Are you still eligible for workers’ compensation if you have a pre-existing condition?
Workplace injuries are unfortunately quite common and unpredictable occurrences. When it happens to you or a loved one, the first step is to receive medical treatment so that you can start receiving workers’ compensation benefits. However, many injured workers with pre-existing conditions encounter more challenges in obtaining the financial help they were promised.
Medical care is expensive and the importance of treatment doesn’t decrease simply because an insurance company refused to pay your claim. What’s more, the claims process is complex, which is where an experienced workers’ compensation attorney can come in handy.
Even though North Carolina laws require most businesses to carry workers’ compensation insurance, insurers make a profit by finding any loophole they can to deny or reduce your claim. This is especially true when a pre-existing health condition aggravates an on-the-job injury.
Are pre-existing conditions covered by workers’ compensation?
Generally speaking, yes.
Despite common attempts by insurance companies and employers to deny coverage, North Carolina covers pre-existing conditions under the state’s workers’ compensation laws.
However, the issue lies in whether your condition worsened after being injured on the job—which is known as an aggravated injury.
If your condition was present before working for your employer, you may have been hired without them having knowledge of your prior injury. Typically, employers don’t request details about your medical history upon hiring. Nevertheless, you shouldn’t hide a previous health issue when filing a workers’ compensation claim.
If your claim was denied based on a pre-existing condition, you should talk to an attorney as soon as possible. They will evaluate the specifics of your case and discover what legal options are available to you under North Carolina law.
Common pre-existing conditions that qualify for workers’ comp benefits
A past illness or injury doesn’t automatically disqualify you from receiving workers’ compensation benefits. Many types of pre-existing conditions are accepted under workers’ compensation coverage, including:
- Arthritis. Degenerative diseases such as arthritis usually develop over a long period of time. If working conditions aggravate a pre-existing bout with arthritis, you may qualify for workers’ compensation.
- Repetitive strain/stress. Stress injuries from repetitive movements can also build over time. Carpal tunnel syndrome, which impacts computer-intensive jobs, is one of the most common of these conditions.
- Back injury. As one of the most common injuries that occur in the workplace, back problems may or may not qualify as a pre-existing condition. This is especially true if you work in manufacturing, construction or another physically demanding industry. A back injury can become re-aggravated with little warning.
- Joint problems. It’s common to re-aggravate a shoulder or knee injury in a sudden accident, through overexertion or repetitive movements.
Other occupational illnesses such as cancer and diabetes may be directly related to your job duties. In such cases, you should speak with a legal expert to determine your eligibility for workers’ compensation benefits as soon as possible since your employer’s insurance company may try to argue that these conditions cannot be proven to be work-related.
Supporting your workers’ comp claim with a pre-existing condition
If you have a pre-existing condition, there are things you can do to support your claim and strengthen your chances of approval.
- Promptly file your workers’ compensation claim. Let your employer know of an accident immediately. North Carolina law requires you to file within 30 days of the injury. If you delay filing a claim, the insurance company might proceed under the assumption that your injury isn’t that serious.
- Consult with an authorized treating physician. Let your treating physician know the details of your pre-existing condition. Give them detailed information about how the work-related injury has affected you. Describe any differences between the pain, discomfort or limitation with your previous injury and the on-the-job injury.
- Follow through on all medical requests. Follow the instructions of the treatment plan prescribed by your physician. The insurance company will also likely make medical requests for documents and records related to your pre-existing health issue.
- Be prepared to have an Independent Medical Examination at the request of the insurer. Complying with this evaluation and other requests is necessary to be approved for workers’ compensation benefits.
Was your claim denied due to a pre-existing medical condition?
If you file a workers’ compensation claim for an injury that aggravated a pre-existing condition, your employer and insurer could decide to deny or reduce your benefits. While North Carolina does allow benefits for most pre-existing conditions, the rules might be unclear in certain cases. Strong medical evidence that your work accidents worsened your pre-existing condition is essential to proving your claim.
Getting maximum compensation can be a complicated process. Even though a workplace accident caused your injury, your employer and insurer may seek to challenge the claim every step of the way. They may even put pressure on you to return to work before you fully recover.