Yes, most of the time workers’ compensation covers pre-existing conditions.
Many injured workers assume that a previous medical condition automatically prevents them from receiving workers’ compensation benefits. Even though you might initially be denied benefits, in reality, a pre-existing injury does not necessarily stop you from pursuing a workers compensation claim after a workplace accident. The key issue is often whether the incident caused a new injury or worsened an existing one.
Here at Pearson Koutcher Law, we regularly help Pennsylvania workers navigate these complex situations. Cases involving workplace injury causation can be challenging because insurance companies may argue that symptoms are related to an older condition rather than a recent work event. In many situations, an aggravation of injury may still qualify for workers’ compensation benefits.
In this blog post, we’ll explain the differences and what they can mean for your claim.
Many workers are surprised to learn that a pre-existing condition does not automatically disqualify them from receiving workers’ compensation benefits. If a workplace accident worsens an existing injury or medical condition, the aggravation itself may be covered under Pennsylvania law.
For example, a worker with a history of back pain may suffer additional damage while lifting heavy materials on the job. In these situations, medical evidence is often used to show how the work incident changed the employee’s condition.
At Pearson Koutcher Law, we help injured workers gather the documentation needed to support these claims and protect their rights.
A new workers’ compensation claim typically involves an injury that arises directly from a workplace accident, repetitive motion, or work-related exposure. Common examples include falls, equipment accidents, or injuries caused by repetitive tasks performed over time.
Even when an injury appears straightforward, employers and insurance companies may investigate how it occurred and whether it is truly work-related. Prompt reporting and medical treatment are important because they create records that can support the claim.
We help clients navigate the claims process and address challenges that may arise during a workplace injury case.
Work Injury
Suppose that ten years ago, you injured your back in a car accident. Your pain was so bad that you needed to undergo surgery. After a few months of physical therapy, your surgeon released you to return to your job in a warehouse which required you to lift heavy boxes. In the next few years, you had occasional back pain, but you were able to do your job. But then three years ago, you slipped on an icy parking lot and re-injured your back. The pain was not as bad as it was following your car accident, but it still caused you to miss work for three months and receive injections from a pain management physician. You went back to work and could handle your physically demanding job. Aside from taking muscle relaxers when your pain would flare up, you haven’t been doing anything for your back.
Second Work Injury
Then, last week, you were lifting a box at work and felt a pop in your low back. Your pain was so intense that you were having difficulty walking. You promptly reported the injury to your supervisor, who directed you to the emergency room. The doctor at the E.R. ordered an MRI for your low back and gave you a note, taking you out of work. You put in a claim for workers’ compensation benefits. Are you entitled to benefits?
Workers’ Compensation Law
There are some key principles of Pennsylvania’ workers compensation law which are applicable in these situations. If a person has a pre-existing condition and then sustains an injury at work which aggravates that condition, rendering the person unable to do their job, as a rule, this is considered a new injury and the person is entitled to workers’ compensation benefits. A possible exception is if the new injury was to exactly the same body part as the old injuries, and the symptoms are the same as they were after those old injuries. The claim could be denied on the basis that you have sustained a recurrence of your old injuries and not a new injury.
Will Workers’ Compensation Be Denied?
If your symptoms are substantially different after this new injury, you have a better chance that your claim will be accepted. So if you only had pain to your lower back following your car accident and slip-and-fall, but after your injury lifting the box, you have pain to your lower back and down your legs, it will likely be found that you have sustained a new injury, entitling you to benefits. In making this determination, the insurance company for your employer – and ultimately the workers’ compensation judge if your claim is denied and a petition is filed on your behalf – will carefully look at the diagnostic studies, such as the MRIs, that you underwent before and after the accident. If the new MRI shows findings that were not present on prior studies, you have a good argument that these new findings were caused by your injury lifting the box. Even if your symptoms were only to your lower back before and after the incident with the box, and the MRIs show identical findings, you may still be entitled to benefits on the basis that you aggravated your pre-existing condition which had been causing you mild, occasional pain but is now causing you severe, constant pain.
Handling Your New Work Injury
Here is some important advice if you find yourself in this situation. When you see doctors for this new injury and are asked questions about your past medical history – in other words, what injuries you have sustained in the past – it’s important that you are completely candid when describing your prior injuries. So under this scenario, tell your doctors about your car accident and surgery ten years ago as well as your slip-and-fall and injections three years ago. Likewise, if you testify before the judge, be candid about these previous injuries and the medical treatment that you received for them. Injured workers sometimes make a big mistake by not revealing their past injuries to doctors or the judge for fear that their claim will be denied based on the old injuries. Your claim is much more likely to be denied if you’re not honest when asked about your previous injuries, and then it comes to light that you in fact had the car accident and slip-and-fall. However, if you’re forthright, provide a complete and truthful history, and emphasize that you were able to do your job until you injured yourself lifting the box at work, you stand a much better chance of winning your claim.
Claims involving prior injuries are often more complicated than standard workplace injury cases. Insurance companies may argue that symptoms existed before the accident or that the worker’s condition is unrelated to their employment.
Medical records, physician opinions, and other evidence can play a major role in determining whether benefits are approved. A strong case often requires a clear explanation of how the work incident affected the employee’s condition.
Because workers’ compensation is all we do, Pearson Koutcher Law has extensive experience helping injured workers address disputes, challenge denials, and pursue the benefits they deserve under Pennsylvania law.
A pre-existing condition does not automatically prevent you from pursuing a workers compensation claim. What matters is whether your job caused a new injury or worsened an existing one. Insurance companies may closely review your medical history or require an insurance defense medical exam as part of the process.
If you have a pre-existing condition and then injure yourself at work and want to know whether you should pursue a
Don’t let them deny your benefits because of a pre-existing injury. At Pearson Koutcher Law, we understand how these cases are evaluated and work to protect your rights every step of the way. Let us put our decades of experience to work for you, helping you navigate the complexities of the Workers’ Compensation laws. Contact us for a free consultation and learn how our experienced workers’ compensation attorneys can help with your claim.