Workers’ Compensation Claims Cannot Be Automatically Denied Due to a Pre-Existing Injury
But the claim must be based on the exacerbation of the prior injury or condition – not the old injury itself
In a workers’ compensation case, a claim cannot be denied simply because the employee has a pre-existing injury or condition. If the incident aggravated or exacerbated a pre-existing injury, then the workers’ compensation carrier is responsible for treatment of that injury. Whether the original injury stemmed from another work-related accident, a car accident or a childhood incident is irrelevant.
While the way in which the worker was initially hurt does not matter, the employee cannot file a workers’ compensation claim based on that injury. Instead, he or she must show that a recent occupational accident made it worse. For example, a worker who hurt his or her knee, as a teenager while skiing cannot file a workers’ compensation claim just because he or she noticed the same knee started aching at work. The employee must demonstrate that something such as a fall at work or an activity such as kneeling to store office supplies aggravated the old injury.
An employee may also be eligible for benefits if he or she can demonstrate that an occupational exposure or job-related activity made the pre-existing injury worse.
Although pre-existing injuries cannot preclude employees from obtaining workers’ compensation benefits, they can impact the type and amount of benefits awarded. Suppose, for instance, that “John,” an employee at Company X, fell and broke his ankle at work five years ago. He filed and received workers’ compensation benefits to cover the cost of his ensuing surgery and rehabilitation. He also received temporary disability payments while he was unable to work and partial permanent disability benefits because he never regained full mobility in the joint.
John has walked with a slight limp since the first accident, but never experienced any significant or unusual ankle pain until last Friday, when twisted the same ankle at his new job. He again filed a workers’ compensation claim and his employer’s insurance company again determined that he had a valid claim. As in the prior case, insurance company agreed to cover all of his essential medical costs and make disability payments while he was out of work. John now faces additional loss of mobility and function in his injured ankle. Even so, his employer’s insurance company decided to reduce the partial permanent benefits to offset the amount awarded in the prior claim.
Now consider a scenario in which John initially broke his ankle playing capture the flag with his friends when he was 10, and re-broke it at work 12 years later. The second injury, which he sustained at work, resulted in additional function and loss of mobility in the joint. In such a case, John’s benefits would be prorated to reflect the disability associated with the aggravation of the prior injury.
The only circumstances in which a pre-existing condition would not have a significant impact on John’s workers’ compensation benefits is one in which it is completely disparate from the current work-related illness or injury.
Due to the complexity of workers’ compensation law, it is important to consult with a highly skilled attorney regarding your eligibility for benefits. Contact the New Jersey workers’ compensation lawyers at Lomurro Law online or call 732-482-9285 to schedule a preliminary meeting now.