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How does workers’ compensation view a pre-existing condition?

Workers’ compensation insurance companies dread a claim that involves a pre-existing condition.

Why? Because they don’t want to pay for it. Insurance company adjusters are encouraged to split hairs between the terms “exacerbation” and “aggravation” when a pre-existing or age-related condition is involved in a workers’ comp claim in order to deny it.

However, pre-existing conditions are not a total bar to a workers’ comp claim and there are things that you can do to try to stop a claim adjuster from wrongfully denying your benefits.

1. Be aware that the insurance company will try to shift the blame

Your insurance provider will likely try to argue that your pre-existing condition was not worsened as a result of your work activity. They may claim that your condition has merely become exacerbated, or flared, for unknown reasons.

You can counter this by making certain that you report injuries immediately after they happen to your supervisor or human resources department. That way, there is less possibility that the insurance company will try to claim your condition isn’t a result of your on-the-job activities. You should also make certain to tell your treating physician exactly how and when your condition worsened.

2. They may try to limit what benefits you do receive

The insurance adjuster may also seek to limit your benefits by asking your physician to clarify how much of your treatment is designed to address the problems caused by your work and how much is designed to treat your underlying condition. They may ask your doctor to try to show objective evidence that your condition has been aggravated by the work activity — something your doctor is usually not in a position to do. At that point, you may be referred to an independent medical evaluation — which is rarely independent at all.

You can combat inaccuracies in the process by taking someone with you to the medical exam to serve as a witness. That’s one way to put the independent medical examiner on notice that he or she is being watched — and will give you a witness if the examiner doesn’t perform a full evaluation.

Pre-existing conditions in workers’ compensation claims are often hotly disputed. If you are having difficulty gaining approval for your claim, it may be time to seek legal assistance.