Do I Qualify for Workers’ Compensation With a Pre-Existing Condition?

Workers' compensation in Ohio is designed to protect workers who have suffered work-related injuries or illnesses. However, many employees aren't sure if they can file a claim if they already have a pre-existing condition. These people often wonder: "Do I qualify for workers' compensation with a pre-existing condition?"

Unfortunately, this is not an easy question to answer. In Ohio, a pre-existing condition doesn't automatically disqualify a worker from benefits. Instead, it depends on whether or not the work injury or accident has substantially aggravated that pre-existing condition.

Let's look into how Ohio handles a workers' compensation claim that involves pre-existing conditions, what challenges a worker with a prior injury may face, and how working with a workers' compensation lawyer can help navigate the system. They can also answer questions like Do I qualify for workers’ compensation after a car accident on the job?

Understanding Pre-Existing Conditions and Workers’ Compensation Benefits

Pre-existing injuries are those that are any injury, illness, or medical problem that existed before a workplace incident. Common examples of a previous injury or condition include:

• Arthritis

• Degenerative disc disease

• Old sports or car accident injuries

• Chronic back pain

• Prior surgeries or fractures

Under Ohio law, if you have one of these medical conditions, it doesn't automatically prevent you from receiving workers comp benefits. The key question here is whether the workplace accident aggravated the prior condition.

The Ohio Revised Code states that workers compensation can cover a new workplace injury, as well as covers pre-existing conditions IF they are substantially aggravated by the injuries sustained at work. For more information, work injury law firms in Columbus may be able to help.

When Does Workers' Compensation Cover Pre-Existing Conditions?

Not all flare-ups of a condition qualifies for worker's compensation. Ohio law requires proof that the workplace incident worsened the pre-existing condition. This is typically shown through medical evidence like x-rays, test results or the doctor's opinion after seeking medical care.

Here are some examples of qualifying situations:

• Back Injuries: An employee with a prior herniated disc manages symptoms with treatment. After lifting heavy boxes at work, the disc worsens, requiring medical attention and surgery. This may qualify as a compensable aggravation.

• Joint Problems: A worker with mild arthritis in the knee slips on a wet floor at work. The fall causes significant cartilage damage, making the arthritis much worse.

• Old Injuries Re-Irritated: A warehouse worker with a healed ankle fracture re-injures the ankle while unloading a truck. The old injury is aggravated, causing new complications to the same injury.

In all of these examples, the accident or workplace makes the condition worse than it was before, and it lessens the worker's ability to do their job. In these cases, injured employees may get benefits to cover the new claim for medical bills, lost wages, vocational rehabilitation, or even disability benefits if the condition becomes long-lasting.

Challenges in Proving a Workers’ Compensation Claim With a Pre-Existing Injuries

Ohio law allows compensation for worsening conditions due to incidents at work, like aggravating pre-existing neurological conditions by doing heavy lifting. However, proving this is more difficult than proving a new injury. Both insurance companies and employers may try to avoid liability by blaming the worker's symptoms on the old condition instead of the new incident.

Common Challenges Include:

• Medical Record Scrutiny: Insurers can request several years of medical history, and they can use this to argue that symptoms existed long before the accident.

• Disputes Over Causation: Insurers may make the claim that the workplace event did not cause a substantial change, only a temporary flare-up. This would not be covered.

• Denials Based on Lack of Evidence: Without clear medical proof, claims will likely be denied.

Here's an example: an employee who has chronic back pain experiences more discomfort after lifting boxes at work. In this case, the insurer may argue that the pain is part of the natural decline of the condition and not related to the work injury.

Though a worker does have the legal rights to get these benefits, they must present very strong evidence to prove that the incident occurred at work.

The Role of Medical Evidence

Medical evidence is the most important part of workers' comp cases involving a pre-existing condition. In Ohio, the evidence must show that the incident caused a substantial and objective worsening of the pre-existing condition. This means that the worker saying that they have more pain likely isn't enough to prove the aggravation. Instead, they will need to have medical evidence. This includes:

• MRI or X-ray images showing structural changes after the incident.

• Physician notes comparing pre- and post-injury conditions.

• Specialist opinions confirming that work activities significantly aggravated the condition.

It's also important to have proof that the condition isn't just a temporary flare-up instead of a permanent or long-term aggravation. While a temporary flare-up can be quickly resolved, a permanent, or long-term aggravation, requires more medical care. Workers who can show things like medical records, prior claim forms, or other evidence are in a better position to get their claim approved.

How an Experienced Workers’ Compensation Attorney Can Help

These cases are very complex, and because of this, having an experience attorney working with you is extremely important. Attorneys who are familiar with workers' comp law understand how to:

• Gather and present strong medical evidence.

• Challenge insurance company tactics aimed at denying claims.

• Coordinate with medical providers to ensure accurate documentation.

• Represent workers in hearings before the Ohio Industrial Commission.

Larrimer & Larrimer has decades of experience helping workers in Columbus and throughout Ohio get benefits even when pre-existing conditions are involved. They know how to use medical evidence, counter insurance arguments, and build a case for compensation.

Without legal help, many injured workers can lose out on benefits they may deserve.

A pre-existing condition does not automatically disqualify someone from receiving workers’ compensation in Ohio. The critical factor is whether the workplace incident caused a substantial aggravation of that condition. With strong medical evidence and experienced legal representation, injured workers may still be entitled to medical benefits, lost wages, and other forms of compensation.

Because these cases are often complex and heavily disputed, speaking with a knowledgeable workers’ compensation attorney is the best way to protect one’s rights. Contact Larrimer & Larrimer for a free consultation.