New York workers’ compensation: the impact of pre-existing conditions

When an employee suffers a work-related injury or disease and applies for workers’ compensation, the impact of a pre-existing medical condition can be complicated under New York law.

New York workers' compensation benefits are normally payable for work-related injuries and illnesses even if connected to pre-existing medical conditions. Because New York law and the medical evidence are particularly complex when an injured worker had a pre-existing condition, it is important to seek legal counsel for assistance with such a case.

The focus in a pre-existing condition case is first on the current injury or disease and whether it arose out of and in the course of employment, making it compensable. The second focus is on the current injury's relationship, if any, to the pre-existing impairment.

Possible scenarios

A claimant may have a pre-existing impairment that still allows performance of the job and the new injury may not impact or be related to that pre-existing condition. In such a case, the pre-existing condition would be essentially irrelevant to the current claim, which would be fully compensable.

Example: A claimant who is able to perform the job despite a hearing impairment slips on liquid on the floor and injures his back. The hearing limitation and the back injury are completely unrelated and the second injury would be completely compensable.

If the claimant had a pre-existing condition that was in remission, not disabling or causing only a level of symptoms that did not prevent him or her from performing the job, a new compensable injury could aggravate the earlier condition so that it became active or symptoms worsened.

Example: A worker has a history of low back problems that have not been severe enough to prevent her from performing the job, but an industrial accident is disabling by causing additional injury to the back that also aggravates the previous back condition.

If the new injury is deemed compensable, then the fact that the previous condition existed and was impacted by the new one does not change the eligibility of the new injury for compensation.

Apportionment

However, the question then becomes whether the pre-existing condition was also work related and separately compensable in workers' compensation in and of itself. If it was the basis of a previous compensable claim, New York law requires that the benefit costs be divided between the two injuries in proportion to their relative impact on the worker's disability. The amount paid on the new injury would be reduced from a full benefit to reflect this apportionment of disability between the two incidents.

If the pre-existing condition was noncompensable and not work related, the new injury would be entirely compensable without any apportionment.

In the previous example, if the first back injury was unrelated to work and still allowed performance of the job, it was not compensable and there would be no apportionment. If the first injury was a compensable work-related injury, the benefit amount would be apportioned between the disabling impacts of the two injuries.

The question of whether apportionment applies is important in a pre-existing condition claim because it can significantly impact the amount of current benefit. Of course, the medical evidence needed to correctly determine these questions under New York law may be complicated. An experienced lawyer can assist such a claimant with gathering and presenting the medical evidence in a helpful light.

(Special provisions in New York workers' compensation law may apply in certain situations when the previous injury involved loss of certain limbs or of certain organs, or in certain cases of previous permanent impairment; or when impairment involves silicosis or another dust disease.)

The lawyers at Angiuli & Gentile, LLP, represent clients with work injuries and occupational diseases in workers' compensation claims, third-party lawsuits and Social Security Disability Insurance.