Do pre-existing conditions affect workers’ compensation claims?
Sustaining a workplace injury can prevent you from performing the functions of your job. Yet, you may feel tempted to work through your pain, especially if you have a pre-existing condition. Your accident may have exacerbated its severity. But you will likely fear that your employer’s insurer will reject your workers’ compensation claim based on your condition. In California, though, this may not be the case.
How California treats pre-existing conditions
California’s workers’ compensation laws treat an aggravated pre-existing condition as a new injury
. So long as it requires additional treatment, you will qualify for benefits through your employer’s insurance company. You will receive them whether you were still recovering from or managing your condition upon your injury, or whether it had healed. The exception to this rule is if your accident exacerbated a past workplace injury. In this case, the employer you worked for when you sustained the original injury may shoulder responsibility.
Defending your claim
Despite California’s laws, many insurers treat pre-existing conditions as a reason to deny workers’ compensation benefits. If your employer’s insurer denies your claim, you can appeal their decision by requesting a hearing through the state’s Workers’ Compensation Appeals Board. Depending on the circumstances of your injury, you may have to go through a priority conference as part of this process. This will happen if there are question about whether your injury arose from your employment or happened during the course of it. If your appeal is accepted – or if a priority conference is not necessary – you will move on to a pre-trial conference. During your pre-trial conference, a judge will likely try settling your claim with you. Your case will move to trial if you cannot come to a resolution during the pre-trial conference.
Employees with pre-existing conditions qualify for workers’ compensation benefits after a workplace injury. But you may have to jump through hurdles to receive them. An attorney with workers’ compensation experience can help you protect your access to coverage.