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Pre-Existing Conditions Can Affect Workplace Injury Validity


If there’s one thing that many modern Americans are painfully aware of, it’s the impact that pre-existing conditions can have on medical insurance claims. If you’re not aware of what a pre-existing condition is, consider yourself lucky, and hope that it doesn’t affect you, or your insurance!

Pre-existing conditions, for those that don’t know, are not a new type of medical condition, so much as a legal term for insurance classification purposes. It simply means that as someone is insured, there may be an acknowledgment of certain health conditions already in place before the insurance coverage that may not be covered by the insurance.

So, for example, if someone is diagnosed with obesity, and then seeks insurance coverage, the obesity may be noted and classified as a pre-existing condition. The insurance company may specify that any medical issues that are related to the pre-existing condition may not necessarily be honored by the insurance coverage when the time comes for medical treatment. So while contracting an illness, such as malaria, might be treated without question, a heart condition that is later diagnosed as having its roots in the obesity, may not qualify.

Workplace Conditions Apply

The same is sometimes true when it comes to injuries that may be sustained in the workplace. In some instances, if someone is injured at work, but the insurance company suspects that the injury might actually be related to a pre-existing condition, then the worker’s compensation and injury claim that is filed might not be straightforward, and easily approved.

One example of this might be repetitive motion syndrome, or RMS, a condition in which muscles can weaken and experience discomfort and strain due to too much of the same motion carried out over and over again. If someone is diagnosed with RMS, such as a specific wrist disorder like carpal tunnel syndrome, this may qualify as a pre-existing condition.

If someone with RMS then works overtime on a project, in the office, using the mouse and keyboard a lot on the computer, and then reports a wrist-related injury afterward, there may be issues here. If the RMS is counted as a pre-existing condition, then if the worker files an injury complaint about the medical treatment that might be required, the workplace may dispute that claim, based on the presence of a pre-existing condition. This is especially true if none of the other workers reported similar injuries at the same time, with the same activity.

Getting Help

This doesn’t mean that people with pre-existing conditions are vulnerable to all manner of injury and mishap at the workplace. However, it does mean that extra care must be taken, especially if there’s a chance that a pre-existing condition can exacerbate due to work demands, and require treatment that a business is under no legal or financial obligation to help with because they are absolved of having to treat pre-existing conditions.

This is why it’s important always to make sure you explore all your avenues, especially legal ones. Just because you’ve filed an injury claim and it’s been rejected, that doesn’t mean this is the end of the story, and you have to pay your own medical bills. There are some cases where a situation may not be as straightforward as it appears, so you should talk to an experienced workplace accident attorney.

You may find, especially once you’ve explained the situation, that there may be other conditions or considerations at play. It may even turn out that a misinterpretation—either accidental or deliberate—of the insurance policy means that you are entitled to some compensation. Always get proper legal advice first, before you decide what to do next.

During his time as a public attorney for the State of Florida, Bernard Walsh developed a passion for defending the legal rights of Florida's citizens. Having seen many people being taken advantage of after being injured and the financial harm that can cause for families he committed himself fully to helping injured clients get justice, by fighting to make greedy insurance companies pay what they owe.

Pre-Existing Conditions Can Affect Workplace Injury Validity

Goldman Babboni Fernandez
Murphy & Walsh




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