When it comes to understanding your rights to receive worker’s compensation coverage after an injury on the job, it may be confusing or overwhelming to figure out whether a pre-existing condition is covered or not. Most employers in North Carolina with three or more employees must carry worker’s compensation coverage for all employees. But what happens when you have a pre-existing chronic condition that is made worse by an accident or simply by repetitive job-related tasks (such as lifting weights or working in a production line)? Here are a few key facts you need to know about filing a worker’s comp claim for a pre-existing condition.
Can I File for Worker’s Compensation if I Have a Pre-Existing Condition?
Having a pre-existing condition does not automatically disqualify a worker from filing a claim, but worker’s comp will not cover your pre-existing condition. What is covered is any aggravated or re-aggravated injury that made your condition worse as a result of your activities during employment. For example, if you already had back issues but ended up with a herniated disc after working with heavy boxes for an entire shift, the herniated disc injury will be covered as long as you can demonstrate it was a direct result of your job activities.
In cases where job applicants withhold information about their physical condition to be hired or misrepresent themselves in terms of having a pre-existing injury or occupational disease, this can be considered “willful misrepresentation in applying for employment” (NC Statutes § 97-12.1) and may disqualify a worker from receiving compensation. For example, if the job a worker applied for required physical abilities such as bending and lifting but the worker failed to disclose that they had a back condition that may put them at risk of developing a more serious injury by engaging in constant bending and lifting, this may be detrimental and make it harder for a claim to be accepted.
Will My Claim Be Denied if My Injury Occurred Due to a Pre-Existing Condition?
First of all, it is important to understand that most worker’s comp insurers work to protect their own interests and bottom lines. Therefore, they will usually try to find ways to reduce the value of your claim and – in many cases – deny it altogether. However, a claim related to a pre-existing condition does not automatically mean it will be denied.
In order to file a claim for a pre-existing condition, you will need to show sufficient evidence that a workplace accident made your pre-existing condition worse. If there was no accident but your condition worsened due to your normal job activities to the point that it is affecting your ability to do your job, you will also need to show evidence to document that. If you are unsure about whether your pre-existing condition may cause your claim to be denied, it may be a good idea to speak to a North Carolina worker’s compensation attorney before filing your claim.
What Are Some Examples of Pre-Existing Conditions That Qualify for Workers’ Comp Coverage?
There are a few pre-existing conditions that are commonly made worse by a job-related accident or by certain tasks necessary to perform one’s job duties. It is important to mention that worker’s comp will not cover the pre-existing conditions themselves, but will cover any injuries or illnesses that aggravated a pre-existing condition.
Some examples of those pre-existing conditions may include back injuries (which can easily become re-aggravated), joint conditions such as injuries to knees, elbows, or shoulders, arthritis and other degenerative diseases, and injuries caused by repetitive strain such as carpal tunnel. Other conditions such as heart disease, diabetes, and cancer may not be directly related to your job but may aggravate your situation and make it harder to return to work. In this case, you may be able to obtain benefits if you can show that your illness was made worse by your job-related activities.
What Should I Do If My Worker’s Comp Claim Was Denied?
Sometimes, even when you present all the necessary evidence and documentation to support your worker’s comp claim, the insurers may find a way to deny it. The insurance company is required to provide an explanation of why your claim was denied. In some cases, they may simply require more information, while in others they may just be acting in bad faith.
If your claim was denied, you have the right to request a hearing before the North Carolina Industrial Commission. The commission will analyze your case and will usually have both sides participate in a mediated settlement conference. If the mediation conference results in an agreement between both parties, a settlement agreement will be drafted including payment details. If no agreement is reached, the case will continue on to a hearing.