The Impact of a Pre-existing Condition on a Georgia Workers' Comp Claim

Guide to Pre-Existing Conditions in Workers’ Comp Claims

How to minimize the effects of a pre-existing condition on your workers' comp payout

There's no denying that benefits are reduced when a pre-existing condition is involved in a workers' comp claim. Learn the impact on your settlement and how to minimize your reduction in compensation.

Pre-existing conditions often seem like the kiss of death for a workers’ compensation claim. It’s easy for the insurance company and even the judge at your workers’ comp hearing to deny you benefits when there’s a pre-existing condition involved. In order to recover damages for a workplace accident involving a pre-existing condition, your claim needs to be managed carefully by a Georgia workers’ comp attorney.

What is a pre-existing condition?

A pre-existing condition refers to either an old injury or on-going medical problem that caused you pain and discomfort. In most cases, a person is aware of their pre-existing injury or condition and underwent at least one form of treatment.

Common examples of pre-existing conditions that are listed in workers’ comp claims include:

  • Degenerative disc disease and herniated discs
  • Arthritis
  • Carpal tunnel and other wrist injuries
  • Elbow injuries
  • Back injuries
  • Neck injures
  • Shoulder injuries
  • Knee injuries
  • Spine degeneration
  • Broken bones
  • Torn ligaments

The conditions above are most commonly cited in workers’ comp claims, but other medical ailments are also considered.

For example, an employee may complain about respiratory problems from exposure to a chemical, but a pre-existing condition of asthma could affect the claim. Because pre-existing conditions vary so much in terms of what impacts your benefits, it’s encouraged that you discuss your claim with an experienced workers’ comp attorney.

It’s worth mentioning that your benefits can’t be limited from unrelated pre-existing conditions. For example, your asthma can’t limit your workers’ comp payout from a workplace slip and fall. If your employer or the insurance company is trying to use an unrelated pre-existing condition to prevent you from recovering benefits, you need to speak with an attorney and possibly report workers’ comp fraud.

The Center for Medicare and Medicaid Services (CMS) reports that somewhere between 50 and 129 million non-elderly Americans suffer from some form of pre-existing injury. Tweet this

What if I didn’t know I had a pre-existing condition?

Undiagnosed pre-existing conditions also impact workers’ comp claims. You may not know you have a condition until you go for an x-ray, CT scan or MRI. For example, an x-ray of a broken finger could show that you also have arthritis. You may have had minor discomfort all along, but never received treatment or visited a specialist.

When a pre-existing condition is discovered during treatment for a workplace injury, your workers’ comp claim is likely to require a hearing. Your employer and the insurance company will try to argue that because you had the pre-existing condition, you aren’t entitled to workers’ comp.

Your attorney, however, will fight this defense by presenting medical records and other evidence to prove that your health was negatively affected by your workplace accident or work-related condition.

Does Georgia allow workers’ compensation benefits for pre-existing conditions?

Legally, yes. Georgia workers’ comp benefits include payment for injuries involving pre-existing conditions. In order to get that compensation, however, an employee needs to demonstrate that their job “aggravated” the pre-existing condition. In other words, your working conditions or a workplace accident made your medical condition worse.

Let’s say, for example, you needed knee surgery 5 years ago. Since then, you’re able to work without a problem. If you fall from a scaffold and your knee becomes injured again, then you’re entitled to workers’ compensation benefits. Your attorney will demonstrate how the accident contributed to new pain coming from an old injury, and you should be able to receive a workers’ comp settlement.

Because Georgia considers the condition to have been aggravated rather than created, temporary total disability is likely to be the category of your benefits. This allows for coverage of medical expenses and lost wages, but only for a specified amount of time.

As a result, your employer’s insurance company will try to stop payments as soon as you’ve “recovered” from medical treatment. In other words, payment could stop once your pre-existing condition returns to its initial level of discomfort. Permanent disability is possible, but unlikely unless you can show that the accident or injury worsened your condition beyond medical treatment.

In order to prevent your coverage from stopping too soon, be sure to consult with your primary care doctor and your workers’ comp lawyer to ensure that you’re doing everything you can to demonstrate that your injury is still eligible for workers’ compensation benefits.

Enjuris tip: Keep track of your pain and day-to-day limitations with our post-accident journal.

Tips for recovering workers’ comp when you have a pre-existing condition

A pre-existing condition is certainly a hurdle for workers’ compensation claims, but handling your condition the right way will help you recover damages. It’s important to remember the following:

1. Tell the truth.

Whether you’re visiting a doctor for your pre-hiring physical or recovering from a work injury, it’s important that you mention whatever pre-existing conditions you may have. If you neglect to mention a previous injury or condition that you know you have, you could be accused of workers’ comp fraud and risk losing the right to any benefits.

2. Be specific.

Whenever you have a medical exam that discusses your pre-existing condition, you need to clarify exactly how you feel and how your condition impacts your life. If, for example, your day to day activities aren’t impacted or you only feel occasional pain, you need to state exactly that. The same amount of detail is needed when you’re being checked after your workplace accident or injury.

By providing a detailed and specific account of your health, you’ll have better documentation of how your work accident aggravated your pre-existing condition. Accordingly, if a change for the worse is obvious, you’re more likely to receive damages.

3. Be consistent.

This is perhaps the trickiest aspect to managing your pre-existing condition. You may not remember if you had rated your previous pain level to be a 6 or an 8. Perhaps you gave an off-the-cuff answer and said that your injury made it painful to lift items, but didn’t specify how heavy the items were.

Inconsistent answers may be innocent on your part but could provide trouble for you in the future. Fluctuating pain levels and daily impact could reduce your workers’ comp payout or restrict your settlement altogether. It’s better to be honest and consistent rather than run the risk of no workers’ comp settlement or even an accusation of workers’ comp fraud.

Pre-existing conditions add a certain degree of complexity to a case and can impact your compensation. If you were injured on the job and have a question about a pre-existing injury, we strongly encourage you to find an experienced workers’ comp attorney near you.

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