Workers’ compensation is meant to cover your medical expenses when you’re hurt on the job in California. This coverage triggers when you suffer a work-related injury or illness. However, what happens if you have a pre-existing medical condition?
The impact of pre-existing conditions
Under California law, workers’ comp covers injuries caused or aggravated by your work. However, if you have a pre-existing condition, the insurance company might argue that your work didn’t contribute to your injury.
If a work-related injury caused you permanent disability, you will undergo an assessment. The physician in charge of assessing your condition will prepare an apportionment report. This report contains the physician’s findings on what approximate percentage of permanent disability was caused by other factors before and after the injury.
The physician might conclude that a pre-existing condition was a larger factor in your permanent disability. However, their report can’t completely deny your medical coverage.
Proving work-related injuries
To navigate these challenges, it’s essential to prove the connection between your work activities and your injury. Detailed medical records can support your claim by showing the extent of the aggravation caused by your job. It’s important to disclose your pre-existing conditions to your treating physician and to discuss how your job duties have worsened your health.
Settling disputes
If your claim is disputed, you may need to undergo a Qualified Medical Evaluation (QME) to assess the impact of your pre-existing condition on your current injury. You must be honest and thorough in describing your medical condition and the work incident that led to it to the QME. The QME’s findings will play a significant role in resolving your claim.
However, should your employer or insurer continue to deny your claim, you still have the right to appeal the decision. A legal professional may be able to help you navigate the appeal process and fight for your right to fair compensation.
