Does Workers Comp Cover Pre-Existing Conditions? Yes. In Wisconsin workers compensation law includes the principle of English and American common law that “you take your victim as you find them.” Basically, if an employer hires a worker, the worker’s susceptibility to injury does not forfeit the employee’s right to worker’s compensation benefits if he gets more injured on the job.
The pre-existing issue usually comes up in the context of an aggravation claim involving a neck or low back injury. An employee who works in a physical job such as manufacturing or construction likely has some degenerative deterioration in his spine. The employee may have gone to a chiropractor or doctor over the years. Then one day at work he or she picks up a box and the back goes out, low back pain followed by pain shooting down their leg. An MRI shows the deterioration as well as a herniated or bulging disc impinging a nerve root. The IME doctor says it’s just a manifestation of a pre-existing condition and therefore not work-related so no worker’s compensation benefits. The injured worker should not accept the IME opinion and insurance adjuster decision but instead consult with an experienced workers compensation attorney.
Workers’ compensation law in Wisconsin is explained by the Lewellyn v DILHR case as follows:
1) If the work injury causes a definite breakage or structural change in the pre-existing condition, such as a herniated disc, then it is a compensable claim and they must pay.
2) If there is no definite breakage, but just symptoms or a manifestation of the pre-existing condition, then benefits can be denied. This is what most IME doctors find.
3) Whether there is breakage or not, if the work injury causes precipitation, aggravation and acceleration of the pre-existing condition beyond normal progression, then benefits should be paid.
In many pre-existing or degenerative disease cases, the damage was done by the injured worker’s job duties over time. McCormick Law attorneys get a thorough job description and ask the treating doctor or surgeon if the job duties over time were at least a material contributory causative factor in his low back condition onset or progression.
At McCormick Law Office in Milwaukee, Wisconsin our attorneys get the best results when we investigate both the traumatic injury aggravation of a pre-existing condition and whether job duties over time contributed to the alleged degenerative disease in the first place. Expert doctor opinions based on honest and trustworthy facts make a solid case. Does workers comp cover pre existing conditions involving neck or back herniated discs resulting in cervical surgery or lumbar fusion surgery? Yes, where treating physicians and surgeons support the case.