Georgia Workers’ Compensation and Pre-Existing Conditions
You fell off a loading dock at work and re-injured your already surgically repaired knee.
How do workers’ compensation and pre-existing conditions work?
I wish I could give you a simple answer, but like most things having to do with workers’ compensation, it’s complicated.
The short answer is that, yes, in the state of Georgia workers’ compensation should cover injuries that aggravate pre-existing conditions.
But it won’t be easy claiming your workers’ compensation benefits.
Let me explain.
Workers’ Compensation and Pre-Existing Conditions in Georgia
Georgia Code § 34-9-1 states:
“‘Injury’ or ‘personal injury’ means only injury by accident arising out of and in the course of the employment and shall not, except as provided in this chapter, include a disease in any form except where it results naturally and unavoidably from the accident. Except as otherwise provided in this chapter, ‘injury” and “personal injury’ shall include the aggravation of a preexisting condition by accident arising out of and in the course of employment, but only for so long as the aggravation of the preexisting condition continues to be the cause of the disability; the preexisting condition shall no longer meet this criteria when the aggravation ceases to be the cause of the disability.”
That’s a bunch of legalese, but it is basically saying that the state of Georgia counts pre-existing conditions as deserving of workers’ compensation benefits if the pre-existing condition is aggravated by a work-related accident.
Examples of Common Pre-Existing Conditions
Here are some of the more common pre-existing conditions that affect workers’ compensation benefits:
- Herniated discs
- Degenerative disc disease
- Back and neck injuries
- Carpal tunnel
- Arthritis
- Shoulder injuries
- Leg and knee injuries
- Rotator cuff syndrome and tendon injuries
- Asthma
- COPD
- Soft-tissue injuries and nerve damage
Regarding workers’ compensation and pre-existing conditions, pre-existing conditions refer to any injuries or medical conditions that you already had before the current work-related injury.
The Aggravation of a Pre-Existing Condition Counts
The key when it comes to workers’ compensation and pre-existing conditions is the aggravation of the pre-existing condition.
For example, the employee who suffers a fall from a loading dock while on the clock at work reinjures their knee where they previously had surgery for a torn ACL.
Since the fall at work aggravates the old injury, they should be able to receive benefits.
But they may not receive as much as they would if they had injured their knee for the first time at work.
This is because workers’ compensation tends only to cover the cost of the worsened injury (or the state of the aggravation).
Let’s say you were diagnosed with carpal tunnel syndrome from typing at work and already received workers’ compensation for this condition.
But after some time, your carpal tunnel syndrome worsens.
In this case, you should still be able to receive workers’ compensation for the aggravation but only for the aggravation, not the carpal tunnel syndrome diagnosis.
[Related Read: Workers’ Comp in Georgia – 7 Things Not Covered]
When Workers’ Compensation for Pre-Existing Conditions Ends
Traditionally, workers’ compensation provides benefits for a certain amount of time.
However, with workers’ compensation and pre-existing conditions, you are only covered while the aggravation is still affecting you.
As soon as the doctor says you are back to pre-aggravation condition, workers’ compensation benefits will end.
The Problem with Insurance Companies
You may have read the last sections and been confused by learning you can receive workers’ compensation for pre-existing conditions but not the full amount and why it can end so suddenly.
Workers’ compensation insurance companies do not want to spend money.
They will look for every opportunity to deny claims and give as few benefits as possible.
They will say, “Hey! We’ve already paid for that! Why should we pay for it again?” or “Someone else already took care of this years ago! Why should we have to?”
And the biggest one – “Did this employee actually suffer an injury AT work that aggravated a pre-existing condition? If they knew they had this problem and reinjured the problem area, they could just be lying and say it happened at work.”
Unfortunately, investigating pre-existing claims is one of the most common insurance company’s delay tactics.
Watch Workers’ Comp Delay Tactics
It Is up to You to Prove
Because insurance companies don’t want to pay a penny more than they have to, it is up to you to prove your work injury aggravated a pre-existing condition.
You will need to prove to your employer and the insurance company that the new injury occurred during working hours at work.
For example, let’s say you tell your boss you reinjured your knee falling from the loading dock while on your shift.
The insurance company may argue that it can’t be proven you fell at work. They may claim you fell at home and are just saying it happened at work to claim workers’ compensation.
Unless you have cameras or witnesses, it will be up to you to prove.
Let’s say you have arthritis as a pre-existing condition, but the daily grind at the office has aggravated it.
It’ll be up to you to prove it is what you are doing day in and day out at work that aggravated your arthritis.
This is why it is so important to have a good doctor and attorney in your corner.
Your Doctor Matters
When you suffer an injury at work, you are required to choose your attending physician from a posted panel of physicians.
This is required to receive workers’ compensation benefits.
Unfortunately, many of the doctors that appear on this posted list are friends with the insurance company.
For example, let’s say you visit an insurance-friendly doctor about back pain.
You are honest with the doctor about a previous back injury.
This doctor may claim your aggravated condition was not caused by a current work injury.
If this happens, you may not receive workers’ compensation benefits.
This makes the insurance company happy and fills the doctor’s pockets with cash.
Don’t just go to the doctor your employer recommends. Choose your own doctor!
[Related Read: My Doctor Gave Me a Full Duty Release. Now What?]
Your Attorney Matters
In addition to choosing your own doctor, it is critical to speak to an experienced workers’ compensation attorney in Georgia.
Workers’ compensation is complicated enough before you add in pre-existing conditions.
You are in pain and need treatment.
Your pre-existing condition should not prevent you from receiving treatment or compensation for your work-related injury.
Attorneys who specialize in workers’ compensation understand the difficult situation you are in with a pre-existing condition.
They will advise you on which doctor to see and will guide you through the complex workers’ compensation process.
But, if you hire just any old lawyer without experience with workers’ compensation in Georgia, you run the risk of not receiving the full amount you should because they are unfamiliar with the tricks of the insurance companies.
If you’ve been injured on the job, contact us today for a free, no-strings-attached consultation.
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