Do you have a pre-existing condition of some kind, or you are accused of having one when you don’t? This question comes up often after a workers’ comp claim is denied. This might be surprising and frustrating, as employers are often trying to claim that your new claim is related to an old one, or some condition unrelated to work. Too often they skip over the fact that your work injury is totally separate or aggravated your pre-existing condition. You could still be entitled to significant compensation through the workers’ compensation system in California.
At Ratto Law Firm, P.C., our California workers’ compensation attorneys understand the frustration of a denial. We help you navigate the challenges of an actual or alleged pre-existing condition and how it might impact your current claim. We know you’re frustrated, but we are here to help.
What Counts as a Pre-Existing Condition?
A pre-existing condition is any medical issue or injury that existed before the workplace incident. Common examples include:
- Chronic back pain
- Prior spinal injuries
- Arthritis
- Degenerative joint disease
- Previous fractures
- Prior surgeries
- Respiratory conditions such as asthma
- Heart disease
- Other long-term illnesses
These conditions do not automatically disqualify you from receiving workers’ compensation benefits. However, they can influence how your claim is evaluated.
How Pre-Existing Conditions Complicate California Workers’ Comp Claims
Insurance companies often argue that your current symptoms are the result of your prior condition rather than your job duties. This may cause:
- Partial Denials: The insurer may try to limit what they pay and only give you part of what you ask for.
- Apportionment of Benefits: Insurers in California can divide responsibility between the actual accident and your pre-existing condition.
- Increased Scrutiny: When you have a pre-existing condition, the insurer will look at records more closely.
California’s Approach to Pre-Existing Conditions
California law is meant to help workers. It understands that people have prior health conditions, and doesn’t try to punish them for it. You are allowed compensation if the workplace injury is:
- Aggravated
- Accelerated, or
- Worsened
by the workplace accident.
Proving Your Claim
To succeed in a workers’ compensation claim involving a pre-existing condition, you must demonstrate that your job duties directly contributed to your current injury or illness. Steps to strengthen your case include:
- Detailed Medical Documentation: Obtain records showing how your condition changed after the workplace incident.
- Independent Medical Evaluations: These can provide objective evidence that your injury is work-related.
- Clear Reporting of Symptoms: Notify your employer promptly and describe how the injury occurred.
- Legal Representation: An attorney can help present evidence and challenge insurer arguments about apportionment.
The Role of Apportionment
Apportionment is a critical concept in California workers’ compensation law. It refers to dividing responsibility for a disability between work-related and non-work-related causes. For example:
- If a doctor determines that 60% of your disability is due to a workplace injury and 40% is due to a pre-existing condition, benefits may be reduced accordingly.
- Apportionment does not eliminate your right to compensation. It simply adjusts the amount based on medical findings.
Because apportionment can significantly affect the value of your claim, it is often a point of dispute between employees, insurers, and attorneys.
Why Legal Help Matters
Workers’ compensation claims involving pre-existing conditions are among the most contested cases. An experienced attorney can:
- Ensure medical evidence is properly documented and presented
- Challenge unfair apportionment assessments
- Represent you at hearings before the Workers’ Compensation Appeals Board (WCAB)
- Negotiate settlements that reflect the true impact of your workplace injury
Let Us Help With Workers’ Comp and Pre-Existing Condition Claims
A pre-existing condition does not automatically make you ineligible for benefits, even if the insurance company or employer makes it feel that way. They may just be trying to get out of paying what they should. In other cases, the pre-existing condition does make the case complicated, but you could still be entitled to the portion of your injuries the work accident caused. Let us help you figure it all out.
Our team at Ratto Law Firm, P.C. provides you with the advice and representation you need. Contact us today for a consultation.