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How Do Pre-Existing Conditions Affect Workers’ Comp Claims in NY?

You should be able to get workers’ comp regardless of your medical history.

In New York, workers are entitled to workers’ compensation benefits, regardless of any pre-existing or chronic medical conditions. New York law mandates that employers accept workers as they find them, which means that pre-existing conditions should not prevent workers from filing a workers’ compensation claim. Moreover, you can get workers’ compensation if your work injury aggravates a pre-existing injury, whether the original injury was sustained on the job or not.

Paperwork for a pre-existing condition

That said, if you have a pre-existing condition and sustain a work-related injury or illness, navigating the process of obtaining workers’ compensation benefits can be difficult. By contacting an experienced workers’ comp attorney, you can receive the guidance and representation you need to help you navigate the system and secure the benefits you deserve.

Common examples of pre-existing conditions

Pre-existing conditions that may impact a workers’ comp claim include but are not limited to the following:

  • Back pain or injury
  • Arthritis or joint pain
  • Heart disease
  • High blood pressure
  • Diabetes
  • Asthma and other respiratory conditions
  • Depression or anxiety
  • Previous injuries such as broken bones or muscle strains
  • Chronic pain conditions like fibromyalgia or chronic fatigue syndrome
  • Neurological conditions such as multiple sclerosis or epilepsy
  • Cancer and other chronic illnesses

Often, an employer and their insurance company will argue that a pre-existing condition is the root cause of a worker’s injury rather than a work-related incident. This argument could result in a denial of or reduction in the benefits to which the employee is entitled. An experienced attorney can push back on that argument and demonstrate that the injury was indeed sustained at work.

Understanding pre-existing conditions and workers’ comp claims

A pre-existing condition can impact your New York workers’ compensation claim in various ways. A few key considerations include:

  • Aggravation of a pre-existing condition: If a work-related injury aggravates or exacerbates your pre-existing condition, you may still be eligible for workers’ compensation benefits. You must establish that the work injury or illness significantly contributed to the worsening of your pre-existing condition.
  • Apportionment: In cases where your pre-existing condition is deemed to contribute to your disability, the New York Workers’ Compensation Board may apportion the benefits. This means that the benefits awarded could be reduced, reflecting the extent to which your pre-existing condition is responsible for the disability. According to the Workers’ Comp Board, apportionment may occur in a case “…when a claimant has one injury claim but has other injuries unrelated to their injury claim due to a prior injury outside of work.”
  • Previous work injury: In situations where the pre-existing condition was itself caused by a work injury for which you received workers’ compensation benefits, the workers’ compensation system needs to divide your claim between the previous work injury and the current work injury. This can significantly affect the value of your new claim, depending on how the previous claim was resolved.
  • Claim denial: If the workers’ compensation board determines that your pre-existing condition is the sole cause of your disability, your claim may be denied, and you would not receive benefits. You may appeal your denied claim, but it’s in your interest to consult with a workers’ compensation attorney who can protect your rights and help you navigate the process.
  • Medical documentation: You may be required to provide additional medical documentation to demonstrate the work-related injury’s role in your current disability if you have a pre-existing condition. This can include records of previous treatments and expert medical opinions.
  • Impact on job duties: If your pre-existing condition limits your ability to perform your job duties after a work-related injury, it may affect the benefits you receive, such as vocational rehabilitation or wage replacement.

Keep in mind that the burden of proof falls on you to demonstrate that your work-related injury or illness caused a material increase in the severity of your pre-existing condition.

Establishing a causal relationship between the work-related injury or illness and the worsening of your pre-existing condition can be difficult, particularly when your pre-existing condition was already severe or other factors contributed to its worsening.

Medical evidence is one avenue through which you could establish a causal relationship. This evidence can take various forms, including medical records, imaging studies, diagnostic tests, and testimony from medical experts.

For instance, if you have a pre-existing back injury and suffer a work-related injury that exacerbates your condition, a doctor specializing in the relevant field could testify that your work-related injury played a significant role in the increase in severity.

However, navigating this situation alone can be tricky, and if you’re not careful, you could lose out on the benefits you’re entitled to under New York law. That’s why consulting with an experienced workers’ compensation attorney is essential if you have a pre-existing condition and get hurt at work.

A New York workers’ comp lawyer can explain your rights

In New York, seeking legal help is critical if you’re pursuing workers’ compensation benefits with a pre-existing condition.

The highly skilled attorneys at Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP understand the intricacies of workers’ compensation law and can provide aggressive representation to ensure you get the outcome your claim deserves. To learn more about how we can help with your potential legal case, contact us today for a free evaluation.

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