Home » Workers' Compensation » Workers’ compensation eligibility for pre-existing conditions

Workers’ compensation eligibility for pre-existing conditions

| Apr 13, 2020 | Workers' Compensation

Workers inquiring about the potential for workers’ compensation coverage regarding the aggravation of a pre-existing condition may find some misleading information from their employer. Wisconsin law makes provisions for those activities that exacerbate an existing injury, condition or illness with regards to workers’ compensation. However, such a claim may be challenging to prove to an employer.

Knowing your rights in the workplace

It shouldn’t matter what injury or pre-existing condition you had before starting your job. Federal regulations under the Americans with Disabilities Act (ADA) prohibit employers from discriminating against workers, employees or job candidates based on a disability. It is common for an employee to enter a position with a pre-existing injury if that person can carry out the tasks the job entails. Despite the protections under the law, many employers will attempt to refute workplace injuries if a pre-existing condition is present. Here are some general criteria for the coverage of a workplace injury (of course, each case has its own facts that may play a role in compensability):

  • The injury/illness must be the result of the activity conducted at your workplace.
  • Injuries from activities not related to your job could face problems for eligibility for workers’ compensation benefits.
  • If a work injury aggravates, accelerates, and precipitates a pre-existing condition beyond its normal progression (generally determined by a physician), the worker likely can bring a claim for worker’s compensation.
  • The state of Wisconsin has classifications related to whether the worsening of an injury creates a new partial, temporary, or total and permanent injury. A total and permanent injury is considered the most severe category, making the worker unable to procure or continue in gainful employment from then on.

Denials

Many insurance companies hire “independent” or adverse medical examiners to evaluate the compensability of a worker’s claim.  These IMEs may say that a worker’s post-injury condition was due entirely due to their pre-existing condition, or age-related condition, or degenerative body process.  These hired IMEs may say that, even though the worker was working without physical problems (despite any alleged pre-existing condition) before the work injury.

If the injured worker’s treating doctor (usually an orthopedic physician) says the worker suffered a permanent aggravation of their pre-existing condition, there is a medical dispute—and the worker can fight out their worker’s compensation case.

Protecting your rights as a worker

Given the contentious nature of a claim involving a pre-existing injury, it is crucial that you find an attorney experienced with workers’ compensation cases to guide you through this process.

Archives

Categories

FindLaw Network