Workers’ Comp and Pre-Existing Conditions: Not the End of the World but Beware  
Female worker on a forklift

Workers’ Comp and Pre-Existing Conditions: Not the End of the World but Beware

I always like to start with good news so let’s start this two-part series with the “not the end of the world part.” Do not let rumors or negative assumptions get you down. Having a pre-existing condition does not prevent you from obtaining workers’ compensation benefits. If you have a pre-existing condition, in order to succeed in a claim for workers’ compensation benefits, you must prove that a work-related accident materially accelerated or aggravated the pre-existing condition.

In other words, your work-related accident must have made your pre-existing condition substantially worse. Keep in mind, this means you can have a successful claim under this standard then, even if the accident wouldn’t have caused the injury without the pre-existing condition being present.

This sounds complicated so here is an example: You have a partial rotator cuff tear but one that still permits you to perform all the functions of your job. One day, the machine you use malfunctions and causes the arm with the partial tear to jerk, causing a complete tear that then requires surgery. That accident may not have caused that type of injury in a person without that pre-existing condition but it does not bar your claim for workers’ compensation benefits.

Meeting the burden of proof in workers’ compensation claims involving pre-existing conditions is rarely as simple as it sounds, but you should try and keep your spirits up because so much is at stake for you and your future.

If your employer or their insurance company is aware that you have a pre-existing condition or they become aware of that fact through investigating your workers’ compensation claim, they are much more likely to deny the claim than a claim without a pre-existing condition involved. That just means that injured workers with pre-existing conditions should consult with an experienced, North Carolina Board Certified Workers’ Compensation attorney to help navigate these often-complicated claims.

In Part 2 of this series, we will discuss NCGS §97-12.1. This statute deals with employees that misrepresent their physical condition when applying for employment. Every employee with a pre-existing condition should be familiar with the statute because a failure to comply with its requirements can bar recovery under our workers’ compensation act.


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