Content reviewed by:
Alex Shulman
A pre-existing condition in a workers’ compensation claim is an illness, injury, or health condition that predates your work-related accident. When a workplace injury aggravates a pre-existing condition to the extent that it prevents you from working at full capacity, you may be entitled to the same workers’ compensation benefits you could receive if there were no pre-existing condition.
However, your employer and their insurer may say your injury is not work-related and deny your claim. Our experienced New York workers’ compensation lawyers can protect your rights and ensure you get the benefits you deserve.
What Is a Pre-Existing Condition in the Context of Workers’ Compensation?
A pre-existing condition in workers’ compensation claims is a health condition you had before your workplace accident. It could be an illness or a previous injury that occurred in your current workplace, a previous workplace, or somewhere else. Having a pre-existing condition does not disqualify you from receiving workers’ compensation. New York courts have consistently protected the rights of workers with pre-existing conditions.
Workers’ compensation is meant to provide injured workers with prompt wage replacement benefits and medical care when they experience work-related injuries that leave them unable to continue working at the same income level. You are not required to prove the employer was at fault. These rules apply even if you have a pre-existing injury to the same site.
In Lattanazio v. Consolidated Edison of New York, the New York Supreme Court held that workers are entitled to full benefits if the pre-existing condition did not affect work capacity before the incident. The courts also prohibit employers from discriminating against workers based on pre-existing conditions, requiring employers to “accept workers as they find them.”
Common Examples of Pre-Existing Conditions
Many pre-existing conditions may be aggravated by everyday work tasks or accidents, such as slip and falls, muscle strains, being struck by an object, or being caught between objects. For example, heavy lifting can aggravate back problems, while head injuries can exacerbate neurological conditions like epilepsy. Toxic exposures can worsen lung conditions. The following conditions are commonly aggravated in the workplace:
- Herniated discs and pinched nerves in the back
- Spinal stenosis
- Sciatic nerve problems
- Arthritis
- Asthma
- Chronic obstructive pulmonary disorder (COPD)
- Cancer
- Multiple sclerosis
- Epilepsy
- Mental health conditions like anxiety or depression
- Carpal tunnel
- Car accident injuries
When job-related conditions or incidents aggravate these conditions so much that you can no longer work at the same level, you may be entitled to receive full workers’ compensation benefits.
How Pre-Existing Conditions Can Impact Workers’ Compensation Claims
A pre-existing condition should not prevent you from receiving workers’ compensation benefits when your current injury is the cause of your disability. Workers’ compensation becomes available when you cannot work at the same level or at all because of an injury, regardless of whether the disabling injury is new or aggravates a pre-existing injury.
If you could work before the incident despite a pre-existing condition, the pre-existing condition should not affect your new claim. However, when permanency is addressed your benefits could be split up among your claims through “apportionment” if your pre-existing condition was work-related.
What Is Apportionment?
Apportionment divides benefits between claims when your pre-existing injury is related to a prior claim.
In some cases, the insurer may unfairly place all of the blame for your disability on the pre-existing condition and deny your claim. However, apportionment is prohibited if the pre-existing condition is not work-related.
Suppose you have a herniated disc, and your job requires heavy lifting. You perform your duties daily anyway. One day, you lift something heavy and worsen the herniation to the extent that you cannot work. Since the pre-existing condition did not affect your work before the incident, the insurer must pay full benefits.
Challenges When Filing a Workers’ Compensation Claim With a Pre-Existing Condition
Pre-existing injuries complicate workers’ compensation claims by giving employers and their insurers an excuse to deny claims or reduce benefits. In any workers’ compensation claim, you should see a doctor as soon as possible to prove your injuries and their extent. When a pre-existing injury is involved, you may need additional evidence to prove your injury is worse than before the workplace incident. Such evidence may include:
- Medical records
- Testimony from your doctor
- Vocational expert testimony
- Diagnostic tests and imaging results
Even with this evidence, the insurance company may say your new injury is part of the natural progression of your underlying condition and that the disability was not because of an incident at work. It can be particularly difficult to prove your claim when the aggravation occurs because of repetitive stress over time, such as from daily heavy lifting. Our knowledgeable workers’ compensation attorneys know how to overcome these hurdles so you get the benefits you deserve.
Steps to Strengthen Your Claim
Following the steps below can protect your claim and put you in the best position to receive your full workers’ comp benefits when your injury involves an aggravated pre-existing condition:
- Report the injury to your employer in writing as soon as possible.
- Seek immediate medical attention.
- Be upfront with the doctor about your pre-existing condition.
- Give your doctor a complete description of your new symptoms.
- Follow your treatment plan and avoid missing appointments.
- Gather medical records related to your condition.
- Hire a reputable New York workers’ compensation law firm.
Importance of Legal Representation
Having an attorney on your side is always important when an employer or workers’ compensation insurer refuses to treat you fairly. It is even more important with cases involving pre-existing conditions because they can be especially complex.
Insurers may try to use a pre-existing condition against you. They might:
- Say your prior injury is the primary cause of your current disability.
- Accuse you of being untruthful about when your injury started or your prior medical history.
- Require an “independent” medical examination with a consultant of their choosing.
- Cherry-pick your medical records to make your pre-existing injury seem worse than it was.
These tactics do not work on our dedicated workers’ compensation attorneys at Shulman & Hill. We have decades of combined experience handling workers’ compensation cases and have recovered more than $1 Billion+ in case results for personal injury clients. We can obtain the evidence you need to prove your claim and work to ensure you receive the full compensation you are entitled to. As real New Yorkers representing New Yorkers, we strive to deliver personalized attention and maximize results for every client.
Get Help for Workers’ Comp Claims With Pre-Existing Conditions
If you are coping with a workplace injury that aggravated a pre-existing condition, our skilled and compassionate New York workers’ comp lawyers can protect your rights and help you get the benefits you deserve. We service all of New York City and have attorneys fluent in Spanish and Russian. Call (212) 221-1000 today or contact us online to schedule your free consultation.
Related Reading
- How Does Workers’ Compensation Work in NYC?
- Workers’ Compensation Coverage for Long-Term Illnesses and Permanent Damage
- How Much Does Workers’ Compensation Pay in New York?
- How To Fill Out a Workers’ Compensation C-3 Form
