Good afternoon, everyone! Rex Zachofsky here, your go-to workers compensation attorney in New York. Today, I want to dive into a topic that might not always make the headlines but is super important nonetheless—preexisting conditions in workers compensation claims. This is something that comes up almost daily in my practice, and I know many of you have questions about it. Whether you're dealing with a nagging injury from years ago or something more recent, understanding how preexisting conditions affect your workers compensation claim is crucial. Let's clear up the confusion and get you the answers you need. If you have questions at any point, don't hesitate to reach out or drop a comment. Now, let’s get started!
So, what exactly are preexisting conditions when it comes to workers compensation here in New York? Simply put, a preexisting condition is any prior injury, disability, or illness that affects the same body part as your current injury. For example, if you hurt your back five years ago and then injure it again recently, that old back injury is considered a preexisting condition.
Common examples include recurring injuries to your back, knee, shoulder, or even conditions like heart disease if you’ve suffered a work-related heart attack. Whether it’s from a previous work incident, a car accident, or even an old sports injury, these preexisting conditions can come into play when filing a new workers compensation claim. Understanding this is key because insurance companies will often bring up these old injuries to influence your current claim.
A question I hear all the time is, "Does workers compensation cover preexisting conditions?" The quick answer is no, workers compensation does not cover the treatment for preexisting conditions unless the original injury was work-related.
So, let’s say you hurt your back at work five years ago and then re-injure it at work today. Workers compensation will not cover the treatment for that old injury; it will only cover the new injury and the worsening of the condition due to the recent accident. However, if the preexisting condition was from something unrelated to work—like a high school football injury—that old injury won’t be covered. The benefits you receive will focus solely on the new work-related aggravation or injury.
One crucial aspect of handling preexisting conditions in workers compensation claims is distinguishing between an exacerbation and a new accident. An exacerbation is essentially a worsening of a preexisting condition without any new specific incident causing it. For instance, if you injured your back five years ago and one morning you wake up with severe pain without any recent trauma, that’s an exacerbation.
On the other hand, a new accident involves a distinct, recent event that aggravates your old injury. Suppose you have that old back injury, but then you hurt it again by lifting a heavy box at work yesterday. That’s considered a new accident.
Understanding the difference is vital because it affects how you file your claim. If it’s an exacerbation of an old work-related injury, you continue under the old claim. If it’s a new accident, you need to file a new claim. Before jumping to conclusions, it’s always best to consult your doctor and lawyer to get the facts straight. If there's any doubt, my advice is to file a new claim to ensure you’re protected. We’ll sort out the details in court if necessary. Better safe than sorry!
Now, let’s talk about how insurance companies use preexisting conditions against you. Insurance companies often try to minimize their liability by attributing your current disability to an old injury. Their goal is to convince the judge that most, if not all, of your current issues stem from that old injury rather than the new work-related accident.
This tactic is especially common if your previous condition was not work-related. For instance, if you had a football injury years ago, they might argue that your current back problems are entirely due to that old injury. Even if your preexisting condition was work-related, they might still try to shift the burden back to that old case for two main reasons:
First, if the previous injury occurred when you were earning less money, the benefits they have to pay you now could be significantly lower. Second, there's a good chance that they weren’t the insurance company handling your case back then, so shifting the burden means they don’t have to pay you anything now, leaving the old insurer responsible.
This makes it extremely important to distinguish between an exacerbation and a new accident accurately.
When it comes to proving a work-related injury, especially if you have a preexisting condition, good medical evidence is your best ally. The first step is to speak to your doctor. Your doctor will help determine whether your current condition is an exacerbation of a preexisting injury or a new accident. This distinction is crucial for filing the correct claim.
Ensure your doctor has a complete picture of your medical history. This includes detailing all prior accidents, injuries, disabilities, and the specifics of your current injury. Comprehensive medical records are the strongest evidence you can present in a workers compensation case.
If there’s any uncertainty about whether your current issue is an exacerbation or a new injury, it’s wise to file a claim for a new accident. It’s better to have a new claim dismissed than to miss out on potential benefits because you thought it was just an exacerbation.
In addition to medical records, consulting a workers compensation lawyer is vital. Cases involving preexisting conditions can become complicated quickly. A lawyer will help ensure you file the correct claims, gather necessary evidence, and represent your interests effectively. Remember, thorough medical documentation and legal advice are key to navigating these claims successfully.
One common question is whether a preexisting condition can reduce the workers compensation benefits you receive for new injuries. The answer isn't straightforward—it’s both yes and no, depending on your specific case.
When you have a preexisting condition that affects the same body part as your new injury, the concept of apportionment comes into play. Apportionment involves determining how much of your current disability is due to the old injury and how much is due to the new one. For example, if you recently broke your leg and already had a previous injury to that leg, a judge might apportion your overall disability between the two incidents, which could affect the benefits you receive.
In some cases, especially with neck and back injuries, there’s an argument that despite a preexisting condition, you were able to work full duty until the new accident occurred. If you’ve been performing your job without restrictions before the new injury, this can support the claim that your current disability is solely due to the new accident.
Doctors will review your medical history, current medical reports, and past records to determine the degree of disability attributable to each injury. This apportionment process is critical as it influences the benefits you’re entitled to receive.
Understanding apportionment can be complex, so having a knowledgeable workers compensation lawyer can make a significant difference. They will help argue your case and ensure you get the benefits you deserve.
Dealing with workers compensation claims, especially when you have preexisting conditions, can be tricky and confusing. That's why it's so important to have the right information and support. If you have any questions or need help navigating your claim, don’t hesitate to reach out. I’m here to help you every step of the way. Give me a call at 212-406-8989. Let's make sure you get the benefits you deserve.
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