Does Workers’ Comp Cover Pre-existing Conditions in Virginia?

Some injured workers hesitate to pursue workers’ compensation because they believe workman’s comp benefits don’t cover their pre-existing conditions. Likewise, some employers and insurance adjusters may assert that a worker’s pain is from a prior health condition and has nothing to do with their work injury – and thus is not compensable. These are misconceptions.

Under the Virginia Workers’ Compensation Act, a worker may claim worker’s comp if a job-related injury aggravated their pre-existing condition. The benefits cover the aggravation of the pre-existing condition, not the condition itself. The challenge is how to show the insurance company that there was indeed aggravation due to a work injury. To do this, you’ll want the help of an experienced workers’ comp attorney.

Examples of Aggravated Pre-existing Condition

A common example of a pre-existing condition is back injury. Let’s say you had a herniated or slipped disc years ago outside of work. After your treatment and therapy, you were able to go back to work on full duty. Unfortunately, an accident at your workplace caused you to hurt your back again, and now, you have severe back pain that disables you from working and requires lumbar fusion surgery.

In this scenario, you may claim worker’s compensation for your lost wages due to your new disability, as well as medical benefits for the new treatment and therapy you need. Disability benefits may be temporary or permanent, depending on how long your impairment will last.

Other pre-existing conditions that could worsen due to work-related incidents include:

• Arthritis (hands, legs, hips, etc.)
• Shoulder injury
• Knee pain
• Foot pain (plantar fasciitis, sprains, etc.)
• And more.

Note that in some states, there is a distinction between aggravation vs. exacerbation in workers’ compensation. “Aggravation” means a permanent increase in the severity of the condition, while “exacerbation” is a temporary increase in severity that returns to its prior level after some time. However, these two terms are used interchangeably in Virginia.

How to Prove Aggravation of a Pre-existing Condition

The first element to establish is that your recent injury is compensable and job-related. In other words, your new injury should have happened within the scope of your work – for example, while you were stocking shelves, lifting materials, or going about your regular duties during work hours.

We then need to show causation – that this latest injury caused the worsening of your pre-existing condition. We can establish this through:

• Your doctor’s statement that your work injury exacerbated your pre-existing condition
• Past and current medical records showing the change in your condition
• Documenting the things you could do before that you cannot do now
• Documenting your new or worsened symptoms (for example, if a prior back discomfort turned into radiating back pain after your work accident).

You can expect the insurance company to argue against your claim, whether by saying your recent injury is not compensable or your recent injury did not cause your aggravated condition. Many worker’s comp claims have sadly ended in a denial because the claimant could not present their case convincingly and with sufficient evidence.

It’s crucial to have a competent lawyer advocate for you if your claim involves a pre-existing condition. Be honest with your attorney regarding your prior medical conditions and treatments. Also, let them know if you’ve had any injury claims prior to this one. In the hands of a capable lawyer, information about your past conditions can be helpful – not damaging – to your current claim.

Talk to a Reliable Virginia Workers’ Comp Lawyer

Attorney Jaleh K. Slominski has helped obtain fair compensation for numerous injured workers in Virginia, even in the most challenging cases. With decades of experience in this field of law, Ms. Slominski has successfully handled workers’ comp claims involving pre-existing conditions.

Talk to Attorney Slominski about your recent work injury and prior medical conditions. Contact us by email, or call (434) 384-9400 (in Lynchburg) or (540) 554-3762 (in Roanoke).