Do you have pre-existing health conditions that have worsened due to your job responsibilities? Are you confused about filing for a workers’ compensation claim because you don’t know if it applies to someone who was already sick or injured?
Such questions arise from a valid place of concern since workers’ compensation claim is commonly associated with injuries in the workplace.
Luckily, the claim does cover pre-existing conditions; but it’s only applicable to cases where the workplace’s involvement can be proven to a certain extent.
This guide covers how these conditions weigh into a claim and how insurance companies handle such cases.
1. Understanding the Impact of Pre-existing Conditions
While some may underestimate how an existing illness or injury could affect someone further due to their workplace, it is important to know that the job’s responsibilities may be putting more weight on or increasing the use of the affected area.
For example, an old shoulder injury can re-emerge if the worker keeps using that shoulder to lift weights. Studies have also found that employees with conditions such as depression or osteoarthritis end up needing longer sick absences if their illness worsens due to work.
Having pre-existing health conditions places workers in more danger because not only do they face the threat of that illness/ injury growing, but are just as susceptible to developing another chronic condition due to constant pain.
2. Proving How Your Work Affected You
A significant part of these workers’ compensation claims is proving the extent of damage caused by your workplace. Here are a few things you’ll need to back your claim.
- Medical Records / History
Having medical records from before and after your job can help highlight the differences brought about by the workplace.
Include prescriptions, tests, X-rays, and MRIs to show your treatment history. If you’ve been treated by a single doctor throughout, make sure you include their note as a medical professional’s confirmation.
- Proof of How the Job Duties Contributed
Documents that mention your job responsibilities are crucial in highlighting how those tasks triggered your condition and serve as written records.
- Performance Analysis
If there are any documents of progress at work over time, use those to show any decline in your ability to perform tasks or meet deadlines. Try to highlight all the issues that were created as a result of your aggravating condition.
- Witness Statements
Although a secondary step, if you have peers and co-workers who were witnesses to your condition and saw how it limited you, have their statements documented. An outsider’s account adds an unbiased assessment of your circumstances.
3. How Such Cases Are Handled
Insurance companies scrutinize cases where pre-existing health conditions are the root of workers’ compensation; most cases are dismissed due to the loophole of the injury having occurred outside work premises.
In cases such as chronic conditions, the insurance company may argue that the illness would worsen regardless of the job.
Often, the company asks for further medical testing through an Independent Medical Examination (IME); the organization is the only recipient of these test results and uses those to determine their verdict.
4. Challenges Faced
Due to their tricky nature, such workers’ compensation claims can be easily dismissed for various reasons. One such reason is insurance companies claiming that the work was not a detrimental factor in the condition getting worse, meaning things would’ve continued getting bad despite the job.
If there is a gap found in your medical history or inconsistent treatment, the aggravating condition is linked to your negligence rather than your work’s outcome.
Lastly, transparency is important. You cannot claim your work made your health worse if you never informed your employer about the illness/ injury.
The Need For Good Legal Representation
With such strict guidelines by insurance companies and the high possibility of workers’ compensation claims for pre-existing conditions getting denied, you may feel unsure about pursuing your case.
However, an experienced law firm could help you see through the process and make a convincing case to back you up. They’ll help you combine all the needed documentation in such a way that your struggle and pain are effectively communicated.
Need a lawyer who specializes in workers’ compensation? Check out the Law Offices of Harley Merritt.
With 28+ years dedicated to representing workers’ claims, we’re well-versed in handling insurance company procedures and documentation as per the case needs.
Want to discuss your case? Fill out the form on our website!
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