How Pre-Existing Conditions Affect Workers’ Compensation Claims in California

When you suffer a work-related injury, you may be concerned about how a pre-existing condition could affect your workers’ compensation claim. In California, the workers’ compensation system is designed to provide benefits for injuries that occur on the job, but pre-existing conditions can complicate the claims process. At Laguna Law Firm, we help injured workers understand how pre-existing conditions may impact their claims and ensure they receive the benefits they deserve. Here’s what you need to know about how pre-existing conditions affect workers’ compensation claims in California.

What Is a Pre-Existing Condition?

A pre-existing condition is any medical condition or injury that you had before the work-related injury occurred. Pre-existing conditions can include a wide range of health issues, such as:

• Chronic Conditions: Conditions like arthritis, diabetes, or heart disease that you’ve been managing for a long time.
• Previous Injuries: Injuries that you sustained in the past, such as a back injury from a car accident or a knee injury from playing sports.
• Congenital Conditions: Conditions that you were born with, such as scoliosis or a congenital heart defect.

In the context of workers’ compensation, a pre-existing condition can become an issue if it’s related to the injury you sustained at work.

The Aggravation of Pre-Existing Conditions

One of the key concepts in workers’ compensation law is the aggravation of pre-existing conditions. If a work-related injury aggravates or worsens a pre-existing condition, you may still be eligible for workers’ compensation benefits.

For example, if you have a pre-existing back injury and you suffer a new back injury at work that worsens your condition, you may be entitled to workers’ compensation benefits for the aggravated condition. The workers’ compensation system recognizes that work-related injuries can exacerbate existing health issues, and benefits may be awarded based on the extent of the aggravation.

Determining Causation

In workers’ compensation cases involving pre-existing conditions, one of the key issues is determining causation. Causation refers to the connection between your work-related injury and your current medical condition. To receive workers’ compensation benefits, you must show that your work injury either caused or aggravated your pre-existing condition.

Determining causation can be complex, especially when dealing with chronic or long-standing conditions. The insurance company may argue that your current condition is solely due to your pre-existing condition and not related to your work injury. To counter this argument, it’s important to provide strong medical evidence that demonstrates how your work injury contributed to your current condition.

Apportionment of Benefits

In California, the concept of apportionment plays a significant role in workers’ compensation claims involving pre-existing conditions. Apportionment refers to the division of responsibility for your medical condition between your work-related injury and your pre-existing condition.

If the workers’ compensation judge determines that your current condition is partially due to your pre-existing condition and partially due to your work injury, the benefits you receive may be apportioned accordingly. This means that the insurance company may only be responsible for covering the portion of your condition that is directly related to your work injury.

For example, if you have a pre-existing back condition that accounts for 30% of your current disability and your work injury accounts for 70%, the insurance company may be responsible for covering 70% of your workers’ compensation benefits.

How to Strengthen Your Claim

If you have a pre-existing condition and you’re filing a workers’ compensation claim, there are several steps you can take to strengthen your claim and maximize your benefits:

1. Seek Immediate Medical Attention: After your work injury, seek immediate medical attention and inform your doctor about your pre-existing condition. Your doctor can help determine whether your work injury aggravated your pre-existing condition and provide documentation to support your claim.
2. Obtain Detailed Medical Records: Gather all relevant medical records related to your pre-existing condition and your work injury. These records will be important in establishing causation and demonstrating how your work injury impacted your condition.
3. Work with a Qualified Medical Evaluator (QME): If there is a dispute over the extent of your injury or the role of your pre-existing condition, you may need to undergo a medical evaluation by a Qualified Medical Evaluator (QME). A QME can provide an independent assessment of your condition and help determine the extent of your work-related injury.
4. Consult with an Experienced Workers’ Compensation Attorney: Navigating a workers’ compensation claim involving a pre-existing condition can be challenging. An experienced workers’ compensation attorney, like those at Laguna Law Firm, can help you build a strong case, gather the necessary evidence, and advocate for your rights.

How Laguna Law Firm Can Help

At Laguna Law Firm, we understand the complexities of workers’ compensation claims involving pre-existing conditions. Our experienced attorneys are here to help you:

• Evaluate Your Claim: We’ll review your medical history and the details of your work injury to determine how your pre-existing condition may impact your claim.
• Gather Medical Evidence: We’ll work with your medical providers to gather the evidence needed to demonstrate how your work injury aggravated your pre-existing condition.
• Navigate Apportionment Issues: We’ll help you understand the concept of apportionment and ensure that you receive fair compensation for the portion of your condition that is work-related.
• Represent You in Disputes: If the insurance company disputes your claim or attempts to minimize your benefits due to your pre-existing condition, we’ll represent you in negotiations, hearings, and appeals to fight for your rights.

Conclusion

Pre-existing conditions can complicate workers’ compensation claims, but they don’t automatically disqualify you from receiving benefits. If your work-related injury aggravated a pre-existing condition, you may still be entitled to compensation. At Laguna Law Firm, we are dedicated to helping injured workers in California navigate the complexities of the workers’ compensation system and achieve favorable outcomes. If you have a pre-existing condition and have been injured on the job, contact us today for a free consultation to discuss your case and learn more about how we can assist you.