How Do Pre-Existing Conditions Impact Workers' Comp in Georgia?

Your pre-existing condition will not necessarily prevent you from qualifying for workers’ compensation coverage. If a work-related accident aggravates your pre-existing condition and leads to a disability, workers’ compensation should cover your medical expenses and partial wage replacement.

However, there is much confusion around how pre-existing conditions impact workers’ comp claims. As a result, procedural mistakes can often occur in the claims process, leading to unfair denials. Enlisting the services of a knowledgeable Georgia workers’ compensation attorney can help you protect your rights and understand your options as you seek the benefits you need.

What Is a Pre-Existing Condition?

A pre-existing condition is any health issue or injury someone has before filing a workers’ compensation claim. These conditions may be chronic illnesses or previous injuries that have already healed. Understanding pre-existing conditions is crucial in the context of workers’ compensation because they can complicate the claims process.

If your accident worsens the symptoms or the clinical findings related to your pre-existing condition, you should qualify for benefits for treating those new or worsened symptoms or findings. Contact our Athens workers compensation lawyer today if you have questions.

What Are Some Common Pre-Existing Conditions?

Some pre-existing conditions appear frequently in workers’ compensation cases. These include:

• Back injuries, such as herniated discs, degenerative disc disease, or chronic lower back pain
• Joint problems, including arthritis in knees, hips, or shoulders
• Respiratory conditions, like asthma or chronic obstructive pulmonary disease (COPD)
• Heart conditions, such as high blood pressure or previous heart attacks
• Mental health issues, including depression, anxiety, or post-traumatic stress disorder (PTSD)
• Diabetes, which can affect wound healing and overall health
• Obesity, which may contribute to other health problems or complicate recovery
• Previous surgeries that may have left an area more susceptible to re-injury

It is crucial to disclose any pre-existing conditions to your doctor and your workers’ compensation attorney. This transparency helps establish a clear picture of your health before and after the work-related incident. Even if you have one of these conditions, you may still qualify for workers’ compensation benefits if your job aggravated or worsened your condition.

When Can I Receive Workers’ Comp Benefits for a Pre-Existing Condition?

According to Georgia workers’ compensation law, an employee is eligible to receive benefits for a pre-existing condition anytime a work-related accident aggravates the condition in question. They remain eligible for benefits only as long as the aggravation is the cause of the worker’s disability.

Confirming your eligibility for workers’ comp after aggravating a pre-existing condition requires a medical evaluation as soon as possible after the injury occurs. In most cases, your employer’s insurer will stipulate that you go to a doctor they have approved. This physician might not have your best interests in mind, and many claimants believe this arrangement subjects them to unfair treatment. An experienced Georgia workers’ compensation attorney can give you the support and advocacy you deserve as you seek a fair diagnosis that will qualify you for benefits.

What Are the Different Types of Claims Involving Pre-Existing Conditions?

When dealing with workers’ compensation and pre-existing conditions, claims generally fall into three categories:

Pre-Existing Condition Related to a Prior Claim

This involves a previous work-related injury that has worsened due to a new workplace incident. For example, a worker who previously injured their back on the job and received treatment might aggravate that same injury in a new workplace accident.

You should receive some compensation for the aggravation of your condition. However, your benefits will likely be reduced based on the previous workers’ comp claim.

Pre-Existing Condition Unrelated to a Prior Claim

This category includes non-work-related pre-existing conditions that a workplace incident aggravates. For instance, a worker with arthritis in their knee might experience increased pain and limited mobility after a slip-and-fall accident at work.

These claims also involve pre-existing conditions that were not caused by work but are aggravated by workplace activities over time. An example might be a worker with a congenital heart condition whose job duties gradually worsen their symptoms.

With these claims, you will likely only be able to collect compensation for the aggravation of the injury.

Pre-Existing Condition Unrelated to a Work Injury

In some cases, an employee may have a pre-existing condition that is completely unrelated to the current workers’ comp claim. This may involve a healed foot injury when the injury currently claimed is an unrelated broken ankle.

An unrelated pre-existing condition should not have any impact on your claim, and you should be owed full benefits. However, your employer or their insurer may still try to argue that it affects your current workplace injury.

Understanding your claim’s category can help you and your attorney build a more convincing case for workers’ compensation benefits.

What Can I Do If My Pre-Existing Condition Got My Georgia Workers’ Compensation Claim Denied?

Do not lose hope if your workers’ compensation claim was denied because the insurer claims you have a pre-existing condition that is the cause of your current condition. You can take the following steps:

• Request a detailed explanation – Ask the insurance company to provide a written explanation of why they denied your claim. This information can help you understand what evidence you need to support your case.
• Gather additional medical evidence – Collect medical records showing how your work-related incident aggravated your pre-existing condition. Ask your doctor to provide a detailed statement explaining the connection between your work and the worsening of your condition. In other cases, you may need a letter stating your current injury is unrelated to your pre-existing condition.
• File an appeal – You have the right to appeal the denial of your claim. In Georgia, you must file your claim within one year of your injury date to protect your right to benefits.
• Consider a hearing – If your appeal is unsuccessful, you can request a hearing before the State Board of Workers’ Compensation (SBWC). An administrative law judge will review your case and issue a decision.

An experienced Georgia workers’ compensation attorney can guide you through the appeals process, help gather necessary evidence, and represent your interests at hearings.

Contact a Georgia Workers’ Compensation Lawyer

If a work-related accident has aggravated your pre-existing condition, do not let the confusing red tape of the workers’ comp process prevent you from demanding the benefits you deserve. At R. Alan Cleveland, LLC, our experienced Georgia workers’ compensation team can use our extensive skills and knowledge to file your claim or appeal an unfair denial.

We are committed to providing compassionate representation and support to help our clients move forward with the care they need to get back to their lives. We have successfully secured over $150 million for our clients, so you can rest assured that we know how to get results. Call us today or contact us online for a free consultation about how we can help you pursue the benefits you deserve.