Are pre-existing conditions covered by workers’ compensation?

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Are pre-existing conditions covered by workers’ compensation?

Workers’ compensation is insurance guaranteeing medical, disability and other benefits to injured workers for work-related injuries. In New York, every business, even one with only a single employee, must carry workers’ compensation unless it belongs to an exempt category, such as non-profit or religious organizations, sole proprietorships and some small businesses.

But what if the injury a worker is experiencing was from an accident that occurred somewhere else, or is an old sports injury, for example? Can the worker still file for workers’ compensation if the injury gets worse with an activity that aggravates a pre-existing condition?

How does a pre-existing condition relate to a current job function?

Depending on the injury, there are many activities and functions that workers perform on the job that can put additional stress on a part of the body that has previously suffered damage. Pre-existing conditions can become worse while performing required job functions, such as:

  • repetitive motions that put added stress on one part of the anatomy, resulting in carpal tunnel syndrome and knee and spinal injuries
  • overexertion from lifting, carrying, or pulling heavy or unwieldy objects
  • work environments with frequent loud noises, or dust or particulates in the air

A worker who experienced a previous knee injury, an office worker who has weak shoulders, or individuals with anxiety, high blood pressure, or asthma, may be working in an environment where these conditions may become worse.

How do I resolve a claim dispute over a pre-existing condition?

When filing an initial claim, it is vitally important to have detailed medical records, both of the pre-existing condition and the work conditions that are aggravating it. Having a knowledgeable legal advocate to maneuver through the complex workers’ compensation administrative channels is essential, especially if the worker has received a claim denial.

When a dispute arises from a claim, such as whether the injury was work-related, the degree of disability that is attributable to the job function, or what treatments the worker is receiving, it may come before the Workers’ Compensation Board for resolution, either in a formal hearing or informally.

It is important to observe the filing deadlines when filing a written objection to the decision. If the Board receives the objection before the deadline, it may refer the issue to a conciliation process or to a Workers’ Compensation Judge, or the Board may issue a modified administrative decision.