Worker’s compensation claim denied due to pre-existing condition and they never had a problem like this before. The old pre-existing condition, and its cousin the catch-all degenerative disease, are the go to reasons insurance adjusters use to deny injured workers’ claims. Once in awhile these defenses have some merit, but mostly they are used unfairly by independent medical examiners, IME doctors, to deny legitimate claims.
A pre-existing condition can still be a compensable worker’s compensation injury if a work accident makes it worse, or if job duties over time contributed to the pre-existing condition.
Where there is a work accident but a pre-existing condition, the question is did the accident at work cause the current disability by precipitation, aggravation and acceleration of a pre-existing progressively deteriorating or degenerative condition beyond normal progression?
Sometimes, a worker will have prior back symptoms and treatment before a work accident. Yes there is a pre-existing condition, but if an MRI or EMG shows a herniated disc or nerve impingement after an accident at work, then the pre-existing condition was made worse and there is a worker’s compensation claim.
A degenerative disease is not really a diagnosis at all. Degenerative changes and their symptoms are the normal effects of aging and we all have it to one degree or another. To deny a claim based on degenerative changes is fairly meaningless.
The question is whether the degenerative disease was caused by an appreciable period of work place exposure, was that exposure either the sole cause of the condition, or at least a material contributory causative factor in the condition’s onset or progression?
In plain language, did the worker’s job duties over time contribute to the degenerative disease or condition. For example, take an iron worker on the job for 30 years, now his low back is so bad he cannot work, may need surgery. His MRI shows bulging discs at multiple lumbar levels, osteophyte formation, ligamentum flavum hypertrophy and neural foraminal stenosis – all classic degenerative disease of the low back. No specific work accident. Does he have a worker’s compensation claim? At [nap_names id=”FIRM-NAME-1″] we think he does and we will prove it.