The workers’ compensation system in California is a crucial form of protection that offers medical and financial support to those who become ill or sustain an injury related to their job. Unfortunately, navigating the claims process can be much more complicated than you would expect when there is a pre-existing health condition.
As an injured worker, it’s essential to understand the impact of a pre-exiting condition on a claim for workers’ compensation. This is a subject we will explore in detail throughout this article, as there are challenges you will face along the way. However, you also have rights and legal remedies that you can utilize in order to obtain the benefits you are entitled to.
Our law firm is committed to the rights of injured workers and ensuring that they receive fair treatment from their employer and workers’ comp insurance provider. If you have any concerns or questions about the process of filing a work injury claim, contact the offices of California Labor Law Employment Attorneys Group.
How Pre-Existing Conditions are Defined in a Workers’ Compensation Case
Under the laws governing work-related injury or illness claims in California, a pre-existing condition is defined as an injury or medical condition that the claimant had prior to the injury they sustained at work. Common examples of pre-existing health conditions in WC cases include arthritis, diabetes, complications from a recent surgery, and chronic pain. Any of these health issues has the potential to complicate whether you can be compensated, along with the amount and the duration of payments.
The laws governing how pre-existing conditions affect a workers’ compensation claim are explained in the California Labor Code Section 4663. This sections states that injured workers are entitled to payment for the portion of disability caused by an injury at work, even if they have pre-existing issues that affect the claimant’s overall disability.
Impact of Pre-Existing Conditions on Workers’ Compensation Claims
In this section, we will discuss how pre-existing conditions may affect your rights as someone who is seeking workers’ compensation.
- Apportionment of Disability – this is the process of figuring out the percentage of disability between your job-related injury and a pre-existing health condition. Once it’s determined that a pre-existing condition contributed to your temporary or permanent disability, the insurance company still has to pay for the portion of disability that’s caused by the work-related injury.
- Medical Evidence – as you are probably aware, medical evidence is the cornerstone of a workplace injury claim. Your treating physicians will provide their opinions on how your pre-existing health issue interacts with a work accident injury or illness.
- Claim Denials and Disputes – When you have a pre-existing condition, there may be disputes between you, your employer, and the insurance provider concerning whether a claim is compensable. Insurance companies often latch onto pre-existing conditions to argue that this is the primary cause of disability, or that your recent injury or illness related to your job is not significant enough to meet the standards for a WC claim.
The challenges in proving your right to compensation is greater when you have a severe pre-existing condition or one that has gotten worse from being injured at work.
What are my Rights as an Injured Worker with a Pre-Existing Conditions?
Labor Code Section 4663 makes it clear that workers cannot be denied compensation solely on the basis of a pre-existing health condition. Instead, it must be determined what portion of a claim is compensable based on the extent to which the workplace injury contributed to or aggravated the injury you sustained through your job.
In addition, the law requires that employees are compensated according to their whole-person impairment. This medical assessment takes into account how the person’s physical and mental well-being are effected by the combination of a work-related injury and their pre-existing health issues. Thus, it is never a matter of one versus the other, but instead, a broad scope approach that focuses on providing an appropriate amount of compensation.
For example, if a work accident injury is worsened by a pre-existing condition, the worker should be paid for the increased disability that is directly related to the aggravation. This is where medical evaluations and opinions really count, as they are the basis for establishing that the injury or illness from one’s job caused a pre-existing condition to get significantly worse.
Challenges You May Need to Overcome
Causation is one of the biggest challenges when it comes to succeeding in a workers’ compensation claim with a pre-existing condition. Essentially, you will need to prove causation by showing that in spite of a pre-existing condition, the injury was a significant contributor to your current disability, i.e., impaired ability to perform your job duties. Detailed medical records and expert opinions from clinicians is paramount to showing a clear and indisputable connection between your disability and the injury in question.
You must also anticipate arguments and request for more documentation from the insurance company that’s handling your claim. They are likely to insist that the condition you already have is the primary contributor to your disability. Alternatively, they may argue that the injury from your job did not contribute enough to the overall impairment, and thus, you are not eligible for worker’s compensation benefits.
Clearly, workers with pre-existing conditions face legal complications that are difficult to understand and overcome on their own. Working with qualified medical professionals and legal experts is in your best interest when you are facing resistance from a workers’ compensation insurance provider. That’s why it’s essential to consult an experienced workplace injury attorney.
Here at California Labor Law Employment Attorneys Group, we have a dedicated group of veteran workplace injury lawyers who will ensure that you receive everything you are entitled to by law. We are available to assist you 24/ 7, so don’t hesitate to give us a call.
Contact a Workers’ Compensation Attorney
Workers’ compensation seems like something you can access easily when you are injured within the course of employment, but that’s far from the truth when you have pre-existing health conditions and other complications. Legal advice and representation is the best way to protect yourself from an unjust claim denial or getting shortchanged on the compensation you are owed.
A California workers’ compensation lawyer is here for you day and night, so please feel free to contact us with any questions or concerns. We also offer a Zero Fee Guarantee in the event you wish to hire us, meaning you pay $0 upfront for the cost of legal services. That way, you can obtain the support you need and recover maximum payment from a WC claim. At the point your settlement is released by the insurance company, a portion of it will be deducted by us for legal fees. If you don’t get paid from a successful work injury or illness claim, you walk away without spending a penny.
Contact our law firm and talk to a lawyer who can help you with a workers’ compensation dispute involving a pre-existing condition.
