Can You Get Workers’ Comp If You Have a Pre-Existing Condition?
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.
Many injured workers misunderstand how prior injuries or chronic medical conditions interact with workers’ comp laws. It’s crucial to understand that a previous injury doesn’t automatically disqualify you from receiving benefits.
Understanding Pre-Existing Conditions in Workers’ Comp
A pre-existing condition refers to any medical issue or injury that existed prior to the most recent workplace accident. This may include orthopedic issues, degenerative disc disease, arthritis, prior fractures, or chronic conditions such as asthma, diabetes, or even mental health disorders.
California workers’ compensation law (Labor Code S4663) recognizes that prior conditions can be legally aggravated by work duties. The core legal question becomes whether the employment caused a new injury or worsened the existing one.
How California Law Handles 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.
This distinction is rooted in California’s “aggravation vs. exacerbation” rule. Under Labor Code §3208.1, a true aggravation is considered a new injury, while a temporary flare-up (exacerbation) of symptoms without lasting damage may not qualify.
Common pre-existing conditions include spinal injuries, hernias, repetitive strain injuries, and knee or shoulder damage. These are particularly common among Los Angeles workers in construction, transportation, and healthcare.
Cumulative Trauma and Pre-Existing Conditions
Many work injuries in California develop gradually. These are called cumulative trauma injuries, defined under CA Labor Code S3208.1(b). For example, repetitive motion, long-term lifting, or exposure to stress can worsen an existing condition.
If your pre-existing condition was aggravated over time by repetitive work-related tasks, you may be eligible for compensation. Los Angeles-area workers in logistics, nursing, and hospitality industries frequently face such injuries.
The Role of Medical Evaluations and Documentation
To prove that a workplace incident aggravated your condition, documentation is critical. Medical evaluations, especially from a Qualified Medical Examiner (QME) or an Independent Medical Evaluation (IME), carry significant weight in court.
These evaluations determine causation, injury severity, and how much of your condition was caused by work. Functional Capacity Evaluations (FCE) may also be used to assess your ability to perform job duties.
Doctors will often “apportion” the cause of the injury between your pre-existing condition and the new work-related incident, which may impact your compensation, not your eligibility.
What If the Injury Relates to a Past Employer?
If your workplace injury worsens a condition caused by a prior job, liability may be shared. In some cases, your previous employer (or their insurer) could be partially responsible. This often leads to legal complexities, especially with long-standing injuries like cumulative trauma.
Burden of Proof in Pre-Existing Injury Cases
Under California law, the burden of proof lies with the injured worker. You must demonstrate that your work duties aggravated or accelerated your prior condition. Medical opinions, time-stamped job duties, and injury progression are vital to support this.
This is where a workers’ compensation attorney becomes critical, especially if apportionment is disputed or multiple employers are involved.
Modified Duty and Return-to-Work Issues
California law requires employers to offer modified or alternative work when medically appropriate. However, this work must not worsen your pre-existing condition.
If your employer in Los Angeles offers modified duty that exceeds your restrictions, or if you’re pressured to return prematurely, it can be challenged through legal channels. A doctor’s note is your legal shield.
Mental Health Conditions and Psychological Aggravation
Workers’ compensation in California also covers mental health conditions aggravated by workplace stress. If you suffer from a pre-existing psychological condition like anxiety, depression, or PTSD, workplace trauma or hostile environments can legally worsen those issues.
As long as you can establish a documented link between your job and the aggravation, you may be eligible for benefits. Psychiatric claims require higher proof standards, but they are still valid under state law.
Defending Your Workers’ Comp Claim with a Pre-Existing Condition
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 questions 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 to settle your claim with you. Your case will move to trial if you cannot come to a resolution during the pre-trial conference.
Employers and insurance carriers often rely on medical reports and causation analysis to dispute claims. Having clear, well-documented proof that your job aggravated your condition can make or break your case.
Legal Representation: Why It’s Essential
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.
A skilled attorney will ensure that your injury is properly documented, your rights are upheld, and that the legal nuances of apportionment and aggravation are addressed in your favor.
Legal support can also ensure timely filing, appeal coordination, and accurate interpretation of QME or IME reports.
Disclosure During Hiring: Does It Affect Your Claim?
If you didn’t disclose a pre-existing condition when asked during the hiring process, this does not automatically disqualify your claim. However, if you knowingly provided false information on a pre-employment medical form, your employer might challenge your credibility.
Even so, California’s no-fault workers’ comp system typically focuses on whether the job aggravated your condition, not when or how you disclosed it.
If you live or work in the Los Angeles area and your job aggravated a pre-existing injury or illness, don’t navigate the legal system alone.
The experienced legal team at Hussain & Gutierrez focuses exclusively on California workers’ compensation law and can help you defend your rights.
Schedule a free consultation today by visiting https://hussaingutierrezlaw.com/
Let us help you secure the benefits you’re entitled to, even with a pre-existing condition.
Frequently Asked Questions
Can I get workers’ comp in California if I have a pre-existing condition?
Yes. California law allows benefits if your work aggravated your prior condition, making it a “new injury” under Labor Code S3208.1.
Will I be denied benefits if I didn’t tell my employer about my prior condition?
Not automatically. California’s workers’ comp system is no-fault. Disclosure may affect your claim, but it doesn’t disqualify you unless there’s proven fraud.
What’s the burden of proof in pre-existing injury claims?
You must prove that your job duties caused an aggravation of your condition. Medical evidence and doctor reports are crucial.
Can I choose my own doctor for a workers’ comp claim?
Sometimes. In California, if your employer has a Medical Provider Network (MPN), you may be required to choose from that list unless you have predesignated your physician.
What if I think the QME report is unfair?
You can dispute it. You have the right to request a new panel QME or challenge findings through legal representation at the Workers’ Compensation Appeals Board.
Can mental health conditions qualify under workers’ comp?
Yes. If your job aggravated a pre-existing psychological condition, such as anxiety or PTSD, and it can be documented, you may qualify for benefits in California.
