I have a pre-existing condition. Can I still receive workers’ comp benefits?
If your on-the-job accident involves a body part which was previously injured or which
has a pre-existing condition (such as arthritis in your knee or shoulder or a degenerative
disc in your back or neck), can you still receive workers’ compensation? The short
answer is “yes.” Under our workers’ comp law, so long as the on-the-job accident
aggravates or accelerates the pre-existing condition, it will be found compensable.
In other words, if the on-the-job injury makes a previous condition worse, it will be
compensable, even if the previous condition was already somewhat symptomatic.
For example, assume an employee has arthritis in her knee, and that she has previously
undergone knee surgery for torn cartilage years ago. Following the surgery, she was able
to return to work and go about her daily job duties. One day at work, she trips over a box,
falls on the knee with the pre-existing condition and the doctor determines that she now
needs a knee replacement. In this example, you have a condition (arthritis in the knee)
that existed prior to the on-the-job incident. Even though the arthritis was not caused
directly by the fall, the employee will be entitled to workers’ comp benefits so long as
the accident (tripping over the box and falling on the knee) aggravated or worsened the
arthritis. In other words, if the fall made the arthritis more problematic or caused it to
become more symptomatic than it was previously, the employee has a compensable
workers’ compensation case. The on-the-job incident does not have to be the direct cause
of the condition. In this example, so long as the on-the-job accident makes the arthritis
worse, the employee has a good workers’ comp case.
The outcomes of workers’ compensation cases involving pre-existing conditions are
determined largely by the medical testimony. If a doctor testifies that the on-the-job
incident aggravated or accelerated the pre-existing condition, then it will most likely be
found compensable by the Industrial Commission. In investigating claims, the insurance
company will look closely through an injured worker’s prior medical records and
history to see if he has pre-existing conditions in hopes that it might deny the claim.
Thus, it’s imperative that an injured employee be very specific and give an accurate
history to the doctor. Tell your medical examiner what the condition was like prior to the
accident (especially if there was a period with no or little problems) and describe how
the condition has changed since the incident. Describe any changes in the nature of the
pain, including its intensity or duration. Describe how it affects activities that you were
able to do before the accident. Be straight. Be accurate. And be honest. Keep in mind
the insurance company will try to obtain your prior medical records, and trying to “hide”
information from the insurance company could have significant legal consequences for
As with all workers’ compensation cases, after the individual has reported the
injury to the employer, been examined by a doctor and filed a form with the North
Carolina Industrial Commission, he or she will be contacted by an insurance company
representative to take a recorded statement. Talking with a lawyer prior to speaking with
the insurance company rep ensures you’ll have the legal guidance needed so that you
don’t unknowingly make a statement that could negatively impact your workers’ comp
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"Thank you John, and all the staff at The Law Offices of John M. McCabe, P.A., for all your help over the years since my accident and for your friendship! I am truly grateful!"
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