Obtaining Workers’ Compensation Benefits and Your Pre-Existing Condition

Pre-Existing Conditions and Your Workers' Compensation ClaimObtaining workers’ compensation benefits after a work-related injury can feel like an overwhelming task. Confusing laws, paperwork, and coordination between parties can make the process frustrating. For those with a pre-existing condition, it can be even more depressing. The parties responsible for paying for the care and compensation of injured workers (employers or the Ohio Bureau of Workers’ Compensation) will often try to find any excuse not to pay, and the existence of a previous medical condition seems like an easy out. Workers have rights, though, and the mere existence of a pre-existing condition does not automatically mean your workers’ compensation claim will be denied.

What Is a Pre-Existing Condition?

A pre-existing condition refers to a medical problem that a person experienced before they were covered by health insurance. For workers’ compensation purposes, it is a condition that existed before the work injury occurred. Ohio law specifically mandates that a pre-existing condition is not an injury covered by the state’s workers’ compensation system. The system covers only injuries that are “sustained in the course of and arising out of employment.” A pre-existing condition would have some other origin, and therefore, be excluded from benefits.

Obtaining Benefits for Injuries Related to a Pre-Existing Condition

Like most things in life, however, exceptions exist. It is possible to obtain workers’ compensation benefits when a pre-existing condition is “substantially aggravated.” This means that if the work conditions cause a measurable worsening of a pre-existing condition, injured employees may be eligible for workers’ compensation benefits for that injury. Recently, laws have become stricter, and the injured worker must prove the substantial aggravation through documentation of “objective diagnostic findings, objective clinical findings, or objective test results.” It is not enough to simply report an onset of or worsening of pain or other symptoms as was previously acceptable. The condition must have been affected in some objectively measurable way.

In addition, sometimes a pre-existing condition affects the care of a different injury. In these cases, maybe the pre-existing condition needs addressed during treatment for a separate work-related injury. The Bureau of Workers’ Compensation (BWC) offers this example: if a worker has diabetes, which is delaying recovery time after surgery for a work-related injury, treatment for the diabetes may be covered to help promote healing. When the worker has recovered from the work injury, however, benefits for the pre-existing diabetes will be discontinued. This is known as a co-morbidity condition.

Recurrent Injury Is Not the Same as a Pre-Existing Condition

Sometimes, employers may want to classify an injury as a pre-existing condition when it is a recurrent injury. A recurrent injury is an injury of the same type and affecting the same body part as a previous injury. These are separate injuries, however, and workers can file a new claim with the BWC for care and compensation. Sprains and strains are common examples of recurrent injuries. It is fairly common, for example, for an employee to strain his lower back lifting heavy boxes. He may receive treatment and recover, only to sustain the same injury a year later doing the same work. Some clients have half a dozen or more claims for low back strains, each reflecting a separate injury.

Employers, however, often try to avoid the financial consequences of a claim by attempting to dismiss it as a pre-existing condition that became symptomatic with the work injury or insist it is still tied to the previous workers’ compensation claim. In either case, the injured worker would likely receive less compensation (or none!) than she would with a new claim. This is because the maximum rate of payment for injuries generally increases every year.

Although Ohio workers’ compensation does not cover pre-existing conditions, there are shades of gray with injuries. An experienced attorney can work with you and your medical team to determine your medical needs and your legal rights. At Monast Law Office, Jim Monast has helped many injured workers obtain the care and compensation they deserve, and he may help you, too. Take a moment to fill out the contact form on this page, and you will hear from a member of our team who can discuss your situation with you over the phone or in person--there is no obligation and no charge for the visit.

 

James Monast
Fighting for Ohio’s Injured Workers and their Families