How Pre Existing Conditions Affect California Workers’ Compensation Claims

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How Pre Existing Conditions Affect California Workers’ Compensation Claims

I’m Ed Smith, a Sacramento Workers Compensation Lawyer.  Many employees are fully capable of performing their job functions successfully despite having pre-existing medical conditions. These conditions are often controlled by medication, therapy, or simply avoiding activities that can worsen them.

New Injury Requirement

California workers’ compensation law requires that any injury an employee tries to seek compensation for must be a “new” injury. This means that if an employee starts at Company A with bulging discs, the employee will be unable to demand that workers’ compensation insurance cover doctors’ appointments and physical therapy for the bulging discs. That will have to be something that health insurance covers.

However, people with pre-existing conditions often run into problems when they are involved in accidents in the workplace. It is difficult to disentangle workplace injuries from pre-existing injuries. If you suffered an injury to a part of your body that is not connected to or related to your pre-existing condition, you should not run into any difficulty with proving that your injury is a “new” injury.

Aggravation of Pre-Existing Conditions

However, what if the workplace accident injury and pre-existing condition are intertwined? California law permits employees to seek compensation for aggravation of pre-existing conditions. While the underlying condition itself is not new, the aggravation caused by the accident qualifies the pre-existing condition as a “new” injury for purposes of recovery.

But what qualifies as an aggravation? According to the law, “aggravation” only covers: (1) “temporary or permanent increase in disability,” (2) a condition that “creates a new need for medical treatment,” or (3) a condition that “requires a change in the existing course of treatment.” If your pre-existing condition reoccurs regardless of any accident or occasionally flares-up without provocation, the law labels the injury as an “exacerbation,” not an “aggravation.” While these words seem synonymous, the law treats them separately. In California, an exacerbation is not “new.”

How to Separate Pre-Existing Conditions from New Injuries

Often times, the very nature of the pre-existing condition serves as proof that the employee had the medical condition prior to the accident. For instance, scoliosis is a degenerative spinal disease usually caused by genetics. It develops slowly over time and cannot be caused by an accident. If you have scoliosis, slip and fall on a puddle in the warehouse, and claim the fall caused scoliosis, the insurance company will likely deny your claim. However, that doesn’t stop you from arguing that the fall aggravated your scoliosis. Scoliosis is often associated with other spinal issues, such as sciatica, muscle stiffness and tightness, and herniated discs. It is possible for an accident to cause a related symptom that didn’t previously exist.

In order to show that either (1) you had no pre-existing condition, or (2) the pre-existing condition was aggravated by the accident, you will need to submit medical documentation. This includes medical records from prior to your accident that document your health and condition in detail. In addition, you will need to submit medical records following the accident that show the injuries you suffered due to the accident. Medical testimony from doctors who treated you will be necessary to explain how your injury was not simply a pre-existing condition (or “old” injury).

How Pre-Existing Conditions Affect California Workers’ Compensation Claims

Sacramento Workers’ Compensation Lawyer

Medical records and scientific research involving the human body is incredibly complex. In order to pursue a workers’ compensation claim when you have a pre-existing condition, it is recommended you consult with a Sacramento workers’ compensation attorney who can advise you on how to proceed, connect you with expert witnesses, and craft a case tailored to your needs and goals.

I’m Ed Smith, a Sacramento Workers Compensation Lawyer. If you or a loved one has sustained an injury at work, please call me at (916) 921-6400  for free, friendly advice. Read more about us on our website, https://www.AutoAccident.com.

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Photo Attribution:  Alfred T. Palmer [Public domain], via Wikimedia Commons

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