Pre-Existing Conditions: What Every Injured Worker Should Know!

Whether you're dealing with a nagging injury from years ago or something more recent, understanding how preexisting conditions affect your workers compensation claim is crucial. Let's clear up the confusion and get you the answers you need. Now, let’s get started!

Understanding Preexisting Conditions in WC

In simple terms, a preexisting condition is any past injury, illness, or disability that affects the same body part you just hurt on the job. For example, if you injured your back five years ago and then hurt it again at work, that old injury counts as a preexisting condition.

Some common examples include:

• Back, knee, or shoulder injuries that flare up again
• Heart conditions if you’ve had a work-related heart attack
• Old injuries from car accidents or sports that now play a role in your claim

Why does this matter? Because insurance companies love to bring up past injuries to try to downplay or deny your new claim. Knowing how preexisting conditions work can help you protect your benefits and make sure you get the compensation you deserve.

Coverage of Preexisting Conditions

I get this question all the time, and the short answer is no—workers’ comp won’t cover treatment for an old injury unless the original injury happened at work.

Here’s how it works:

• If you hurt your back at work five years ago and then re-injure it at work today, workers’ comp won’t pay for treatment related to that old injury. But it will cover the new injury and any worsening of your condition caused by the recent accident.
• If your preexisting condition came from something unrelated—like a football injury from high school—that old injury isn’t covered at all. Workers’ comp will only cover the new work-related injury or aggravation.

Bottom line: Workers’ comp only kicks in for injuries caused—or made worse—by your job.

Distinguishing Exacerbation from a New Accident

One of the biggest things to understand when dealing with a preexisting condition in a workers’ comp case is the difference between an exacerbation and a new accident—because it directly affects how you file your claim.

• Exacerbation = Your old injury gets worse without a specific new incident. Example: You hurt your back five years ago, and one morning you wake up in serious pain for no clear reason. That’s an exacerbation.
• New Accident = A recent event aggravates your old injury. Example: You have an old back injury, but yesterday you lifted a heavy box at work and felt a sharp pain. That’s a new accident.

Why This Matters

• If it’s an exacerbation of an old work injury, you continue under your existing claim.
• If it’s a new accident, you need to file a new claim.

Before making any decisions, talk to your doctor and lawyer to make sure you’re handling it the right way. And if you’re unsure? File a new claim—it’s always better to cover your bases and sort out the details later in court if needed. Better safe than sorry!

Impact of Preexisting Conditions on WC Claims

Let’s talk about how insurance companies try to dodge paying you by using your preexisting conditions against you.

Their go-to move? Blame your old injury for your current disability. They’ll try to convince the judge that most (or all) of your issues are from that previous injury—not your recent work accident—so they don’t have to pay up.

This tactic is especially common when your old injury wasn’t work-related. Let’s say you had a football injury years ago—they might argue that your current back problems are because of that, not your job.

But even if your old injury was work-related, they’ll still try to push responsibility onto that old case. Why? Two reasons:

1. Lower Payouts – If your old injury happened when you were making less money, your benefits would be based on that lower wage—meaning they’d owe you way less now.
2. Shift the Blame – If a different insurance company handled your old claim, shifting the responsibility means they don’t have to pay you at all—the old insurer does.

This is why it’s so important to properly define whether you’re dealing with an exacerbation or a new accident—because how your case is classified can make or break your benefits.

Proving a Work-Related Injury with a Preexisting Condition

If you have a preexisting condition, proving your work injury the right way is crucial—and strong medical evidence is your best weapon.

Step 1: Talk to Your Doctor

Your doctor will determine whether your current condition is a flare-up of an old injury or a new accident. This distinction is important because it decides how you file your claim.

Make sure your doctor has your full medical history, including past injuries, accidents, disabilities, and exactly how your current injury happened. The more detailed your medical records, the stronger your case.

Step 2: When in Doubt, File a New Claim

If you’re unsure whether it’s an exacerbation or a new accident, file a claim for a new injury anyway. If it turns out to be a new accident, you’ll be covered. If not, the claim might get dismissed, but that’s better than missing out on benefits you deserve.

Step 3: Get a Workers’ Comp Lawyer

Cases involving preexisting conditions can get complicated fast. Insurance companies often try to use old injuries against you to avoid paying out. A workers’ comp lawyer can help you file the right claim, gather the best medical evidence, and fight for the benefits you’re entitled to.

Can a Preexisting Condition Lower WC Benefits?

A lot of people wonder if having a preexisting condition will reduce the workers’ comp benefits they get for a new injury. The answer? It depends.

How Apportionment Works

If your new injury affects the same body part as an old one, the insurance company might try to divide up the responsibility—this is called apportionment. Basically, they’ll argue that part of your disability comes from the old injury, not just the new one, which could lower your benefits.

For example, if you break your leg but already had an old injury in that same leg, a judge might decide that only part of your current disability is from the new accident—which could impact what you get paid.

What If You Were Working Fine Before the New Injury?

With some injuries—especially to the neck or back—you may be able to argue that even if you had a preexisting condition, you were still working full duty with no issues before the accident. If that’s the case, your lawyer can push to have your entire disability blamed on the new injury, making sure your benefits aren’t reduced.

Doctors Play a Big Role

To figure all this out, doctors will dig into your medical history. They’ll look at old records, new medical reports, and current test results to decide how much of your disability is from each injury. This process is what determines how much workers’ comp pays you.

Why a Workers’ Comp Lawyer Helps

Apportionment is complicated, and insurance companies will do everything they can to reduce what they owe you. A good workers’ comp lawyer will fight to make sure you get every dollar you deserve.

Contact Us For Help With Your Workers' Compensation Case

If you have any questions or need help navigating your claim, don’t hesitate to reach out. I’m here to help you every step of the way. Give me, Rex Zachofsky, a call at 212-406-8989. Let's make sure you get the benefits you deserve.