If you have a pre-existing medical condition and suffer an injury at work, you may worry that your condition will prevent you from receiving workers’ compensation benefits. Perhaps you have a history of back pain, arthritis, a previous knee injury, or a degenerative disc condition.
Having a pre-existing condition does not automatically disqualify you from receiving workers’ compensation benefits in Wisconsin. If your work activities cause a new injury or aggravate an existing condition, you may still have a valid claim.
Understanding how Wisconsin law treats pre-existing conditions can help you protect your rights and make informed decisions after a workplace injury.
How Does Wisconsin Workers’ Compensation Law Treat Pre-Existing Conditions?
Wisconsin workers’ compensation law recognizes that an employee may have an underlying medical condition before a workplace injury occurs. If a work-related accident or activity causes a new injury or aggravates an existing condition, the employee may be entitled to benefits.
Wisconsin courts have recognized that a work-related injury can be compensable when workplace activity aggravates and accelerates a pre-existing degenerative condition beyond its normal progression. Whether a claim qualifies depends on the medical evidence and the circumstances of the injury.
For example, imagine you have a history of lower back pain but can perform your regular job duties without significant limitations. One day, while lifting a heavy box at work, you experience a sharp increase in pain and develop symptoms that prevent you from continuing your job.
If medical evidence establishes that the lifting incident caused a new injury or worsened your existing condition, you may qualify for workers’ compensation benefits.
The important question is not simply whether you had a medical condition before the incident. It is whether your work contributed to the injury or worsening of that condition.
What Types of Pre-Existing Conditions Can Affect a Claim?
Many medical conditions can become relevant when an employee suffers a workplace injury. Common examples include:
- Back and neck problems: Previous disc injuries, herniated discs, or degenerative spinal conditions may become more painful or disabling after lifting, bending, or repetitive work.
- Arthritis: Repetitive movements, prolonged standing, or physically demanding duties may aggravate existing joint problems.
- Previous knee or shoulder injuries: A new workplace accident may worsen an injury that had previously improved.
- Degenerative conditions: Conditions that develop over time may be aggravated by workplace activities.
- Chronic pain conditions: A workplace injury may worsen existing symptoms or create additional functional limitations.
Each claim is different. Having one of these conditions does not automatically mean your claim will be approved or denied. The connection between your work and your current symptoms must be evaluated based on the facts and supporting evidence.
What If Your Employer or Insurance Company Blames Your Existing Condition?
An employer or workers’ compensation insurance company may question whether your symptoms resulted from a workplace injury or from a condition you already had.
For example, an insurance company might argue that your back pain is caused by degenerative disc disease rather than a workplace lifting incident. It may also question whether your need for additional treatment or time off work is related to the work injury.
However, the existence of a pre-existing condition does not, by itself, resolve whether you are entitled to benefits.
Wisconsin law distinguishes between a condition that naturally progresses on its own and one that is worsened by work-related activity. Medical evidence may be important in establishing that distinction.
Your claim may require medical records, an examination, or a physician’s opinion explaining how the workplace incident affected your condition. The specific evidence needed will depend on the nature of your injury and the issues disputed by the insurer.
What Evidence Can Help Support Your Claim?
If you have a pre-existing condition, documentation can help establish what changed after your workplace injury and whether your work contributed to that change.
Consider taking the following steps:
1. Report the workplace injury promptly.
Notify your employer about the incident or worsening symptoms as soon as possible. Explain what happened, when your symptoms began, and which work activities were involved.
2. Seek medical attention.
Tell your healthcare provider about the workplace incident and your previous medical history. Be specific about any new symptoms, increased pain, or changes in your ability to perform everyday activities or job duties.
3. Follow your treatment plan.
Attend recommended appointments and follow your provider’s instructions. Keep records of your treatment, symptoms, work restrictions, and recovery.
4. Keep relevant documentation.
Save copies of incident reports, medical records, work restrictions, communications with your employer, and correspondence from the insurance company.
5. Be accurate about your medical history.
Do not hide a pre-existing condition. Instead, explain how you were functioning before the workplace incident and what changed afterward. Accurate information helps your healthcare provider assess the relationship between your work and your symptoms.
What Benefits May Be Available?
If your injury or aggravation of a pre-existing condition qualifies as work-related under Wisconsin law, you may be eligible for benefits depending on your circumstances.
Potential benefits may include:
- Medical expenses related to the compensable workplace injury.
- Temporary disability benefits if the injury prevents you from working or reduces your ability to earn wages.
- Permanent disability benefits if the work injury results in qualifying lasting impairment.
- Vocational rehabilitation benefits in circumstances where you qualify under Wisconsin law.
Benefits are not automatic, and the amount and duration of any benefits depend on the applicable legal requirements, medical evidence, and individual circumstances.
What Should You Do If Your Claim Is Denied?
If your workers’ compensation claim is denied because of a pre-existing condition, do not assume that the decision is necessarily correct.
Start by reviewing the denial letter to understand the insurer’s reasons. The dispute may involve whether the workplace incident caused an injury, whether your condition was aggravated beyond its normal progression, or whether particular treatment or disability is related to the work injury.
You may wish to obtain additional medical documentation and speak with a Wisconsin workers’ compensation attorney about your options. An attorney can review the circumstances of your claim, explain the applicable requirements, and help you understand whether challenging the denial may be appropriate.
Deadlines may apply to workers’ compensation disputes, so it is important to seek advice promptly rather than waiting until the situation becomes more difficult to resolve.
Speak With a Wisconsin Workers’ Compensation Attorney
A pre-existing medical condition should not automatically prevent you from exploring your rights after a workplace injury. If your job caused a new injury or worsened an existing condition, the circumstances deserve careful consideration.
At Bykhovsky Law, we help injured workers understand their legal options and navigate workers’ compensation concerns. If your claim has been denied, your benefits are being questioned, or you are unsure whether your existing condition affects your eligibility, getting legal guidance may help you understand your next steps.
Contact Bykhovsky Law for a free consultation to discuss your situation with our workers’ compensation attorney and learn more about your options.
This article is for informational purposes only and is not legal advice. Every workers’ compensation claim is different, and eligibility depends on the specific facts and applicable Wisconsin law.
