The Implications of Pre-Existing Conditions on Workers’ Compensation Claims

Pre-Existing Condition on clipboard with pills and money and forms - pre-existing condition and workers comp concept

Workers’ Compensation coverage is designed to help ensure you obtain the compensation you need to cover medical treatment and lost wages if you are injured in the workplace. Importantly, you should still receive Washington Labor & Industries (L&I) benefits if you have a pre-existing condition and are hurt on the job. In the event the accident worsened a health condition or injury you previously had, coverage for the aggravated condition will also be included in the Workers’ Compensation claim. What is a Pre-Existing Condition in a Workers’ Compensation Claim?

A pre-existing condition is one that a worker had before they sustained a workplace injury. It can be either a physical injury or illness, or a mental condition. Some common pre-existing conditions in Workers’ Compensation claims include the following:

  • A congenital condition
  • Old sports injuries
  • Previous work injuries
  • Past car accident injuries
  • Arthritis
  • Degenerative disc disease
  • Carpal tunnel syndrome
  • Neurological disorders
  • Orthopedic problems

An employer and their insurance company may argue that a pre-existing condition — such as one of the conditions above — is the actual cause of a worker’s symptoms, rather than the workplace accident. This could result in a denial or reduction of L&I benefits.

When Does Workers’ Compensation Cover Pre-Existing Conditions?

Under Washington law, Workers’ Compensation protects workers who have a pre-existing condition. If a workplace injury activates a pre-existing asymptomatic condition or worsens a pre-existing symptomatic condition, L&I must provide coverage for it. However, L&I will not take responsibility or provide coverage for the pre-existing condition if the work injury does not impact it.

Does Workers’ Compensation Cover Pre-Existing Degenerative Conditions?

Often, pre-existing conditions that are degenerative can be aggravated by a workplace injury. These types of conditions frequently affect the knees, shoulders, and spine. For example, degenerative conditions can include degenerative disc disease, shoulder tears, degenerative meniscus tears, and arthritis. In the event a workplace injury causes such injuries to become symptomatic or accelerates them to make them worse, L&I must provide coverage for the claim under Washington law.

What Happens if L&I Won’t Provide Coverage for a Pre-Existing Condition?

It is not uncommon for L&I to deny claims that involve pre-existing conditions. In some cases, L&I may deny a claim by asserting that the condition is congenital or degenerative. However, an injured worker may still have options available if a claim is denied. A worker can either file a protest to L&I’s decision or appeal the decision to the Board of Industrial Insurance Appeals.

Typically, there is a 60-day deadline to protest or appeal the denial of a claim, from receipt of the L&I order. Failure to challenge a claim within this time frame results in a waiver of the right to do so. Claim denials require the assistance of a skillful Workers’ Compensation attorney who can best advise you and fight for the benefits to which you are entitled.

Contact an Experienced Washington Workers’ Compensation Attorney

Workers’ Compensation claims involving pre-existing conditions can be complex. It is vital to have a skilled Workers’ Compensation attorney by your side who can guide you through the process of filing an L&I claim. The Bellingham Workers’ Compensation attorneys at Robinson & Kole provide reliable representation to injured workers throughout Washington State and strive to secure the best possible results in each case. We welcome you to contact us for a free consultation by calling 800.640.5616 or by using our online contact form. Se habla Español.