Pre-Existing Work Injuries
Massachusetts law provides workers’ compensation benefits when a worker sustains an injury or illness in the course and scope of their employment. The law also provides for workers’ compensation benefits in instances when an injured worker aggravates or exacerbates a pre-existing illness or injury. Simply put, a Massachusetts employer is said to “take their workers as they find them.” Notwithstanding this fact, it is essential that an injured worker retain a skilled and experienced workers’ compensation attorney when pre-existing injuries are at hand, as employers and their defense attorneys commonly attempt to dismiss or deny claims on the basis that the new injury or aggravation is a non-compensable pre-existing injury.
A pre-existing injury or illness is simply an illness or injury that the worker sustained prior to the current workplace accident or injury. Pre-existing work injuries occur in many forms. For example, physicians may notice certain degenerative conditions that predated a new injury based on diagnostic studies such as x-rays, MRIs, and CT scans. Examples of conditions commonly noted through these diagnostic instruments include degenerative disc disease or spinal stenosis. Pre-existing conditions may affect the feet, ankles, knees, hips, hands, wrists, elbows, shoulders, and spine. Other pre-existing conditions or illnesses may be psychologically rooted, as is the case with depression, anxiety, and PTSD. They can also manifest in illnesses and diseases such as asthma, heart, and pulmonary conditions, and also include injuries such as hearing and vision loss.
An aggravation of a pre-existing condition can result in lost time from work, additional impairment, loss of function, earning capacity, as well as the need for costly medical treatments, hospitalizations, and medical prescriptions. Because of the costs associated with pre-existing work injuries, employers routinely deny or seek to deny claims on the basis of a pre-existing injury defense. Thousands upon thousands of claims are initially denied by employers on this basis, notwithstanding the fact that the employee’s may have been symptom-free or pain-free from the pre-existing injury for months or even years prior to sustaining the new aggravation or progression of the workplace injury or illness.
In most cases, pre-existing work injuries were completely asymptomatic and the new work-related injury permanently advanced, aggravated, or exacerbated the pre-existing injury creating new symptoms and at time, causing previous symptoms to arise. In spite of these clear facts, employers and workers’ compensation insurance carriers flat-out deny these claims and make it incredibly difficult for an injured worker to receive the benefits to which they are entitled under Massachusetts law.
For example, take the case of an injured worker who had a pre-existing herniated disc in his back that was surgically repaired and now has been asymptomatic for years. He begins a new warehouse position and while performing his job duties, bends over to lift something off a pallet and re-herniates that very same disc, experiencing new symptoms and pain that requires another costly surgery. Against this factual backdrop, an employer or workers’ comp insurance carrier will almost certainly deny this claim. However, given facts at hand, the worker clearly suffered a new injury within the course and scope of his employment that is the “major cause” of his symptoms and need for treatment. Thus, under the law and despite his pre-existing injury, his new injury would be compensable.
Employers, workers’ comp insurance carriers, and their defense lawyers frequently go out of their way to fight even the most compensable of workers’ compensation claims. Nowhere is the fight as prickly as when an employee with a pre-existing injury suffers a new workplace injury. Employers and their representatives defending your claim will thoroughly comb and sift through past medical records in search of what they think are pre-existing work injuries in their unmitigated quest to deny a comp claim and save company money. In fact, not only will they attempt to initially deny the claim in its entirety, but they often use the pre-existing injury defense to deny certain prescription medications on claims that have already been accepted as compensable. In such cases, it is absolutely paramount that the injured worker retains a skilled and experienced workers’ compensation attorney to fight back and protect their statutory right to workers’ compensation benefits.
Under Massachusetts’ workers’ compensation statutes, the exacerbation or aggravation of a pre-existing injury is compensable. The law holds that a new injury sustained within the course and scope of a workers’ employment must be covered by workers’ compensation, so long as that injury is a “major cause” for the cause of the workers’ disability or need for treatment. Of course, this means that the injured worker is entitled to all of the medical, lost wages, permanent incapacity, and loss of function benefits that the Massachusetts workers’ compensation laws provide, just like any other compensable workplace injury or illness.
Other compensable pre-existing injury cases can become quite complicated, particularly when it comes to the apportionment of a workers’ permanent impairment or incapacity, as the parties attempt to determine what portion of an employee’s incapacity resulted from the new workplace injury, as opposed to the portion that pre-existed the new injury. Apportionment of incapacity is a very important issue during settlement negotiations and directly impacts the dollar value of the injured worker’s settlement. The workers’ compensation insurance carrier’s attorney will unquestionably try to apportion all of the new incapacity or impairment to the pre-existing injury to deny you your entitled share of benefits. An injured worker needs an attorney to counter this attack. It is imperative that an injured worker retain a seasoned and skilled workers’ compensation attorney navigate them through this process to ensure that they get the maximum possible permanent incapacity and/or loss of function award. An experienced attorney will know the proper questions to pose to the worker’s medical providers to assure the best possible outcome.
It is absolutely essential that an injured worker with pre-existing conditions contact a lawyer immediately when faced with a new, as the employer and/or workers’ comp carrier most certainly will.