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Aggravation of Pre-Existing Conditions

If you have a pre-existing condition, filing a workers’ compensation claim can suddenly become much more difficult. This is especially true if your condition is related to your current claim. However, the existence of a pre-existing condition does not automatically disqualify you from seeking workers’ compensation coverage. It just makes your claim more difficult to prove. A seasoned Orange County workers’ compensation attorney at Invictus Law, P.C. can help.

The California workers’ compensation lawyers at Invictus Law, P.C. have years of experience helping injured workers in Orange, Riverside, and San Bernardino counties recover in a variety of cases ranging from the simple to the complex. We understand how to prove up complicated and nuanced workplace injury claims, and we know how to fight for maximum coverage.

Excluded Injuries

California workers’ compensation law specifically excludes certain categories of injury from coverage. In addition to injuries sustained outside of work, workers’ compensation does not cover injuries that were intentionally self-inflicted or those that occurred while the employee was intoxicated.   Workers who sustained injuries in a physical fight that they started, or in the pursuit of criminal activity, are not covered. Workers are also not covered for legitimately off-duty, voluntary activities, even if they happen at the workplace. Pre-existing conditions, on the other hand, are not automatically excluded, provided that the injury was aggravated by work on the job. An injury may result from a combination of covered and non-covered activity. The legal effects of such a cumulative injury are discussed below.

What Qualifies as a Pre-Existing Condition?

Pre-existing medical conditions are injuries or illnesses that predate a workplace accident (and were not in turn related to workplace activity). Pre-existing conditions can be obvious existing injuries such as herniated discs, broken bones, torn ligaments, knee injuries, back injuries, neck injuries, etc. Pre-existing medical conditions may also include general health or medical conditions such as age-related spine degeneration, carpal tunnel, post-traumatic stress disorder, anxiety, depression, or arthritis. If you show up to the job and you already have one of these injuries, illnesses, or disorders, and they were not caused by your current job, you cannot file a claim for workers’ compensation for that condition.

Aggravation of an Existing Condition

If you have a pre-existing condition such as those described above, you are not necessarily disqualified from workers’ compensation, even if the claim is related to that same injury. California workers’ compensation will cover an injury connected to a pre-existing condition provided that workplace conduct constituted a “new” injury that aggravated the pre-existing condition.

Take, for example, a physical therapist who suffers from arthritis in her lower back. While at work, she attempts to help a patient out of bed, which causes a disc in the affected area of the worker’s back to bulge. As a result of the disc injury, the therapist is unable to work. The bulging disc is a “new” injury, caused by workplace activity, even though it was connected to a pre-existing condition. California law asks if there was a new injury, whether there is a new need for medical attention or a change in the course of existing treatment, caused by new workplace activity. If so, then the injury is called an “aggravation.” The aggravation here would be covered by workers’ compensation.

It is important to note that workers’ compensation will not cover claims for previous conditions that simply “flare up” while you are on the job. In the example above, if picking up the patient merely caused the arthritis to become more acute, causing some pain but not affecting the worker’s ability to work, then workers’ compensation would not apply. The acute pain is not a “new” injury, but rather is a mere “exacerbation” of an existing condition. Exacerbation is a temporary increase in the symptoms of an existing condition and is not covered by workers’ compensation. Distinguishing between aggravation and exacerbation is complicated and requires the knowledge of a skilled workers’ compensation attorney.

How Pre-Existing Conditions Affect the Coverage Amount: Apportionment

If your pre-existing condition has been aggravated by a workplace injury, then you can file a workers’ compensation claim. Your employer’s insurer will cover your medical bills for the aggravation. If you are unable to work due to the aggravation, then you are eligible for temporary disability benefits. When you can return to normal work, your benefits cease.

If the aggravation of your pre-existing condition is such that you will never return to work, then you may qualify for permanent disability. When pre-existing conditions are involved in permanent disability claims, your coverage will be affected by the “apportionment” of fault between the new injury and the pre-existing condition. Claims adjusters will work to account for the percentage of the illness or condition that predated the workplace injury. For example: A worker files a claim based on severe neck pain, but that worker was previously in a car accident. The examining physician finds that 30% of the neck problems are related to the prior car crash rather than the workplace activity. The worker will be entitled to 70% of what they would otherwise have collected as part of their workers’ compensation coverage for their neck.

Apportionment can apply even where there was no pre-existing condition, provided that the injury complained of was caused by a combination of work and non-work factors. For example, if an employee suffers from shoulder issues caused by heavy lifting at work, but the worker also plays recreational sports, then the amount of workers’ compensation will depend on the percentage of fault for the injury attributed to the workplace conduct as opposed to the non-work recreational activity.

Learn About Workers’ Compensation and Aggravation of Pre-Existing Conditions in a Free Initial Consultation

Invictus Law, P.C. offers injured workers proven methods to get the workers’ compensation benefits and medical care they need to recover. Call us anytime at 949-287-5711 or use our online contact form to tell us about your situation and set up an appointment. We offer flexible hours.

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