You got hurt at work. You filed a workers’ compensation claim. Then the insurance company denied it, claiming your injury resulted from a pre-existing condition. This is one of the most common—and frustrating—reasons for workers’ comp denials. Here’s what you need to know: having a pre-existing condition doesn’t automatically disqualify you from receiving benefits.
How Pre-Existing Conditions Actually Work
Ohio workers’ compensation law recognizes that many workers have pre-existing conditions—bad backs, arthritis, old injuries, or degenerative conditions. What matters is whether your job aggravated, accelerated, or worsened that condition. If your work made an existing problem significantly worse, you’re entitled to benefits for the aggravation.
The insurance company will try to argue that your condition would have worsened anyway. They’ll point to your medical history and claim your work had nothing to do with it. Don’t fall for this. If you were managing your condition and working without problems until a specific work incident or repetitive work activities made it worse, you have a valid claim.
Common Scenarios Where Pre-Existing Conditions Matter
Workers with pre-existing conditions face these situations regularly:
- A worker with prior back problems lifts heavy equipment and herniates a disc
- An employee with arthritis develops severe pain after repetitive assembly line work
- A construction worker with an old knee injury re-injures it after a fall at work
- A warehouse employee with a healed shoulder injury tears their rotator cuff on the job
In each case, the work-related incident or activity aggravated an existing condition. That aggravation is compensable under Ohio law. More importantly, the preexisting condition doesn’t disqualify your claim.
Fighting a Pre-Existing Condition Denial
Medical evidence is critical. You need documentation showing that your condition worsened due to work activities. This often requires expert medical opinions that establish the connection between your job duties and the aggravation of your condition. The insurance company’s doctors will minimize this connection—your medical evidence must be stronger.
Don’t Give Up on Your Claim
Insurance companies deny claims hoping you’ll accept their decision and walk away. Many injured workers do exactly that, believing they have no recourse. You have the right to appeal and fight for the benefits you deserve. Pre-existing conditions make cases more complex, but they don’t make them impossible.
The Law Offices of Tim Misny can help you with your workers’ compensation claim. When insurance companies deny benefits you’re entitled to, I’ll Make Them Pay!® Call my office at (877) 944-4373 so that I can evaluate your case right away.
