How Do Pre-Existing Conditions Affect My Claim?

By Law Office of Justin S. Eppler, LLC

Workers’ compensation has been created to protect workers in the case of an injury incurred at work. But if you already have a pre-existing condition, you may be wondering how workers’ compensation insurance affects you. Unfortunately, this can affect your settlement, as insurance companies tend to deny any claim they can, and they can use your pre-existing condition as a reason for denial. 

Our team of experienced workers’ compensation attorneys at the Law Office of Justin S. Eppler, LLC can help you recover compensation. We understand the struggle that often accompanies a workplace injury, and we are ready to help you obtain the financial benefits you deserve through workers’ compensation. 

Based in Anchorage, our firm proudly represents clients throughout Alaska, including Fairbanks, Juneau, Wasilla, and Palmer.

What Qualifies as a Pre-Existing Condition?

In Alaska, all employers must carry workers' compensation insurance, so most employees are covered. For workers’ compensation purposes, a pre-existing condition is defined as an injury or medical condition that pre-dates the current condition or injury that is prompting the employee’s claim. Some pre-existing conditions include the following:

  • Arthritis

  • Degeneration of the spine

  • Fractures

  • Herniated disks

  • Knee injuries

  • Strains and/or sprains

  • Diabetes

  • Epilepsy 

  • Depression

  • Anxiety 

  • Cancer

Essentially, it doesn’t matter if treatment has occurred. If you’ve been diagnosed with one of these conditions (or others), you may be denied due to a pre-existing condition. 

How Pre-Existing Conditions May Affect the Claim

It’s important to understand that just because a pre-existing condition won’t affect your ability to qualify for workers’ compensation or other insurance, it can affect whether or not your claim is approved. 

Not surprisingly, when your work injury is closely related to your pre-existing condition, it can complicate your claim. For instance, if you have a history of arthritis in your left hand, and you injure your left hand at work, it will be more difficult to determine the amount of benefits you will receive. In this case, the employer would only be held responsible for the amount of pain worsened after the injury, but that can be hard to determine due to the pre-existing pain. 

Another complicating factor occurs if your pre-existing injury is associated with a different workers’ compensation claim. Your award will be difficult for companies to agree upon. Benefits can either be related to the existing injury or turn to permanent disability, and your awarded settlement will relate to permanent disability benefits. It can be complicated to diagnose. 

Appealing a Denial Based
on a Pre-Existing Condition

If your workers' compensation claim has been denied, or you disagree with the amount of your benefits, you can dispute the decision with the Alaska Workers' Compensation Board. You must appeal the denial decision within two years. 

Formal action needs to take place with the Alaska Workers’ Compensation Board, and it must be a written claim and the reasons why you believe your claim should be heard. It’s then taken to the Adjudications Section of the Alaska Workers’ Compensation Board. They have a mediation program that can bring you and the insurance company together to agree on a settlement. Their main goals include enforcing laws and ensuring benefits. Finally, a judge will make a final decision based on the evidence they’ve come face-to-face with. Hopefully, the insurance company will settle before then, but if they don’t, this is the final stage. 

Experienced Guidance You Can Trust

Workers’ compensation benefits can be a lifeline, especially if you have a pre-existing condition. If your claim was denied because of this pre-existing condition, our firm can help.

The Law Office of Justin S. Eppler, LLC offers the guidance that you need in your workers’ compensation claim process. If you live in Anchorage, Alaska, or the surrounding communities of Fairbanks, Juneau, Wasilla, and Palmer, contact us today to request a consultation.