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How Do Pre-Existing Conditions Affect My Claim?

Slape & Howard March 17, 2023

If you have been injured at work, you may be wondering what factors will impact your workers' compensation claim. While it is possible for workers with pre-existing conditions to receive benefits, there are certain factors that need to be taken into consideration in order to determine if a pre-existing condition will have an effect on your claim. 

Consider speaking with our attorneys at Slape & Howard to discuss your individual case and determine whether or not your pre-existing conditions could make you ineligible for workers’ compensation. From our office in Wichita, Kansas, we serve injured workers throughout the state of Kansas.  

Qualifying for Workers Compensation   

In order to qualify for workers’ compensation benefits, you must meet certain criteria. The most important criteria are that you must have been injured on the job or suffered an occupational illness as a result of working. You must also be able to provide evidence of your injury or illness and prove that it was caused by work activities. It is also important to note that not all injuries are covered by workers compensation – only those that occur while or from performing work operations or duties are.  

What Qualifies as a Pre-Existing Condition?  

A pre-existing condition is any medical condition that existed prior to the incident resulting in the injury or illness for which you are claiming benefits. This includes any physical or mental health issues, including chronic pain syndromes, arthritis, diabetes, heart disease, depression, and anxiety disorders. Additionally, any injuries you have suffered in the past (e.g., at work or in a car accident) also qualify as a pre-existing condition.  

According to the Centers for Medicare & Medicaid Services, an estimated 82 million U.S. citizens with employer-based coverage have pre-existing medical conditions. It is important to understand that pre-existing conditions do not necessarily prevent you from receiving benefits. However, they can affect how much compensation you receive and how long your claim process takes.   

How a Pre-Existing Condition Can Affect a Claim  

Your employer's insurance company may use information about your pre-existing condition in order to lower the amount of money they will pay out for benefits because they may argue that some of your symptoms could be due to your preexisting condition rather than the workplace accident/injury/illness for which you are filing a claim.  

Additionally, if it is found that there was an existing medical issue prior to the workplace incident causing increased symptoms then this could potentially delay or even deny payment of benefits due to “previous history” considerations by insurance companies.   

Appealing a Claim Denial  

If the employer’s insurance company denied your workers compensation claim because of your pre-existing condition, contact a workers’ compensation attorney as soon as possible. You may still have a chance to appeal the denial of your claim. Having an attorney to help you navigate the appeal process is critical to pursuing a successful outcome.  

Why You Should Hire an Attorney If You Have a Pre-Existing Condition  

If you have been injured on the job and also have a pre-existing condition, then it is highly recommended that you hire an attorney who specializes in these types of cases. An attorney can help protect your rights and seek all of the benefits owed to you under the law.  

Lawyers who specialize in this legal area know exactly how insurance companies operate when dealing with these types of cases and will fight hard for their clients in order to ensure they get their rightful entitlements under the law regardless of any pre-existing medical issues involved. Your attorney will gather all available evidence to help you prove your case and recover the benefits you deserve.  

Protect Your Rights After Your Injury 

If you have been injured at work and believe that you may have a pre-existing condition that could impact your ability to receive full workers compensation benefits, then hiring an experienced attorney should be one of your first steps toward protecting your rights. Contact our attorneys at Slape & Howard to schedule a consultation and get your questions answered today.