Can Workers’ Comp Be Denied For Pre-Existing Conditions?

There is bad information out there about what is covered.

There is a lot of talk these days about coverage for pre-existing conditions under health insurance. What about pre-existing conditions under workers’ compensation? Can you be denied benefits if you have a medical condition or previous injury?

Maryland workers’ comp does covers pre-existing conditions … if doing your job aggravated your condition or prior injury. Don’t let your employer or their insurer tell you different. Get legal help if you are having trouble with your claim.

 What the law says about pre-existing conditions

Many times workers’ compensation claims are flatly denied if the employee’s claim is related to a pre-existing medical condition, such as a heart condition or asthma or herniated disk. Previous injuries are likewise treated as a pre-existing condition. After a prior shoulder injury or knee injury, a subsequent workers’ comp claim involving the same joint may be denied.

Many people have some medical ailment, minor impairment or past injury that does not prevent them from working — unless it resurfaces or worsens. The law says injuries are covered when they arise in the course of employment. A claim denial or termination of benefits can be appealed to the Maryland Workers’ Compensation Commission. The key is proving that your pre-existing condition was aggravated or made worse by working:

• The aggravation was due to a specific accident, such as a workplace fall.
• The medical condition or old injury flared up from cumulative effects of the job, such as repeated bending or lifting.

Employers and insurance companies commonly argue that the pre-existing condition or re-injury was not work-related. Fabricating a work injury for something that happened off-duty is workers’ compensation fraud. But most people are not faking. An appeal may hinge on medical records and medical experts, so it is critical to seek medical care promptly, continue treatments and follow the doctor’s orders.

Maryland also provides relief through the Subsequent Injury Fund. The SIF encourages employers to give jobs to people with impairments or a known history of injuries. If that worker does becomes disabled from a subsequent work injury, the SIF covers part of the costs so that employers don’t bear the full burden.

With so much at stake, you should consult an attorney before filing or appealing a claim that involves a previous injury or pre-existing condition.