Boston Workers’ Compensation and Pre-Existing Conditions

Workers’ compensation benefits are designed to provide pay for medical care and lost wages that result from a workplace injury. While in most cases the work injury results from a single traumatic event – a work accident – a worker may suffer a medical illness or injury that happens over time due to the workplace conditions or due to the performance or repetitive work activities.

A worker who suffers a rotator cuff tear to the shoulder as a result of performing years of repetitive movement of the shoulder and upper extremity at work is just as eligible to receive workers comp benefits as a worker who suffers a rotator cuff tear while pulling a heavy piece of equipment or machinery. Insurance companies frequently deny repetitive trauma injuries and argue that the alleged injury is simply pre-existing arthritis not related to work.

However, the main rule for workers’ compensation is that the injury needs to be work-related. Cases involving Boston workers’ compensation and pre-existing conditions involve very complex legal-medical issues. Unless you hire an experienced attorney, you will be unable to fight successfully to receive your workers’ compensation benefits if the insurance company has denied your claim.

What Is a Pre-Existing Condition?

In its simplest terms, a pre-existing condition is one that existed prior to the work injury. One of the most common examples of a pre-existing condition is arthritis or degenerative changes. Another way of thinking about Boston workers’ compensation and pre-existing conditions is that it’s a factor of your age.

However, while an x-ray or diagnostic tests such as an MRI or CT-Scan may show arthritis or degenerative changes in a shoulder joint, knee joint or spinal discs, the injured worker may never have felt any pain or symptoms prior to the work accident. When viewed through the lens of a workers’ compensation claim, a pre-existing condition is one that existed in the worker’s body prior to the work accident. What significance, if any, the pre-existing condition has on the worker’s right to workers comp benefits will be the subject of the legal fight.

A worker may be rendered unable to work at any time during their employment. This could be the result of a catastrophic accident or an accumulation of pain or lack of mobility over time due to repetitive trauma resulting from the performance of repetitive work activities. Catastrophic accidents are less likely to result in an insurer’s objection on pre-existing condition grounds, since they typically manifest suddenly and without warning. They are well-documented and the mechanism of injury is clear.

Examples of Pre-Existing Conditions

There is no specific list of pre-existing conditions provided by law. However, a pre-existing condition is typically a chronic condition that may or not affect an employee’s ability to work. Classic examples include:

  • Back injuries such as herniated disks or nerve impingements
  • Incurable illnesses such as cancer
  • Joint pain resulting from irreparable cartilage damage
  • Loss of vision or hearing
  • Arthritis in a joint such as the shoulder, hip, knee or ankle
  • Bursitis in the shoulder

If the insurance company denies the claim on this ground, pursuant to Massachusetts General Laws Chapter 152 §1(7A), the injured worker carries the burden of proving that the worker suffered a work injury that combined with the pre-existing condition and that the work injury is a major cause of the injured worker’s need for medical treatment and disability from work.

Pre-Existing Conditions Can Derail a Workers’ Compensation Claim in Boston

If an insurance company denies your workers’ compensation claim based on a pre-existing condition, you have the right to appeal the denial by filing a workers comp claim. The workers’ compensation claims process is very technical and complicated. It’s even more so for cases involving pre-existing conditions, repetitive trauma and causation issues.

During the claims process, medical records and doctor reports that speak to how your current job was responsible for your current inability to work and a clean bill of health prior to starting the job could be powerful evidence if you are able to obtain them. A dedicated workers’ compensation lawyer could help you gather this information and any other evidence and hire medical experts that might bolster your claim. Call today for more information on Boston workers’ compensation and pre-existing conditions.