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What if I Had a Pre-existing Injury?

Does a preexisting injury affect my workers compensation claim?

A pre-existing injury does not automatically bar workers’ compensation coverage under North Carolina law. As long as a new work-related injury aggravated the preexisting injury, you can still receive unemployment benefits. One basis for this legality is the theory that the employer takes the employee as is, with whatever health conditions the worker comes along with. If the preexisting condition was not significant enough to prevent the employee from working, it is not significant enough to bar a workers’ compensation claim. This applies even if the preexisting condition is a latent one, like cancer or a back injury. If you’re being told otherwise, you should speak with a workers compensation attorney about your claim.

The Cause of the Injury

The difficulty in these cases arises in the determination of whether the work related accident caused the present injury. In order to receive compensation, the current injury must result from a job related incident. It can’t merely be a flare up of the preexisting injury. You must prove some intervening work related event that exacerbated the previous injury.

For example, Jane is a worker with a preexisting back injury. She has been employed in her position for five years. During her sixth year of employment, her back pain begins to increase to the point where she is no longer able to perform her job duties. When she seeks workers’ compensation insurance, she must show one of two things:

  • That a work related accident caused complication with her preexisting back injury; and/or
  • That the duties of her job aggravated her back injury to the point where she was prevented from working.

If neither of these conditions apply, Jane’s claim will likely be denied. It is helpful to examine this principle using the “but for” analysis. If Jane can say that “but for” her job duties, her back injury would not have been aggravated, then the insurance company should pay her claim.

Handling Your Claim with a Preexisting Injury

It is not uncommon for an employer or insurance company to quickly deny a workers’ compensation claim based on the presence of a preexisting condition. While many employees accept the denial without any further pursuit, it’s important to note that it is unlawful for an insurance company to automatically deny a claim solely on these grounds. In North Carolina, the insurance company must provide a detailed explanation for the denial, which gives you an opportunity to review and analyze the strength of the company’s denial. If you feel that your claim was unfairly denied because of your preexisting condition, you have a couple of options available to you:

  • You can request an appeal through the North Carolina Industrial Commission by submitting Form 33; or
  • You can seek the assistance of a workers’ compensation attorney to help you file a lawsuit in an appropriate North Carolina court.

To strengthen your case, begin keeping a record whenever your preexisting conditions begin to cause problems. Note when the pains occur and after what work activities. A detailed documentation of your injuries will help you accurately explain your situation to the insurance company and your physician. It will also help you should an appeal become necessary.

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