Injuries or illnesses suffered before an on-the-job accident could negatively affect the outcome of your workers’ compensation claim. The insurance adjuster might argue that your medical condition doesn’t qualify for workers’ compensation benefits because it is a pre-existing condition.
This creates various challenges while pursuing coverage. You could face a denied claim and need to appeal the decision or take your case to court.
Even if you have a pre-existing condition, you might be entitled to benefits through your employer’s workers’ compensation insurer. You should hire an experienced New York workers’ compensation attorney to assist you with the legal process.
Understanding a Pre-Existing Condition
When it comes to a workers’ compensation claim, a pre-existing condition is an injury or condition that happened before a workplace accident. For example, a broken bone in a car crash could have occurred months or years before the injured person fractured a bone while working.
Sometimes, workplace accidents worsen an injury or symptoms of a pre-existing condition. Unfortunately, insurance companies will blame an employee’s medical problems on the pre-existing condition instead of looking at the complications of the recent incident that happened on the job.
Navigating a Workers’ Compensation Claim in New York
State law does not prohibit workers’ compensation benefits if an applicant has a pre-existing condition. As long as your injury happened while you performed your job-related duties, you should receive benefit payments for your medical treatment and lost wages.
The insurance company still might try to deny your claim or provide lower benefit payments than you deserve. Common reasons for denied workers’ compensation claims involving pre-existing conditions include:
- The injury is due to a pre-existing condition – The insurance company will review your employment and medical history to determine whether the injury that is the subject of your claim is from a recent workplace accident or was an injury you already had.
- Worsening symptoms are unrelated to the job-related accident – An aggravated or worsened pre-existing condition and symptoms aren’t eligible for workers’ compensation benefits unless it relates to the workplace accident. For example, you could recover benefits if you suffered a concussion in a car crash and started experiencing worse symptoms after a recent fall at work.
- The pre-existing injury or condition and workplace accident occurred close together – The insurance company could argue that your symptoms are negative effects of the injury or illness you suffered right before the occupational accident. Instead of sustaining a new injury, the previous incident caused your pre-existing condition and continues to affect you because it hasn’t healed.
- You worked against your doctor’s orders – If your medical provider advised you not to return to your job, but you did anyway, the insurance company could deny your claim. Suffering an injury or condition while violating a doctor’s order is a valid reason for a denied workers’ compensation claim.
How to File a Workers’ Compensation Claim
If you have a pre-existing condition, you must proceed with the claims process carefully. You should hire an experienced lawyer immediately after the workplace accident to assist you with each step. Pursuing a case without legal representation could lead to unfavorable results.
These are the steps you should take when you have a workers’ compensation claim:
- Report the incident – First, you must report what happened to your employer within 30 days of the accident. Although it’s not a requirement, notifying your employer in writing can benefit your case.
- File the claim – Your employer should provide you with a form to complete. You should fill out each section completely and accurately and return it to your employer. They can submit it to their insurer to initiate the claims process.
- Schedule an appointment – State law requires injured and sick workers to attend doctor’s appointments with physicians authorized by the Workers’ Compensation Board. If you see an unauthorized medical provider, you will likely have to pay for the appointment out of your own pocket.
- Maintain all records – You must submit evidence of your workplace injury when you file your claim. The insurance company needs to see documentation of when the incident occurred, the type of injury or illness you suffered, and the treatment you require to recover or treat symptoms.
Your lawyer can follow up with the insurance carrier for a status update. You should receive benefit payments each month after an approved claim. If the insurer denies your claim, your lawyer can appeal the decision or file a lawsuit.
Contact Fusco, Brandenstein & Rada, P.C.
Fusco, Brandenstein & Rada, P.C. believes in protecting the rights of sick and injured workers in New York. We have represented clients for over 40 years and are ready to do the same for you. When you hire us, we will be your advocate and fight for the workers’ compensation benefits you deserve.
If you suffered an on-the-job injury or illness, call Fusco, Brandenstein & Rada, P.C. for your free consultation with a New York workers’ compensation lawyer at 516-496-0400. We’re available 24/7 to speak with you about your case.