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Pre-Existing Conditions and Workers’ Compensation Claims

January 7, 2022

It is not uncommon for a worker in Colorado to have a pre-existing medical condition or injury at the time of suffering a new injury at work. Unfortunately, a pre-existing condition can lead to challenges during a workers’ compensation claim. An insurance company may unfairly use this as a reason to deny the claim or reduce the financial benefits available. This is why it is important to discuss your case with a workers’ compensation attorney in Denver.

Pre-Existing Conditions and Workers’ Compensation Claims

What Is a Pre-Existing Condition?

A pre-existing condition describes any health or medical condition, illness, disease, or injury (including injuries that have previously healed) that a worker had prior to the workplace accident that is involved in the new insurance claim. In general, a pre-existing condition will only come up during an insurance claim if it affects the same part of the body as the new work injury; for example, if you sprain a muscle in your back where you already had a herniated disk. Common examples of pre-existing conditions include:

  • Healed broken bones
  • Muscle and ligament injuries
  • Back injuries
  • Herniated disks
  • Knee injuries
  • Elbow injuries
  • Repetitive motion injuries
  • Degenerative spine conditions
  • Sleep apnea
  • Lupus
  • Diabetes
  • Arthritis
  • Cancer
  • Pregnancy

Almost any type of injury or condition that you had before your latest work accident can qualify as a pre-existing condition for insurance purposes. If you have a pre-existing injury that is relevant to your case, it is important to disclose this to the insurance company during your workers’ comp claim. If it appears that you intentionally tried to hide this information, this could disqualify you from benefits.

Can a Pre-Existing Injury Disqualify You for Workers’ Compensation?

No. While a pre-existing condition may impact your workers’ comp claim, it will not bar you from benefits. Nevada Revised Statute 616C.175 states that employers must provide workers’ comp benefits to employees with pre-existing injuries if the work-related accident exacerbated, aggravated or otherwise affected the pre-existing condition. In other words, a pre-existing injury or condition does not disqualify a worker from using workers’ comp insurance to pay for medical bills, lost wages and other losses.

If an insurance company denies your workers’ compensation claim on the grounds of a pre-existing injury, you have the right to file an appeal requesting a change of the insurer’s decision. You can also fight back if the insurance company appears to have reduced the financial benefits available because of a pre-existing condition. By law, an insurer must pay for your full workers’ comp benefits – even if they are more than they would have been without your pre-existing condition – unless it can prove that your work injury did not exacerbate your existing injury.

How to Handle a Claim With a Pre-Existing Condition

An insurance company will use any excuse to devalue your claim or reject benefits altogether. Steps that you can take to protect your right to a financial recovery if you have a pre-existing condition are filing your insurance claim promptly, telling your medical provider about your pre-existing condition, obtaining medical documents that prove that your new work injury is affecting your pre-existing condition, following your doctor’s treatment plan and hiring an attorney to represent you during the claims process.

Although your right to recover workers’ compensation is reserved even if you have a pre-existing condition, this is an obstacle that can make it more difficult to obtain fair financial benefits after a workplace accident in Colorado. If you have this complication, a workers’ compensation attorney can help you obtain the medical records that you need to submit with your insurance claim, as well as combat insurance bad faith tactics and handle claims paperwork for you.

An experienced attorney will do what it takes to maximize your financial recovery after a workplace accident. Contact an attorney at The Fang Law Firm today for a free workers’ comp consultation.