Workers compensation file folder on judge desk

How Do Pre-Existing Conditions Affect My Workers’ Compensation Claim?

Gerstner Adam Law Sept. 28, 2023

We all have unique histories and characteristics, which is why it is not unusual for workers to have some type of pre-existing condition at the time they are injured in a workplace accident. However, just because a worker has a pre-existing condition does not automatically disqualify them from receiving benefits through their employer’s workers’ compensation insurance.  

Nonetheless, it is true that many insurance companies can be quick to deny workers’ compensation claims when claimants have a pre-existing condition or, if the claim is not denied outright, to substantially reduce the amount of benefits they must pay.  

At Gerstner Adam Law, we understand how insurance companies operate and can put our experience and knowledge to use in your case to help you fight the compensation you deserve even if you have some type of pre-existing condition. Our workers’ compensation attorneys have an office in Billings, Montana, but also serve the surrounding area, including Sidney, Glendive, and Miles City.  

Qualifying for Workers’ Compensation 

Workers’ compensation in Montana is a no-fault system that allows workers to obtain benefits regardless of fault. Workers qualify for benefits when they have both injuries that occur on the job and occupational illnesses caused by work.  

In some cases, it can be difficult to prove that the injury or illness was caused due to the worker’s job duties to be eligible for workers’ compensation benefits, especially if the symptoms took a while to appear. The situation can become even more complicated when the worker has a pre-existing condition in the same area of the body as the work-related injury.  

What Qualifies as a Pre-Existing Condition?

The term “pre-existing condition” can cover a wide variety of medical conditions and complications that existed before a particular event (e.g., a workplace accident) and affect the same area of the body as the more recent injury. Some of the most common pre-existing conditions in workers’ comp cases are: 

  • Torn ligaments 

  • Back injuries 

  • Herniated disks 

  • Neck injuries 

  • Arthritis 

  • Fractures 

  • Spine degeneration 

  • Carpal tunnel syndrome 

Claimants in workers’ compensation cases may not always be aware of their pre-existing conditions before they suffer a work-related injury and they receive comprehensive medical evaluations, which uncover the conditions that existed before the workplace accident.  

How a Pre-Existing Condition Can Affect a Claim

The insurance company will most likely not let the claimant’s pre-existing condition go unnoticed. Insurers often use pre-existing conditions as an excuse to deny claims or pay less than what the claim is worth by arguing that some or all of the claimant’s symptoms may be related to the condition that existed before the more recent injury.  

That is why it’s in your best interest to handle the claims process with an attorney—especially when you know you have a pre-existing condition that could affect your workers’ compensation claim. However, lying about pre-existing conditions on your insurance complication is not a way out. If you get caught providing inaccurate information or you simply forget about your pre-existing conditions, it can seriously jeopardize your claim.  

Proving Your Workers’ Compensation Claim with a Pre-Existing Condition

When filing a workers’ compensation claim with a pre-existing condition, the claimant has the burden to prove that the workplace accident caused a new injury or aggravated their existing condition. However, establishing a link between your work-related injury and your pre-existing condition can be difficult, especially if the latter was not properly documented before the injury on the job.  

For this reason, you might want to seek assistance from an attorney who can help you prove your claim and maximize your compensation. Workers’ comp claims with pre-existing conditions are always subject to an increased level of scrutiny from insurance companies. Our attorneys at Gerstner Adam Law are familiar with the tactics insurance companies use to reduce, delay, or deny claims to protect their bottom line.  

Address Your Most Important Questions

If you have suffered a work-related injury and have a pre-existing condition that could affect your ability to receive fair and full compensation, contact Gerstner Adam Law right away. Our firm will take the necessary steps to protect your rights and secure the maximum compensation to which you are entitled in your case. Contact our Billings, Montana office today to schedule a free consultation and discuss the details of your case.