Pre-Existing Condition healthcare concept, flat lay

The Wisconsin workers’ compensation system provides benefits to workers who were hurt on the job, even if you had a pre-existing condition. However, while preexisting conditions do not bar you from receiving compensation after a workplace injury, worker’s compensation insurance companies or their paid doctors often use pre-existing conditions as an excuse to deny your claim.

If you were injured at work but the worker’s compensation insurance company is denying your claim because of a preexisting condition, Kingree Law can help. Wisconsin workers’ compensation attorney Luke Kingree has extensive experience representing injured workers throughout Wisconsin. He knows the laws and legal precedents that apply to workers’ compensation claims and will work to obtain and present evidence to show that your injuries were caused at work, or that the pre-existing condition was permanently aggravated. And if your claim was denied, he will prepare an appeal to help you recover the benefits you deserve.

What Is a Preexisting Condition?

A preexisting condition is any past injury that you sustained, a condition you were born with, or a degenerative condition. If you received treatment for a past injury or condition, or simply mentioned prior problems with the injured body part to a medical provider, the worker’s compensation insurance company may try to deny benefits.

Many workers start a new job with preexisting conditions such as a bad back, a prior knee injury, or degenerative arthritis. Unfortunately, after a workplace accident or occupational exposure (work activities), many employers or worker’s compensation insurance companies tell injured workers they are not eligible for workers’ compensation benefits because of a preexisting condition. This simply is not true.

How Will a Preexisting Condition Affect My Workers’ Compensation Claim?

Under Wisconsin workers’ compensation law, your employer takes you “as is.” This means that if you have a preexisting condition or you are predisposed to a work injury, even from work activities or a work injury that would not have injured a similar worker without a pre-existing condition, you may still be entitled to worker’s compensation benefits. If a work injury or work activities aggravate a pre-existing condition beyond normal progression, the entire condition can become work-related and compensable. Work activities or a work injury must only be a “material contributory causative factor” in the onset or progression of a condition, which the Labor and Industry Review Commission has defined as being as little as a 5% to 10% contribution toward permanent aggravation of a condition. In other words, a work injury or work exposure only needs to be “a cause,” not “the cause,” of permanent aggravation of a condition.

Suppose you had previously suffered a back injury while working for a different employer. If you were hurt at your new job, you are still entitled to workers’ compensation benefits if the work injury or work activity caused the need for medical treatment sooner than you otherwise would have needed it.

Similarly, if you have degenerative arthritis in your knee, and even if your doctors have told you that you might eventually need a knee replacement, but a work injury or work activity accelerated the need for the knee replacement by only several months, the knee replacement is considered work-related and compensable as a work injury. The same principle applies to a pre-existing tendon tear in, for example, your shoulder. Even if you did not know you had a tendon tear, but the work injury or work activity makes the tendon tear symptomatic and results in the need for shoulder surgery, that surgery is compensable.

What Preexisting Conditions are Not Compensable?

It is a valid defense to worker’s compensation benefits if a preexisting condition “manifested itself” during work activities or a workplace incident, without any contribution toward the condition by the work activities or a workplace incident. In other words, you just so happened to become symptomatic while performing work activities. Worker’s comp insurance company defense doctors (also called “Independent Medical Examiners” or “IME”) often use this defense. They are saying that you would have experienced the same symptoms at the same time if you were performing everyday activities outside of work.

When an IME doctor says this, whether you will be entitled to worker’s compensation benefits depends upon what your own doctors say about whether the work activities or a work injury permanently aggravated a pre-existing condition. Most cases where benefits are disputed by an IME doctor in this manner come down to a judge deciding which doctor is correct: the IME doctor or your own doctor.

It is possible for a pre-existing condition defense to succeed in a case and for you to be denied worker’s compensation benefits by a judge. One important factor is whether you simply become symptomatic during work activities or after a workplace incident, but after work activities are over, or after a few months have passed after a workplace incident, your condition returns to baseline. In that circumstance, recovery of benefits may be difficult.

Proving Aggravation of a Preexisting Medical Condition

The key to proving permanent aggravation of a preexisting condition is what your doctors say about it. To that end, it is helpful to ask your doctors whether the work activities or a workplace incident contributed at least 5% toward permanent aggravation or acceleration of your condition. Another way of asking them is whether you would have needed the treatment you need at this point in time if the work injury had not occurred. The doctors must put this in their dictated notes after the appointment has ended.

To prove an aggravation of an existing condition, it can be helpful to provide detailed documentation about your condition and any treatment you received, how your symptoms had been reduced or eliminated, whether were cleared to return to work without restrictions, and whether you were pain free. You should also take care to describe the new injury, or your work activities, and how any pain and discomfort from that injury or work activities is different from the prior injury or made your symptoms worse.

Successfully disputing a denial of worker’s compensation benefits because of a preexisting condition is not easy. It often requires skilled, time-intensive, and experienced help from a professional. Attorney Luke Kingree can assist with contesting these denials, as he has done many times throughout his career.

Kingree Law: Standing with Wisconsin Workers

Having a claim for workers’ compensation benefits denied is frustrating. But Kingree Law will help you work through the process of having your claim for benefits approved, even if you have a preexisting condition.

Kingree Law has offices in Madison and Eau Claire, and proudly represents injured workers throughout Wisconsin.

To learn more about how Kingree Law can help, visit our FAQ section and Information Center. Then contact us today to schedule a free, confidential consultation to discuss your situation and how we can help.