Arizona Pre-Existing Conditions and Workers' Compensation Claims
Like most states in the U.S., Arizona has workers’ compensation laws that require most employers to carry workers’ comp insurance. This type of coverage protects eligible employees who are injured on the job by helping them pay for injury-related losses, such as medical expenses and lost wages from missed time at work. However, injured workers with pre-existing conditions may have unique difficulties with their claims.
When employers and their insurance providers know that you have a pre-existing condition, they often see it as an opportunity to deny or reduce the value of any workers’ comp claims you file if you are hurt at work. This means that unless you can prove that your work-related accident caused or aggravated your current condition, you may be forced to cover your own expenses out-of-pocket.
Fortunately, Arizona workers’ compensation law provides specific protections for employees with pre-existing conditions. If you were injured at work and are worried about filing a workers’ comp claim because of a pre-existing condition, the Phoenix workers’ compensation lawyers of Matt Fendon Law Group are here to help.
Our team has extensive experience handling complex workers’ compensation claims, including those involving employees with pre-existing conditions. To learn more about whether you could recover benefits for a re-aggravated pre-existing condition in a workers’ comp settlement, contact us today for a professional case review.
Can I File for Workers’ Compensation with a Pre-Existing Condition?
If your pre-existing injury was aggravated in a workplace incident, you may be wondering whether you can file a workers’ comp claim for your secondary injury. The short answer is that you can, but there are certain limitations.
First of all, you will not be entitled to benefits for your underlying condition or injury. Second, you must demonstrate that a work-related incident aggravated your pre-existing injuries. An aggravation is anything that makes a certain situation or condition get worse, such as a repetitive motion that intensifies pre-existing back pain.
If your claim is successful, you will only be eligible to receive compensation for the aggravation of your pre-existing condition. If the aggravation is only temporary and your pre-existing condition returns to its previous state after a period of time, you may qualify for benefits that cover treatment of the aggravation for as long as it lasts. However, if you suffer an aggravating condition that permanently worsens your pre-existing condition, you may be entitled to long-term disability benefits.
For example, say that before you took your current job, you tore your rotator cuff and had surgery to repair the damaged tissue. After a few months on the job, you suffered a workplace slip and fall accident, threw out your arms to brace yourself, and felt a jolt of severe pain in your arm. Doctors then determined that your rotator cuff, which was not causing you any pain before the incident, suffered another small tear when you fell.
A workers’ comp insurance adjuster would likely consider your arm pain an aggravation of your pre-existing condition. While you would not be entitled to coverage for medical treatment related to your underlying rotator cuff issue, you could still recover benefits for any suffering you experience as a result of the slip and fall.
Can My AZ Workers’ Comp Claim Be Denied for a Pre-Existing Condition?
According to the Industrial Commission of Arizona, workers’ comp claims cannot be denied simply because workers suffer from pre-existing conditions. Symptomatic aggravations of pre-existing conditions qualify as new injuries and are covered under workers’ comp law as long as they necessitate medical care. This includes secondary injuries that occur gradually, such as pre-existing conditions that are worsened over time by repetitive strain or use.
However, even though your employer cannot deny your workers’ comp claim simply because of a pre-existing condition, your pre-existing condition may affect the amount of benefits you could recover. Workers’ comp benefits are only intended to provide you with compensation for injuries that you sustain at work, so your employer’s insurance provider is only responsible for reimbursing you for losses related to those work injuries, not for a non-work related injury.
Pre-Existing Medical Conditions That Still Qualify
Every person’s medical history is different, so determining whether you still qualify for workers’ compensation benefits when you have a particular pre-existing condition can be tricky. The following list includes examples of common pre-existing conditions that may be aggravated by work-related injuries and potentially eligible for workers’ comp coverage:
- Arthritis – If you were previously able to manage your arthritis but now experience pain that was worsened by repetitive or strenuous motions at work, you could recover benefits for this secondary injury.
- Back and neck injuries – If an existing muscle strain or herniated disc is aggravated by lifting motions or the impact of a falling object, you may be entitled to compensation for additional injuries caused by the workplace incident.
- Asthma and other respiratory illnesses – When employees with conditions like asthma are exposed to environments that contain smoke or hazardous substances, their airways may experience additional inflammation and require medical attention.
- Anxiety, depression, and post-traumatic stress disorder (PTSD) – If you had a serious mood disorder before you began your current job, you could be entitled to workers’ comp benefits if you can demonstrate that work-related stresses aggravated your condition.
This is not a comprehensive list of the pre-existing conditions that could still qualify for workers’ comp benefits. To learn more about the eligibility for pre-existing injury workers’ compensation, contact a knowledgeable workers’ compensation attorney to discuss your case.
What Is a Re-Aggravated Injury?
A reaggravated injury is a pre-existing condition that flares up again after a secondary incident. For example, you may have suffered a non-work related muscle strain a few years ago. You were no longer feeling any pain or spasms from the injury until you re-injured the same part of your body in a work accident.
When insurance providers consider workers’ comp claims for injured Arizona employees, they typically investigate workers’ medical histories to identify any possible pre-existing conditions that could have contributed to the injury.
Since many insurance adjusters will do everything they can to minimize or deny your claim, it’s important to demonstrate that the effects of your secondary injury go above and beyond those of your pre-existing condition and that the re-aggravated injury was directly caused by your work-related duties. An experienced workers’ comp lawyer can help you support your claim with evidence, such as:
- Video footage from workplace security cameras
- Previous medical records showing treatment of your pre-existing injury
- Recent medical evaluations demonstrating the effects of your secondary or re-aggravated injuries
- Statements from co-workers, customers, or other eyewitnesses who saw the conditions or incident that aggravated your pre-existing condition
- Journal entries and other unofficial records of your health and wellness history
What Should I Do If I Was Denied for a Pre-Existing Condition?
If your workers’ comp claim has been denied because you suffer from a pre-existing health problem, it will be up to you to show your employer and their insurance provider that a workplace incident caused your current, aggravated condition. There are a few simple steps you can take to improve your chances of recovering the full and fair compensation you deserve, including:
- Be honest about your pre-existing injury – You can expect that the insurance adjuster assigned to your claim will conduct a thorough investigation of your medical history. If they discover that you had a pre-existing condition and you failed to disclose it, your workers’ comp claim may be denied, and you could even be found guilty of insurance fraud.
- Be detailed and consistent – Any time you speak to a healthcare provider about your condition, be specific about how it impacts your day-to-day life. Provide detailed and consistent descriptions of the pain you feel and the limitations you experience as a result of your aggravated injuries. Be sure that you mention changes to your pre-existing condition that occurred after the accident, such as an onset of pain.
- Keep a post-accident journal – Keep a daily journal to record the levels of discomfort and day-to-day limitations you endure. This way, you have your own reliable account of the ways your workplace accident affects you over time.
- Don’t give up hope – If your workers’ comp claim was denied, Arizona law allows you to appeal that decision within 90 days. A skilled workers’ comp lawyer can help you understand the appeals process and establish the strongest possible foundation for your claim.
- Contact an experienced attorney – A pre-existing condition can seriously complicate your Arizona workers’ comp claim. Contact an attorney who has experience with complex medical evidence, employment law, and previous court decisions that could help your claim.
How Can Matt Fendon Law Group Help Me?
If you have been hurt on the job, the experienced Arizona workers’ compensation lawyers of Matt Fendon Law Group can help you demand the full amount of benefits you rightfully deserve. Our team is standing by now to answer your questions. We offer free consultations for all workers’ comp cases. Contact us today to get started with your initial case review.