Pre-Existing Medical Conditions and Workers’ Compensation

The Pennsylvania Workers Compensation Act provides medical treatment coverage and wage loss compensation to employees suffering from work-related injuries or disease.

However, in order to be eligible for benefits, Pennsylvania workers’ compensation law dictates that an injury must be directly related to a specific workplace incident, repetitive workplace activity causing a chronic injury, or the “aggravation” of a pre-existing condition or injury.

These guidelines create unique questions and challenges for Pennsylvania pre-existing injury workers’ compensation claimants, concerned about their relative eligibility and claim valuation.

How Pre-Existing Injuries Affect Workers’ Comp Claims

Unlike many other states, in workers compensation cases involving pre-existing injuries, Pennsylvania holds employers responsible and mandates compensation for the entire injury, rather than just the aggravation of the existing injury.

Aggravation of a Pre-Existing Injury

Under Occupational Safety and Health Administration (OSHA) guidelines for the determination of the work-relatedness of injuries in workers’ compensation cases, any “injury or illness is a preexisting condition if it resulted solely from a non-work-related event or exposure that occurred outside the work environment.”

As a result, under the Pennsylvania Department of Labor Aggravation Rule, a widely accepted doctrine of general workers’ compensation law, “where an employment-related injury contributes to, combines with, or aggravates a pre-existing disease or underlying condition, the entire resultant condition is compensable” and “the relative contributions of the work-related injury and the prior condition are not weighed to determine claimant’s entitlement.”

In fact, in the evaluation of workers’ compensation claims, Pennsylvania law considers the aggravation of a prior injury to be an entirely new injury, mandating that liability be assumed by “the employer for whom the claimant was working when the aggravation occurred.”

While employers or insurance companies may attempt to deny a workers’ compensation claim by arguing they were not aware of an employee’s pre-existing injury, the Pennsylvania Workers’ Compensation Act requires employers to provide benefits regardless of the visibility or awareness of a pre-existing condition.

Further, in order to be compensated under Pennsylvania law, an employee is only responsible for demonstrating that their conditions of employment and workplace activity resulted in an “increase in symptoms [of their injury] resulting in disability.”

Pre-Existing Injuries and Workers’ Comp Claim Benefits

In Pennsylvania, worker’s compensation claim benefits in addition to medical treatment, are largely based on a metric known as Average Weekly Wage (AWW). In accordance with the Pennsylvania Workers’ Compensation Act, AWW is calculated as of the date of injury (not the date of the disability) and is based on whether the claimant is a salaried or hourly employee.

Typically, Pennsylvania Workers’ Compensation Claim Handing Guidelines provide total disability compensation for those in the lowest wage brackets at “a rate equal to 90% of the AWW,” while most wage ranges are awarded “66.66% of the AWW with a maximum weekly benefit rate.” While there are no adjustments for a change in the cost of living, the Pennsylvania Department of Labor and Industry does adjust the compensation rate schedule annually.

In order to be eligible for total disability benefits, claimants must be unable to work, in any capacity, for at least 14 days. Claimants seeking compensation for partial disability – “any disability less than total” – will be awarded benefits at a rate of “66.66% of the difference between pre and post-injury wages.” Claimants are eligible to receive partial disability benefits for up to 500 weeks following injury.

Workers comp claimants with preexisting conditions and injuries should expect to receive wage loss benefits in accordance with typical AWW rates, unless they already collect other wage benefits, such as Social Security, pension, or disability.

How Pre-Existing Medical Conditions Affect Workers’ Compensation

As is the case with pre-existing injuries, under Pennsylvania law, pre-existing medical conditions aggravated in the workplace are fully compensable under the Pennsylvania Workers’ Compensation Act.

Aggravation of a Pre-Existing Medical Condition

Similar to that of pre-existing injuries, certain pre-existing diseases and conditions are treated as injuries rather than diseases, under Pennsylvania law. For example, pre-existing heart diseases that are aggravated by work-related exertion are compensable under Pennsylvania workers’ comp, in the event of an actual heart attack or other disabling symptoms related to that individual’s condition.

As such, in the state of Pennsylvania, pre-existing medical conditions workers compensation cases are subject to the same OSHA guidelines and Department of Labor Aggravation Rules as pre-existing injuries cases.

Pre-Existing Medical Conditions, Workers’ Comp Claims, and Benefits

In Pennsylvania, pre-existing medical condition worker’s compensation benefits are determined under the same Pennsylvania Workers’ Compensation Claim Handing Guidelines as pre-existing injury cases.

This means – barring claimants who already receive wage benefits from Social Security, pension, or disability – claimants seeking total disability benefits will receive between 66.66% and 90% of their AWW in wage benefits, while those seeking partial disability benefits will receive 66.66% of the difference between their pre and post-injury wages.

Pre-Existing Injuries, Medical Conditions, and Reduced Benefits

Because Pennsylvania law requires employers to provide complete workers’ compensation benefits for claimants with pre-existing injuries and medical conditions, the only way an individual’s wage loss benefits can be reduced is if they already receive wage benefits from Social Security, short-term and long-term disability, pension or a pre-existing worker’s compensation claim.

Reduced Benefits and Social Security

In accordance with Pennsylvania law and workers’ compensation guidelines, claimants who receive Social Security retirement benefits may have up to 50% of their Social Security benefits credited against their individual workers’ compensation wage loss benefits.

While the specific percentage of reductions largely depends upon the amount of benefits an individual already receives, claimants may also see additional reductions to their workers’ compensation benefits if they receive wage benefits from unemployment, pension, severance, or disability benefits.

Reduced Benefits and Previous Workers’ Compensation Claims

Pennsylvania law awards full compensation to claimants whose pre-existing conditions are aggravated due to workplace activity. However, for claimants receiving workers’ compensation benefits due to a previous workplace injury, their benefits are likely to be reduced to account for the prior worker’s compensation claim.

The amount of the reduced benefit is largely dependent upon the amount of compensation the claimant receives from the previous claim and the nature of the new injury, yet claimants should expect to receive a reduction in both wage loss benefits and permanent disability benefits (after the fact).

Contact Krasno, Krasno, & Onwudinjo to Discuss Your Workers’ Compensation Case Today

The workers’ compensation attorneys at Krasno, Krasno, & Onwudinjo have significant experience helping clients with pre-existing medical conditions navigate Pennsylvania’s workers’ compensation laws.

Contact us today at (844) 243-4932 for a free consultation.

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