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How Pre-Existing Conditions Can Affect Your Workers’ Compensation Claim

If you have any pre-existing conditions or injuries, the insurance company might use them to say that you were injured before the accident happened.

man looking at workers comp denial

Most businesses in the state of Missouri are required to carry workers’ compensation insurance. Workers’ compensation insurance is a type of insurance coverage that is meant to compensate employees who are hurt on the job and is commonly called workers’ comp.

The trade-off to workers’ compensation, however, is that if you collect it, you are generally not able to sue your employer in a court of law for personal injury. Employers who have workers’ compensation are absolved from being sued in court in most instances.

Although workers’ compensation insurance is not based on negligence or fault, if you are hurt while working, you do have to show that you were specifically engaged in activities that are under the scope and authority of your job. If you are engaged in anything other than sanctioned work activities, then workers’ compensation insurance may deny you coverage.

When you are hurt, it is critical that you do two things. The first is to let your employer or supervisor know that you hurt yourself so they fill out an incident report that will be on the record. This will state that you hurt yourself while engaged in work activities and will be important to your claim. The second thing to do is to seek medical attention. You will want to see a doctor immediately to document what happened.

How Can an Insurance Company Use Pre-Existing Conditions to Limit Their Liability?

If you have any pre-existing conditions or injuries before the accident, the insurance company might use them to say that you were injured before the accident happened. Even if you can prove that you were hurt while working, the insurance company might insist that you required more medical care due to your previous injury or condition.

That might make them offer you less or deny specific types of treatment or rehabilitation services by maintaining that you needed them before the accident because of things other than the injury you sustained while at work.

Do They Have to Pay for Your Medical Bills?

If you have a physician’s recommendations outlining the care for your on the job accident, then the insurance company may ask that you have an independent medical examination or an IME. The means that you will need to be examined by another doctor to decipher whether the injuries you sustained were actually from the current accident, or from something in your past. If everything reveals that you have been telling the truth, the insurance company will need to compensate you for economic damages.

Do I Have to Comply with an IME Request?

If you are asked to submit to an IME, then you must comply or you risk losing your workers’ compensation eligibility. It is a good idea to contact an experienced workers’ compensation attorney as soon as possible after you have been injured to ensure that you get the compensation that you are entitled to, regardless of whether or not you have a pre-existing injury or condition. Having someone defend you in case you are denied coverage, is imperative to collecting everything to which you are entitled.

If you have had your workers’ compensation claim denied or are being asked to submit to an IME, speak with an experienced attorney at the Law Office of James M. Hoffmann to ensure your legal rights are protected. Call (816) 399-3706 24/7 for a FREE case evaluation.
Updated: August 23, 2019

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