What is a “Pre-existing” Condition Under Workers Comp in Massachusetts?

When a person is injured at work, they can file for workers’ compensation to cover their expenses while recovering from their injuries. Only injuries sustained in on-the-job accidents may be covered, and pre-existing conditions are usually excluded from compensation.

A pre-existing condition is a condition or injury that arose or occurred before the work-related accident. a pre-existing condition may complicate a workers’ insurance claim. an injured worker may already be receiving permanent partial workers’ compensation benefits for a pre-existing condition in many cases. After another accident at work, the worker might need additional workers’ compensation to cover the new injuries. The situation becomes even more complicated when a new injury combines with a pre-existing condition.

If you already had a pre-existing condition when you were injured at work, your workers’ compensation claims may be frustratingly complex. Our Massachusetts workers’ compensation lawyers can help you through this process to get the benefits you need. Call the Law Office of John J. Sheehan at (617) 925-6407 for a free case review.

What is a Pre-existing Condition Under Workers’ Compensation in Massachusetts?

The term “pre-existing condition” pops up frequently in medical jargon and the insurance industry. In short, a pre-existing condition is a condition or injury that existed before the injury you sustained at work.

Pre-existing conditions tend to make getting compensation or benefits for job-related accidents more complicated. Our Massachusetts workers’ compensation attorneys have experience working with clients with pre-existing conditions.

For example, if you were injured in an accident at work, but you already suffered from a bad back from an old sports injury, your bad back would be a pre-existing condition. Our Boston workers’ compensation attorneys can help you get the benefits you need even with a pre-existing condition.

When it comes to pre-existing conditions, employers must take employees as they are. While a pre-existing condition does not necessarily entitle an employee to worker’s compensation benefits, it might make them more susceptible to injuries on the job. These on-the-job injuries may be compensable under workers’ compensation.

For example, suppose an employee has a pre-existing medical condition where their bones are very fragile and susceptible to fractures. Simply having this condition does not merit workers’ compensation benefits. However, suppose that employee fell while performing work-related tasks and suffered a severe fracture. In that case, the fracture is a compensable injury under workers’ compensation even though any other employee would have walked away from the incident perfectly fine.

How Does a Pre-existing Condition Affect Workers Comp in Massachusetts?

Having a pre-existing condition often makes getting workers’ compensation challenging. The process can take a while, and injured workers sometimes feel driven to give up. Our Malden workers’ compensation attorneys will stick by your side and see you through to the end, and hopefully, you will get compensation for your injuries.

What If I Am Already Injured?

If you’re already injured or have a pre-existing medical condition at the time of your on-the-job accident, workers’ compensation gets you back to where you started before the accident. it does not necessarily restore you to the position you were in before your pre-existing condition.

For example, if an employee had previously lost a leg in a car accident several years ago, the amputated leg would be considered a pre-existing condition. Now suppose that the employee broke their other leg at work and needs worker’s compensation to cover their injuries. Workers’ compensation will only cover their broken leg, not both legs.

If the pre-existing injury is not causally connected to the new injury or the work-related accident, employees typically do not get compensated for them. As described below, the situation becomes trickier when a person receives other benefits for their pre-existing condition when they file for workers’ compensation.

Benefits for Pre-existing Conditions

If you were already receiving benefits for your pre-existing condition, those benefits might complicate your claims for workers’ compensation for your new injuries. However, it is not impossible to receive compensation for both injuries simultaneously. Our Wakefield workers’ compensation attorneys can help you advocate for the maximum award of benefits possible.

In some cases, workers are already receiving compensation for pre-existing conditions. In these situations, the pre-existing condition is related to a prior work-related accident. Workers’ may be receiving temporary or permanent partial benefits because they can return to work but not to their full capacity.

When an injured employee already receives workers’ compensation for a pre-existing condition, those benefits may influence their claims for new injuries. For example, a person receiving temporary benefits may not receive more than 60% of their gross weekly wage. If you can still work with both the pre-existing and new injuries, you may still receive partial benefits, and those benefits may not exceed the legal maximum.

When a New Injury Combines with a Pre-Existing Condition

In some cases, a worker’s pre-existing condition is not work-related and is not covered by workers’ compensation. Even so, there may be circumstances in which an employee’s on-the-job injury combines with or exacerbates a pre-existing condition. it can become difficult to differentiate between the injuries to determine compensation and benefits in such a case.

According to Mass. Gen. Laws Ch. 152 § 1(7A), when a compensable injury combines with a non-compensable pre-existing condition, the new combination-injury may only be covered by workers’ compensation to the extent that the compensable injury is a significant cause of the overall condition.

For example, suppose your pre-existing condition is an old neck injury that causes recurrent bouts of pain. Next, suppose that you suffer a compensable on-the-job injury to your neck and the pain becomes debilitating and constant. Workers’ compensation may cover you only to the extent that your new injury exacerbates your condition.

Naturally, disentangling two injuries that combine into one painful condition is difficult, and your claims for workers’ compensation may be met with skepticism. Our Somerville workers’ compensation attorneys can help you get the compensation you need to recover from your injuries.

Call Our Massachusetts Workers’ Compensation Attorneys for Assistance

If you were receiving benefits for a pre-existing condition when you were injured at work, you can still file for worker’s compensation. Our Cambridge workers’ compensation lawyers can help you maximize your compensation. Call the Law Office of John J. Sheehan at (617) 925-6407 for a free case evaluation.