Pre-Existing Conditions in California Workers’ Compensation Claims
California’s workers’ compensation system is designed to support employees who suffer job-related injuries or illnesses, regardless of fault. But when a worker has a pre-existing condition, questions often arise about whether the injury is truly work-related and to what extent the workplace contributed to the employee’s current state. At Invictus Law, P.C., we represent injured workers in Orange County, the Inland Empire, and beyond, helping them navigate complex claim denials and appeals, including those involving pre-existing medical conditions. Contact us today for advice and representation from a knowledgeable and experienced Southern California workers’ compensation lawyer.
What Is a Pre-Existing Condition?
A pre-existing condition is any health issue, injury, or illness that an individual had before suffering a workplace injury. This can include:
- Chronic conditions like arthritis or degenerative disc disease
- Prior injuries to the same body part (e.g., an old back injury)
- Surgeries, even if they were deemed successful
- Congenital or age-related health problems
Having a pre-existing condition does not automatically disqualify you from receiving workers’ compensation benefits in California. In fact, many injured workers have some form of pre-existing condition. The key legal question is whether your current condition was aggravated, accelerated, or lit up by your work activities.
California Law on Pre-Existing Conditions
Under California Labor Code § 4663 and § 4664, compensation for a work injury must account for apportionment, which is the division of disability between what was caused by the work injury and what was caused by other factors, including pre-existing conditions.
This means your benefits may be reduced if a portion of your disability is attributed to a non-industrial cause. However, if your job duties worsened or aggravated the pre-existing condition, you are still entitled to compensation for that aggravation. This is sometimes referred to as the “lighting up” of a pre-existing condition.
Aggravation vs. Exacerbation
Understanding the difference between aggravation and exacerbation is important:
- Aggravation refers to a permanent worsening of the underlying condition due to a work-related injury. This qualifies for workers’ compensation benefits.
- Exacerbation is a temporary flare-up of symptoms, which may not result in permanent disability but may still entitle the worker to medical treatment or temporary benefits.
Medical evidence plays a central role in determining whether a condition was aggravated or merely exacerbated.
How Doctors Handle Pre-Existing Conditions
When you file a workers’ compensation claim, your treating physician or a Qualified Medical Evaluator (QME) will issue a medical-legal report. This report will include:
- A diagnosis of your condition
- A determination of how much of your disability is due to the work injury versus pre-existing factors
- An apportionment analysis that assigns a percentage to each contributing cause
For example, if you have a pre-existing back injury and your current job duties led to a new herniated disc, the doctor might determine that 70% of your current disability is work-related, while 30% is due to your prior condition.
Your benefits will then be proportional to that apportionment.
Challenges Workers Face
Insurance carriers often try to minimize payouts by blaming the injury on a pre-existing condition. Common tactics include:
- Denying that the injury is new or related to work
- Arguing that all or most of the disability stems from your prior condition
- Disputing your need for additional treatment
These tactics can leave injured workers without proper medical care or benefits, especially if they try to handle the case on their own.
That’s why it’s so important to work with an experienced workers’ compensation attorney. At Invictus Law, we understand how to counter these strategies and present strong medical and factual evidence to support your claim.
What If You Didn’t Know About the Pre-Existing Condition?
You can still qualify for benefits even if you were unaware of your pre-existing condition. For example, many people have degenerative changes in the spine that don’t cause symptoms until a workplace injury “lights up” the problem.
In these cases, your employer “takes you as you are.” If your job duties caused your condition to become symptomatic or worsen, it is still considered a compensable injury under California law.
Strategies for Strengthening Your Claim
Here are some ways to help your case when pre-existing conditions are involved:
- Be honest about your medical history. Hiding prior injuries can hurt your credibility and damage your case.
- Explain clearly how your current symptoms are different from or worse than before.
- Document everything. Keep a record of your symptoms, job duties, and how your condition has changed over time.
- Seek medical treatment promptly, and make sure your doctor is aware of your work duties and injury history.
- Consult a workers’ compensation attorney who can guide you through the apportionment process and advocate for full and fair benefits.
How Invictus Law Can Help
At Invictus Law, P.C., we’ve helped many workers recover benefits in claims involving complex medical histories. Whether your case involves an old sports injury, prior surgery, or age-related degeneration, we know how to build a strong claim and push back when the insurance company tries to downplay your injury.
Our offices in Orange and Ontario are well-positioned to serve injured workers throughout Southern California, including Orange County and the Inland Empire. We understand the medical-legal process and work closely with respected medical experts who can accurately assess causation and apportionment.
Don’t Let a Pre-Existing Condition Derail Your Claim
Just because you had a prior condition doesn’t mean you should go without benefits. If your job aggravated that condition or caused it to become symptomatic, you have the right to pursue medical treatment, wage replacement, and compensation for permanent disability.
At Invictus Law, we fight for injured workers every day, ensuring they receive the care and compensation they deserve, even when insurance companies try to avoid responsibility. Contact us today for a free consultation to discuss your case and find out how we can help. There are no upfront costs, and we don’t get paid unless you win.
