing condition, the worker could still receive workers' comp benefits. However, the benefits may be reduced due to the apportionment of disability.
In summary:
| Aspect | Impact of Pre-Existing Conditions | |-------------------------------|---------------------------------------------------------------------------------------------------| | Claim Denial Risk | Higher risk due to insurer scrutiny and IMEs attributing injury to prior conditions | | Benefit Reduction | Possible apportionment reducing compensation to the incremental disability caused by work injury | | Medical Treatment Coverage | Still typically covered if linked to work injury, even if pre-existing condition complicates care | | Credibility and Legal Defense | Potential disputes over nondisclosure or causation affecting claim outcomes |
While pre-existing conditions complicate workers' compensation claims and can reduce benefits, they do not automatically prevent claim approval. Proper medical and legal advocacy is crucial to counteract the insurer's tactics focusing on pre-existing health issues.
- Science can play a vital role in support of a workers' compensation claim when pre-existing conditions are involved, as it may provide evidence that the work injury worsened an existing condition.
- In the workplace-wellness context, it's crucial for individuals with chronic medical conditions such as chronic kidney disease to maintain detailed records of their symptoms and treatments, as this documentation can strengthen a workers' comp claim and help negotiate benefits.
- Awareness and understanding of chronic diseases like chronic kidney disease can help employers and insurers to make accommodations and provide appropriate care for affected employees in the workplace, aiming at overall health and wellness enhancement.
