Does A Pre-existing Condition Affect Workers Compensation? 

Does A Pre-existing Condition Affect Workers Compensation? 

Both employers and employees are alarmed when a pre-existing condition is being tackled because insurance companies tend to use this term to avoid payment, blaming workplace sustained injuries to already existing medical conditions. As a responsible and considerate employer, it is your obligation to know how a pre-existing condition can affect your employees, most especially their compensation benefits.  

In this post, you’ll learn more about a pre-existing condition and how it can affect workers’ compensation claims and benefits.  

Defining Pre-existing Condition  

According to Mike Rainwater, most employees are greatly concerned about how pre-existing conditions can affect workers’ compensation benefits, so employment law is designed to protect the health and interest of workers. Employers should also do the same. 

A pre-existing condition refers to a health problem or medical condition already experienced by a person before enrolling in insurance coverage. When it comes to workers’ compensation purposes, a pre-existing condition is a medical problem that already existed before the employee started working under their current employer. It may also pertain to a health issue that occurred before an injury or an accident. 

The common examples of pre-existing conditions include the following: 

  • Arthritis 
  • Asthma 
  • Muscle tears or strains 
  • Heart disease 
  • Orthopedic problems 

Pre-existing Condition Complicates Claim  

If an employee has been injured while performing their duties, having a pre-existing condition can complicate their compensation claim. It can nullify or void a claim, which can impact an employee’s benefits.  

As an employer, you should make sure that your employees are educated about the impacts of pre-existing conditions in processing claims. You’ll become their advocate for healthcare, which strengthens employee-and-employer relationship. In toto, choosing the best insurance company for liability insurance safeguards both you and your employees. 

Reduced Or Denied Workers’ Compensation Benefits 

Employers should be aware that if a worker previously got injured on a specific body part while working for a company, then sustained another injury on the same body part while working for a new company, the amount of workers’ compensation benefits can be reduced. For related injuries, the new employer might only pay for the compensation of an increase in permanent impairment.  

For instance, if an employee has been diagnosed with permanent disability and is eligible for a $20,000 permanent impairment award, they will only be given the remainder if they already received a portion of this amount. If proven that the pre-existing condition didn’t permanently worsen the most recent workplace injury, the worker won’t receive any permanent partial disability award. 

On the other hand, the current employer will be required to pay hospitalization and other medical expenses for the treatment of a new work-related injury. Also, the employer would need to pay temporary disability benefits or time-loss compensation benefits if the employee is unable to work. 

Determining Pension And Permanent Disability 

As an employer, you should also know how any pre-existing condition and an unrelated condition affect a total and permanent disability. For instance, if an employee has a significant pre-existing condition and current industrial injuries, the employer has options that can affect the full payment of pension and disability benefits.  

Can an employee get disability insurance even with a pre-existing condition?  Yes, definitely. The pre-existing condition can be excluded, and the employee can get income protection for other causes of injury or disability. That’s why consulting a workers’ compensation lawyer is essential to ensure that employees receive their pension and disability benefits accordingly. 

Here’s a list of how a workers’ compensation lawyer can help both employers and employees: 

  • Enables employers to develop a better workers’ compensation plan for employees 
  • Gathers substantial evidence, such as medical reports, laboratory analysis, studies, and findings of different medical professionals, to support the claim 
  • Assesses all possible loopholes of the insurance company’s reason for reducing the benefit or denying the claim 
  • Ensures that the amount of workers’ compensation benefit is fair enough. Insurance companies can present evidence that an employee shouldn’t be given the full amount of benefits, but a good work comp lawyer can help the employee counteract them.  
  • Finds ways to increase the amount of work comp, pension, and disability benefits 
  • Handles the case and brings it to the next level or court trial as needed  


Pre-existing conditions can greatly affect workers’ compensation claims. If your employees or the insurance company starts to ask questions about pre-existing conditions, it’s a clear signal that you need to be readily discussing the legalities. Consult a workers’ compensation lawyer right away if this event happens to ensure that your employees obtain maximum compensation benefits they deserve while protecting your company against the legal consequences of not providing what your employees deserve under the law.    

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