How does a pre-existing condition affect my workers’ compensation benefits?

The term pre-existing condition often sets off alarm bells for both patients and insurance companies alike. Those suffering from an illness or injury worry about the type of treatment they will be able to obtain, while it seems insurance companies hope to use the term as a pass to avoid payment. It’s natural, then, that many Iowa workers have concerns about how a pre-existing condition would affect their ability to obtain workers’ compensation benefits. Fortunately, state law seeks to protect the interests and health of employees, and it is very often possible to still obtain benefits despite previous illness or injury. Here, we take a closer look at these conditions and what they mean for injured Iowa employees.

What Is a Pre-Existing Condition?

A pre-existing condition is a health problem that a person experiences before being enrolled in insurance coverage. For workers’ compensation purposes, it would be a medical problem that existed before the employee began working for his current employer or that occurred before the accident or injury in question. Some of the more common pre-existing conditions include asthma, arthritis, orthopedic problems, muscle strains or tears, and much more.

Iowa Workers’ Compensation Covers the Aggravation of an Old Injury

In Iowa, a pre-existing condition does not automatically exclude an employee from eligibility for benefits, and state courts have repeatedly affirmed this notion over the years. Workers who have a pre-existing that is “aggravated, accelerated, worsened or ‘lighted up’” under circumstances related to their employment are entitled to compensation. One ruling stated that the “mere existence [of a condition] at the time of a subsequent injury is not a defense” for the employer.

How a pre-existing condition affects a workers’ compensation claim is often described using the words “but for.” If an employee could have continued to perform his job duties and the pre-existing condition would not have been an issue but for an accident or aggravation experienced on the job, the employee likely can pursue benefits.

For example, consider an employee who injured his knee playing basketball outside of work. He underwent surgery and recovered. He has been working for his employer performing job functions without issue for two years until he falls down a set of wet stairs, re-injuring that same knee. His previous injury would have little to no bearing on his claim. But for the wet stairs, the employee could have continued to work without issue.

Employers and Insurance Companies Will Likely Dispute These Claims

Unfortunately, when an employer and insurance company are aware of previous illness or injury, they will likely attempt to minimize their financial obligations by attributing an employee’s pain or disability on the pre-existing condition. In those situations, it often becomes the burden of the employee to demonstrate that the work conditions caused the worsening or re-injury. An experienced Iowa workers’ compensation attorney can help injured employees obtain the benefits to which they are entitled by focusing on:

  • Work conditions. Workers’ compensation claims are based on work-related injuries. When the employee can show that specific work conditions aggravated an injury or caused an accident that caused further problems with an old injury, it supports the claim and diminishes the effects of the pre-existing condition.
     
  • Medical testimony. The testimony of a physician or other medical expert can make a significant impact on a claim. This testimony can establish the difference or change that occurred in the worker’s physical condition because of the accident or injury. This can prove that the worker is entitled to benefits for a new or worsening injury, rather than seeking unfair compensation for an old issue.

As with any workers’ compensation claim, it is important to seek medical care right away and tell your provider how your injury is related to work. Also, report the injury or illness to your employer as soon as possible. Finally, keep records of all correspondence with your employer and medical provider, as well as a detailed list of missed days of work and medical appointments. Often, employers and insurance companies will also dispute the timeline of the injury to avoid paying benefits. These claims can be confusing, as many times there is not one specific incident that caused the worsening of the old injury, and employers may object to the claim based on the statute of limitations.

If you or someone you love re-injured or worsened an old injury or illness while at work, it can be possible to obtain workers’ compensation benefits in Iowa. Call the experienced attorneys at the Pothitakis Law Firm to learn more about your rights and how our legal team can help.