If you have a pre-existing condition, you are generally only eligible for compensation if there is a direct cause that leads to an injury.
Whenever a worker gets injured at their job, they are covered by workers compensation, an insurance policy the state of Missouri requires most employers to carry.
The matters are generally straightforward: you are at work, and you get injured. After that, you file a claim and receive payment to cover your medical bills and recovery, possibly even time off work if you’re looking at a long rehabilitation. However at times, it’s not so simple, and many workers wonder how this insurance policy can cover them if they have a pre-existing condition.
What Does the Law Say?
Employers do not have the right to avoid hiring someone simply because they have a pre-existing condition, as long as they can medically carry out their work responsibilities. Doing otherwise could be deemed a discriminatory action.
If the employer falls under the list of companies obligated to carry workers compensation, there is no mention in the state rules that people with pre-existing conditions cannot be covered.
Matters generally get more complicated whenever a worker with a pre-existing condition gets injured, and files for compensation. The Missouri law added an addendum specifically saying that workers with pre-existing conditions are eligible for workers compensation, though a few criteria must be met.
The statute mentions that any injury caused by an accident (an unexpected traumatizing event, or diseases caused by long-term exposure to certain environments), and claims for workers compensation are only eligible if there is a direct cause between your suffering and your activity at work.
Moreover, the statute clearly says that an injury is not compensable if the work activity is only a triggering or precipitating factor. As such, if you have a pre-existing condition, you are only eligible for compensation if there is a direct cause (an accident, as defined by the statute) that leads to an injury. Your claim can be denied if the work activity is only one factor that leads to your worsened condition.
“What if My Pre-Existing Condition Was Worsened by a Work Accident?”
As we’ve discussed, in Missouri, worker’s compensation insurance generally covers employment-related injuries that make your preexisting condition worse. But it’s not as simple as it sounds. To have a valid claim, you must prove beyond a reasonable doubt that the workplace injury or illness aggravated your pre-existing condition. This is not easy because it can be a somewhat subjective area.
Working with an experienced workers’ comp attorney in this situation can be very helpful. An attorney can connect with experts who can demonstrate that the intensity of your pre-existing condition worsened after you got injured. They can also connect you with top doctors who can evaluate your health accurately. Experienced attorneys can also help you avoid settling for less than you legally deserve.
3 Categories of Pre-existing Conditions and How They Can Affect Your Claim
- Pre-existing medical condition connected to a prior claim
If an on-the-job injury has worsened a previously claimed injury, you should receive some benefits. However, this compensation may be reduced to account for the previously received claim.
Not sure which injury to file? An experienced work injury lawyer can help you know whether you should file a new injury claim or aggravation of a previous employment-related injury.
- Pre-existing condition not connected to a prior claim
You may have a pre-existing condition due to natural aging or a previous injury not related to work but can be aggravated by an employment-related injury. For example, you could have dislocated your arm during a soccer match, only to worsen the injury when offloading heavy boxes at work. You may receive compensation, but it will generally only cover the aggravation of your condition due to the injury suffered on the job.
- A totally unconnected pre-existing condition
Your pre-existing condition may be totally unrelated to the new work-related injury. In such a scenario, the pre-existing condition may not affect your claim. Workers’ comp should generally cover the medical bills for the new injury.
My Claim Is Denied. What Now?
If you’ve filed for workers’ compensation and the claim has been denied on the basis of a pre-existing condition, all is not lost. You should consider speaking with a Kansas City Workers Compensation Attorney to help you refile the claim, and sit with you during negotiations with the insurance company and your employer.
A lawyer can help you gather the medical data that proves your injuries are a direct cause of your work activity and possibly get the funds for your medical recovery. If they don’t, the lawyer can also file another claim on your behalf with the Missouri Department of Labor. They will review the case and decide if you should be awarded workers comp
Legally, you should be able to get workers compensation even if you have a pre-existing condition. If you find yourself in this situation, give us a call 24/7 at (816) 399-3706 to speak with an