Can I Receive Workers’ Compensation in Ohio If I Have A Pre-Existing Condition?

Many people have an old injury that’s no longer symptomatic or an illness that’s under control. After months or years without problems, issues can resurface. Sometimes, the problem gets worse because of a job-related accident or situation. Under normal circumstances, people who suffer work-related injuries and illnesses are entitled to workers’ compensation benefits. However, it can be challenging to get your claim approved if you have a pre-existing injury.

Let’s say you slipped and fell in the office and immediately, you experienced excruciating back pain. When you went to the doctor, you learned that your pain resulted from a herniated disc. You’d previously suffered a similar injury in a car accident but thanks to physical therapy and medication, you were still able to work. The new injury, however, is so painful that you can no longer perform your duties. At this point, you may worry that you’ll be ineligible for benefits.

Workplace injuries that are linked pre-existing conditions are far from black and white. Whether it’s a chronic health problem or an old injury, your employer is likely to challenge your claim. The Ohio Bureau of Workers’ Compensation can also deny parts of your claim. However, it’s not impossible to receive benefits under certain circumstances. If you’re unsure about how to proceed, you should reach out to a Cincinnati workers’ comp attorney for guidance.

When Workers’ Comp Cover A Pre-Existing Condition

The BWC will look at two factors when deciding whether your injury qualifies for compensation. These are relatedness and medical necessity. Relatedness means that your job-related injury or illness substantially aggravated your pre-existing condition. The BWC will seek to determine whether your condition would have been exacerbated were it not for your job. Going back to our earlier scenario, you would need to prove that were it not for your fall, you would not have experienced additional back problems. If you can successfully prove this, you may be able to get compensation for your injuries.

There are some pre-existing conditions that wouldn’t typically be covered by workers comp. However, when they affect the treatment of a covered injury, they may be authorized. This is known as co-morbidity. Let’s illustrate this with a different scenario in which a worker has diabetes. This condition isn’t considered an occupational disease and it’s, therefore, not covered by workers’ comp.

However, the worker suffers a laceration during a workplace accident. This is a covered injury. Because the individual is a diabetic, the injury takes an unusual amount of time to heal. In such a situation, the BWC may cover the treatment of the pre-existing condition while the worker recovers. As soon as the laceration heals and the employee goes back to work, they won’t be able to make a diabetes-related claim.

The Challenge of Proving “Substantial Aggravation”

Before, 2006 an increase in symptoms that required medical treatment was considered aggravation. Typically, the worker only had to:

  • Testify that they were experiencing more pain
  • Show that they were seeking treatment

This was usually enough to secure benefits under the workers’ comp system. However, the standards have changed. To get benefits, the worker now needs to show that their condition was substantially aggravated. This puts an increased burden on the employee since they have to present documented evidence of their worsened condition.

Medical professionals need to present clinical findings or test results that indicate a previous injury is now symptomatic or a chronic condition has worsened. Each case of injury or illness is different so the required evidence will vary.

When you go to the doctor with the aggravation of a pre-existing condition, be sure to mention all your symptoms. Don’t leave out anything even some of the things you’ve experienced seem minor. You will need a comprehensive report from your doctor to prove you are entitled to compensation.

Get Legal Help from a Workers’ Comp Lawyer in Cincinnati Today

If you want to improve your chances of getting the compensation you deserve, you’ll need a lawyer. It can be tough to get workers’ comp claims approved even without a pre-existing condition. However, you don’t have to handle the situation alone. Our workers’ comp attorneys in Cincinnati will work hard to protect your rights and ensure you don’t suffer undue hardship. Not being able to work and earn a wage can affect your household significantly. Call us today to schedule a consultation and get an expert legal opinion on your case.