Pre-Existing Conditions and Workers’ Compensation
Dealing with pre-existing conditions in applying for workers’ compensation benefits can sometimes lead to complications that warrant assistance from an experienced workers’ compensation attorney.
Workers’ Compensation is a complex law and it varies from state to state with small differences that can have a large impact on individual workers.
For example, under a recent Wisconsin Supreme Court decision, a woman will not be able to receive workers’ compensation for her surgery because, according to the Court, the surgery treated a pre-existing condition that was unconnected to her work injury.
The woman, a store supervisor at the Walmart in Chippewa Falls, sought compensation under Wisconsin Statute section 102.42(1m) but lost by a 4-3 decision in the state Supreme Court.
That’s Wisconsin and it’s state specific law. What about in Pennsylvania?
In Pennsylvania, if a work injury aggravates a pre-existing condition, it is technically covered under the Pennsylvania Workers’ Compensation Act. However, there can sometimes be complications involved in dealing with insurance companies and pre-existing conditions as they affect current work injuries and treatments needed.
In these circumstances, working with an experienced workers’ compensation attorney is strongly recommended.
Workers’ Compensation and Health Insurance
Citizens are able to seek workers’ compensation under state law. In the Wisconsin case, that statute required an employer to indemnify an employee who sustained a disability and/or compensable injury as a result of medically acceptable invasive treatment (like surgery), even if that treatment does not end up treating a work-related injury.
However, the Wisconsin Supreme Court held that the plaintiff did not meet the requirements of the statute because she underwent surgery to treat a medical condition that was not technically work-related.
In other words, the Wisconsin court ruled that the treatment itself must be directed at treating the work-related injury or disability.
Pennsylvania’s Workers’ Compensation does not directly address invasive treatments except in circumstances when a listed provider prescribes invasive treatment to treat a work injury.
Where and How a Lawyer Helps Protect Workers’ Rights
In Pennsylvania, occupational diseases are covered if they occur within a set period of time after a worker’s previous employment (where they were exposed to the cause of the disease) and/or caused or aggravated by their current employment. There are very strict requirements for both insurance companies and employers to meet regarding workplace injuries.
And that’s where the expertise of a skilled workers’ compensation attorney is put to use as they know the best ways to interpret the law and help their client receive their proper benefits.
For example, with certain types of lung disease you must have worked in an occupation involving asbestos, silica, or coal for at least two years in Pennsylvania during the 10 years prior to the disability.
Workers’ compensation coverage is not limited to just chronic ailments or previous occupations: Any aggravation of a pre-existing condition is covered, whether or not that injury occurred in conjunction with previous employment.
However, that is not to say that both employers and health insurance companies do not frequently challenge claims that involve pre-existing injuries by claiming that any current injuries and disabilities and the treatments obtained for them are entirely linked to pre-existing conditions. These challenges require in depth knowledge of the law and years of experience in the courtroom to safely navigate the system for a client. The workers’ compensation lawyer is there to protect the client from being undermined by the system.
Get the Facts about Workers’ Compensation and Pre-Existing Conditions
Some basic facts to remember when it comes to workers’ compensation and pre-existing conditions:
- Pre-existing conditions can include obvious injuries such as
broken bones or herniated discs, or even conditions that require more close
monitoring, such as arthritis or Carpal-Tunnel Syndrome
- Insurance companies cannot initially deny an injury claim solely
based on a pre-existing condition
- There is no difference in terms of coverage for medical expenses
and lost wages between a new injury on the job and a pre-existing injury that
has been aggravated in your current job; However, how you proceeded to treat
the previous injury in terms of your doctor’s recommendations could affect your
- Your doctor’s report is important in any workers’ compensation claim. Make sure you are thorough and detailed in discussing any discomfort and pain you are experiencing, as well as concerning your history of any injuries
- If you have any questions about pre-existing conditions and workers’ compensation benefits it’s in your best interest to contact an attorney as soon as possible
If You are Hurt on the Job in Pennsylvania
If you are injured at work and have a pre-existing injury or disability, your workers’ compensation claim can become more complicated, particularly if there is a strong link between the two injuries and/or your previous injury and current medical condition. Regardless, your employer is required to cover your medical expenses and treatment related to your new work-related injury.
This is especially important if the combination of your pre-existing condition and new injuries renders you permanently disabled, as this could trigger additional benefits.
A Workers’ Compensation Attorney Can Help
If you have been hurt at work, it is critical that you reach out to an experienced workers’ compensation attorney. Here at, Krasno, Krasno, & Onwudinjo our knowledgeable attorneys will ensure you receive the proper guidance throughout the claims process. Our attorneys work on a contingency basis, meaning we only get paid if you get paid. Contact us today at (877) 299-0779.