Pre-existing conditions and workers’ compensation claims
We all have certain aches and pains as we get older. Maybe while in high school you suffered an injury while playing sports. If you do the wrong thing at the wrong time, you experience severe pain and discomfort. You may have been in an auto accident that required you to receive treatment for shoulder or back injuries.
The impact that these injuries have upon your daily life can be increased tremendously due to your required responsibilities in the workplace. For example, constantly lifting packages over your head can cause that shoulder injury to become more serious.
These types of conditions are often called “pre-existing conditions.” This means that this is something that happened outside of the workplace. Now, in the event that these injuries flare up due to your daily workplace activities, you may still be able to recover benefits under the workers’ compensation system. But it is not easy.
In this article, we discuss the impact that pre-existing conditions have upon a workers’ comp claim. We provide you with some information that you can use to learn a little more about pre-existing conditions and the difficulties workers may have when attempting to recover compensation.
How pre-existing conditions are examined under the law
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.
What this means is that your situation will be examined to determine if your work responsibilities caused the pre-existing condition to once again require care and treatment. If a link can be made, you could potentially receive benefits for your situation. If there seemingly is no connection, you might struggle when attempting to file a successful claim for workers’ compensation payments.
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 is a very complex concept in workers’ compensation law, and it often leaves many people confused about the benefits and payments they may be able to receive. The concern here is 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.
This means that any benefits would be split between the injuries, and the compensation for each injury depends on the impact of each injury. If your pre-existing condition was the subject of a previous claim, and this injury is what is causing the most difficulty in your ability to do your job, the benefits that you receive will be significantly reduced because of the previous compensation you received.
One important note: If the pre-existing condition was noncompensable and not work related, the new injury would be entirely compensable without any apportionment. In other words, you would be able to receive the entire amount of workers’ compensation benefits that you are entitled to receive under your current workers’ compensation claim.
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.
These are very difficult cases, because there may be differing opinions over the impact that each injury has upon your ability to do your job. Doctors may make findings that insurance companies dispute, leading to even longer timelines for your case.
The thing to keep in mind is that if you are in this situation, there are things that you can do to make this process easier on yourself. An experienced lawyer can assist such a claimant with gathering and presenting the medical evidence in a helpful light.
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.
(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.)