Pre-Existing Medical Conditions and Workers’ Compensation
Will a pre-existing condition prevent you from receiving workers’ compensation benefits? Let’s look at a hypothetical to answer the question.
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.
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?
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.
But 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.
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.
Here is one more piece of advice: If you have a pre-existing condition and then injure yourself at work and want to know whether you should pursue a workers’ compensation claim, call the lawyers at Pearson Koutcher for a free consultation. Every one of our lawyers has been handling workers’ compensation cases for more than twenty years and will be able to discuss your case in detail with you, advise you if you have a viable claim, and if so, file a petition on your behalf.
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