The Impact of Preexisting Conditions on Workers’ Compensation Claims
In Georgia, an aggravation of a preexisting condition is considered to be a compensable workers’ compensation claim. This means that just because you had a previous injury or condition to the same part of your body that was injured on the job, you may still be entitled to receive workers’ compensation benefits and medical treatment. In the area of workers’ compensation, employers take employees “as they find them”, including any preexisting conditions. Therefore, an aggravation may give rise to a compensable workers’ compensation claim.
In 1994, the Georgia Legislature amended the definition of “injury” and “personal injury” in O.C.G.A. Section 34-9-1(4) to state that “an injury and personal injury shall include the aggravation of a preexisting condition by accident arising out of and in the course of employment, but only for so long as the aggravation of the preexisting condition continues to be the cause of disability; the preexisting condition shall no longer meet this criteria when the aggravation ceases to be the cause of the disability.”
The difficult issue in preexisting condition cases is determining when the aggravation ceases and whether the injured worker has “returned to baseline.” If the work injury aggravates a preexisting condition to the point where the employee can no longer work, then the injured worker is entitled to receive income benefits and medical treatment for the aggravation. However, if the Employer/Insurer can prove that the injured worker’s condition resulting from the work accident has resolved and he or she has returned to their pre-injury condition, then the aggravation is no longer present and the injured worker is not entitled to receive further medical treatment and/or income benefits. An aggravation of a preexisting condition can be the result of a specific accident at work, cumulative work-related trauma or the onset may be a gradual one from performing repetitive activities.
In a workers’ compensation claim where the focus is on aggravation of a preexisting condition and whether the injured worker has returned to baseline, the Employer/Insurer will look at several factors to determine whether the condition and disability are due to the work injury or the preexisting condition. Those factors include:
- Duration and frequency of medical treatment for the preexisting condition before the work injury.
- Prior MRI’s or imaging studies.
- Work restrictions or disability prior to the work injury.
- The nature and severity of the work injury itself.
- Pain scores reported to the treating doctors both before and after the work related accident.
Many times injured workers think that they are not entitled to receive workers’ compensation benefits or medical treatment because they have a preexisting condition. That is not the case. Preexisting conditions must be investigated on a case by case basis. The factual circumstances of both the preexisting condition and the work injury are critical. It is crucial to retain a knowledgeable workers’ compensation attorney as soon as possible after your accident to ensure that your rights are protected and that you receive the benefits that you deserve.