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Aggravating Pre-Existing Conditions in Massachusetts Workers Compensation

If you have been injured at work or become sick as a result of your working conditions, you will be entitled to make a workers' compensation claim, even if you have a pre-existing health condition.

Among the most important reasons an insurer would refuse a workers' compensation claim in Massachusetts is that the employee's injury is the result of a pre-existing condition instead of a work-related injury. Workers' compensation would not pay benefits for a pre-existing condition alone; but, if the employee experiences an aggravation of a pre-existing condition as a result of his or her employment, this may be the basis for making a legitimate workers' compensation claim.

To be protected by workers' compensation, the injured employee must demonstrate that the work-related injury was a primary cause of the medical condition for which the injured employee is claiming benefits. A pre-existing condition does not generally prohibit an injured worker from receiving workers' compensation benefits. Since this is a fact-specific review, employees can consult with an experienced workers' compensation attorney in their particular regions regarding their specific accidents or illnesses to decide if they have a legitimate claim for a fair and sufficient grant of workers' compensation benefits.

Workers’ Compensation and Pre-Existing Conditions

Employers in Massachusetts are required to provide workers' compensation insurance to cover any accidents or illnesses that their employees may suffer on the job. A worker who has a current medical problem or disease is not barred from claiming benefits merely because of a pre-existing medical condition. A worker would be entitled to claim workers' compensation for an aggravated condition if a pre-existing medical condition was aggravated by a work-related injury. It is necessary to note that a worker cannot recover benefits for injuries sustained before beginning work at their current job or for injuries sustained outside of the workplace. He or she would only be able to recover if a work-related accident or illness aggravated their pre-existing condition.

A worker with a pre-existing condition can face a more difficult time receiving workers' compensation benefits. In certain cases, state law may make it more difficult for these workers to obtain benefits, but with the appropriate guidance and representation, a worker may be able to resolve the increased obstacles.

When a workplace accident or event triggers any of the following, it substantially aggravates a pre-existing injury or illness:

  • Medical treatment
  • Loss of consciousness
  • Days away from work
  • Days limited when an employee is unable to perform daily duties; or, 
  • Transfer of Job.
Massachusetts Pre-Existing Conditions

Vision and hearing disorders, repetitive stress injuries (RSIs) such as carpal tunnel syndrome and neck and back injuries are all common pre-existing conditions. Pre-existing conditions contain diagnoses that are often aggravated by work. Someone who has served in the military, for example, may be at a greater risk for hearing loss and it is not unusual for them to leave the service with a substantial hearing loss. Later in life, a veteran with hearing loss can work in a factory where loud noises are present. This could cause the employee to lose even more hearing. An employer could claim that the employee had a pre-existing condition and refuse workers' compensation benefits. While this may be a problem, it would not prevent an injured worker from receiving a complete and sufficient grant of workers' compensation benefits. Occupational exposure to loud sounds must be a significant cause of the employee's hearing loss. This case would include the aggravation of a pre-existing condition as a consequence of an occupational injury.

Major Disability Causes

A worker who files a workers' compensation claim will be subjected to a series of medical assessments and examinations to ascertain the degree of his or her disability: complete and permanent, total but temporary, or partial. Any pre-existing medical conditions that a worker may have will be revealed by the medical tests. If a worker has a pre-existing condition, an insurer or employer can claim that his or her accident or illness is a symptom of that condition and has nothing to do with his or her actual job or work-related injury. This is referred to as the “combination injury defense”.

Once the defense is raised, the worker must show that the workplace accident or disease is a significant cause of his or her impairment or need for care. The workplace contribution to the accident does not have to be the primary cause of the injury or disease, but it must be a significant cause.

If you were hurt at work and it exacerbated a pre-existing condition, you could still be eligible for benefits. An insurer or employer can attempt to refuse your claim or restrict the number of benefits it will pay out based on your pre-existing condition. You should hire an experienced workers' compensation attorney at the Bellotti Law Group, P.C. who can efficiently handle any possible insurer arguments to restrict your right to recovery.

Evaluation and Assessment of Pre-Existing Conditions

Insurers sometimes contend that an employee's illness is the result of a pre-existing condition rather than an on-the-job accident or illness. Our workers' compensation lawyers understand that providing an extensive medical history is critical to achieving a favorable result.

The first thing an injured employee can do is ensure that his or her attending physician, as well as all other physicians with whom they consult, prepare a full description of the injuries and the cause of said injuries. If the doctor thinks the current accident is work-related, the records should explicitly say so. If the employee's medical records show a history of that form of a medical condition, an assessment that the current condition was a work-related deterioration of that condition would be highly useful. After receiving this note, a claim for workers' compensation benefits may be filed.

The workers' compensation provider will have fifteen (15) to thirty (30) days from the time a claim is made to either pay or reject the claim. If the claim is dismissed, the employee must file a claim with the Massachusetts Department of Industrial Accidents (DIA).

Prior medical reports can be requested by the employee to indicate that the on-the-job accident was, in fact, a significant cause of the current injury or illness.

Consult With Our Massachusetts Workplace Injury Attorney

If you were injured on the job in Massachusetts and have a pre-existing condition, the work injury attorneys at Bellotti Law Group, P.C. will help you assert your right to benefits. We have treated a large number of workers' compensation cases and will represent you if the employer's insurer denies your claim. Our attorneys will determine and prepare the evidence you need to assist you in every Department of Industrial Accidents’ proceeding.

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