Challenges of Pre-Existing Conditions in Work Comp Injury Claims

by Steve Fields | May 31st, 2018

If you’ve been injured at work, filing a Workers’ Compensation claim for benefits can often seem overwhelming. It’s difficult to find information on how to ensure you receive the benefits you need to see your doctor, pay your bills and focus on getting better so you can return to work. Depending on the type of work injury, you may be confused about whether you even qualify for Workers’ Compensation.

Whether you were hurt in a construction accident, injured your back while lifting a patient, or your doctors are telling you that you have a repetitive stress injury, we can help with your claim for benefits. No case is too complicated and the Workers’ Compensation attorneys at Fields Law are happy to discuss your legal options with you and provide our free case review.

What can make a claim more complicated is when you have multiple dates of injury or several injuries, because there may be several employers or insurers on the file. This will not prevent us from pursuing your claim, however. Issues of liability, or who is ultimately responsible, are common in any type of litigation; workers’ compensation is not immune from that argument. Insurance companies commonly look for other parties to share in the liability.

Don’t Give Up If The Insurance Company Denies Your Claim

Some examples of this sharing of responsibility or “passing the buck” are when they blame the injured workers current condition on prior non-work-related injuries or pre-existing conditions. These types of defenses are the most commonly claimed defenses by the insurance companies. If an insurer denies your claim because they say that you had a pre-existing condition, it’s important to understand that is not the final word and you have the right to appeal that decision to the State of Minnesota Office of Administrative Hearings.

If the insurer issues a Notice of Primary Liability and say that they are denying they claim due to pre-existing conditions, you should not stop attempting to collect your Workers’ Compensation benefits. Your attorney can file a Claim Petition with the State of Minnesota Department of Labor and Industry to petition the court to reconsider this determination of liability. Even when a claim is primarily denied, you can still collect Workers’ Compensation benefits, it just may take longer. Our law firm can review your options and help you find the resources you need until your claim gets resolved.

How The Insurance Company Uses an IME Report to Deny Claims

Oftentimes even a claim that is originally accepted and getting paid will be denied later or the employee will be “cut off” due to information later discovered by the insurance company about pre-existing conditions or superseding incidents. This is typically what is about to happen when the insurance company sends you to “their doctor”.

An Independent Medical Evaluation (IME) is fairly common and you do need to keep the appointment, however it’s important to to understand the IME doctor visit is not intended to treat your injury. They are performing an evaluation of your injury and will provide a report to the insurance company indicating if there was a pre-existing condition, a temporary aggravation, or the injury claim is not a work-related injury. The IME report will most likely be favorable to your employer/insurer and will lay the groundwork to deny your benefits. In that case, your attorney will need to step in and file the appropriate pleadings to attempt to get you the disputed benefits.

Here are a few examples of how our work injury attorneys have been able to help clients in similar situations.

Benefits Denied After IME Reported Pre-existing Condition

A woman working at a fitness chain severely injured her low back resulting in multiple decompression and fusion surgeries. Though the insurance company properly paid wage loss and medical benefits for a while, problems arose when the woman was sent to an independent medical examination. The doctor stated the woman’s disability was from a pre-existing condition even though she had never seen a doctor for back pain before. Our Law Firm assisted our client in challenging the denial of ongoing wage loss benefits and successfully negotiated a large settlement of $150,000.

Benefits Denied After IME Report Stating Temporary Aggravation of Pre-existing Condition

A woman contacted our Workers’ Compensation attorneys after she slipped on water and twisted her back while working at an adolescent treatment facility. As a result of the injury, she suffered a disc herniation in her low back and had to undergo a fusion surgery. The Workers’ Compensation insurer sent the woman to an Independent Medical Examiner, who concluded that the woman’s back condition was due to pre-existing back problems. The Independent Medical Examiner believed that her need for surgery and her inability to work had nothing to do with her work injury. The team at Fields Law Firm fought back and was able to secure a $150,000 settlement from the employer and its Workers’ Compensation insurer after the client received a second opinion from another doctor, supporting the permanent injury was a result of a work injury.

Benefits Approved Despite Pre-existing Conditions

While it is typically easier to present a claim for benefits when you have no pre-existing conditions, even claims where the employee had a pre-existing condition are still possible so long as the employee’s doctors state that the work injury was a substantial contributing factor to their current condition.

Our law firm represented a nursing assistant, with significant pre-existing conditions, who was injured at work when she was assaulted by a resident for whom she was caring. She suffered injuries to her shoulder, her hand, her neck, and suffered from PTSD as a result of the incident. The insurance company eventually denied the client’s wage loss benefits claiming the injured worker was not making an adequate job search, as well as denying her ongoing medical treatment. We filed a claim petition on her behalf. We eventually secured a settlement in the amount of $115,000 to help the injured worker pursue retraining options at her own pace, and future medical treatment was left open.

If you have questions about filing a Workers’ Compensation claim for benefits, you’ve been denied benefits, or the insurance company is sending you to an IME, call us today. Our Minnesota Work Comp attorneys can review your case for free and help you understand your options and protect your rights.