A prior injury or medical condition does not disqualify you from filing a workers’ compensation claim in Pennsylvania if you suffer a work-related injury. Many legitimate claims involve workers who were already managing a back condition, joint pain, or a prior injury before something at work made it worse.
If you’re worried that a pre-existing injury or illness will undermine your workers’ compensation claim, here’s what you need to know.
Your medical history doesn’t define your case
Pre-existing conditions are often used as an excuse to deny claims. For instance, an insurer may argue that your current pain is simply “the same old problem” flaring up on its own. However, the law draws a line between natural progression of a condition and a work-related aggravation.
The question is not whether you have a pre-existing condition. The real issue is whether your job caused a new injury or a measurable aggravation of what was already there. If the work activities were a substantial contributing factor leading to a material change to the condition, that will be considered a new injury for purposes of the Pennsylvania Workers’ Compensation Act.
What you should do immediately
After a workplace accident, report the incident promptly to your employer and seek timely medical care, making sure to advise your employer, preferably in writing such as an e-mail or text message, that even though the condition may have been pre-existing, you believe that your work activities made it worse. Your employer will have to advise their workers’ compensation insurance carrier and the carrier will investigate the claim and accept or deny the claim within 21 days of you giving notice. Be specific with your doctor about what changed and when. Vague descriptions give insurers room to argue that your condition isn’t qualifying. At the same time, don’t exaggerate or downplay your symptoms. It could lead to unintended complications down the road.
If you’ve already filed a claim and received a denial citing your medical history, that denial is not the final word. You may appeal the decision and ask for a review of the evidence supporting your claim, including your medical records, work history, and the circumstances of your injury.
Reaching out for experienced legal guidance can help protect your rights and interests as you navigate such complexities of the workers’ compensation claims process in Pennsylvania. Contact a certified specialist workers’ compensation attorney to assist you with your claim, whether it has been accepted or not.