What is a pre-existing condition?
A pre-existing condition is a medical issue that affects an individual prior to their health insurance going into effect. Pre-existing conditions are usually long-term and chronic in nature. The term also includes specific predispositions to reinjury due to past injuries or accidents, such as a previous back or neck injury, for example.
According to the U.S. Department of Health and Human Services, there are 50 to 129 million Americans suffering from aggravated pre-existing conditions, including diabetes, heart disease, arthritis, herniated disks, and torn ligaments—just to name a few. Mental health conditions, such as depression and anxiety, are also considered pre-existing conditions that have shown to be aggravated at work.
Can certain jobs make pre-existing conditions worse?
The short answer to this question is yes. Depending on your pre-existing condition and the types of duties you’re expected to perform, your job can definitely aggravate or worsen a pre-existing health issue.
Below are some of the most common pre-existing conditions that can be exacerbated at work.
Arthritis is often associated with aging, but it can strike at any time. It’s not a single disease but a series of conditions that involve inflammation of the joints and surrounding tissue.
Over 50 million Americans suffer from arthritis, which includes rheumatoid arthritis, osteoarthritis, gout, lupus and fibromyalgia. Symptoms include redness, stiffness, swelling and pain around 1 or more joints. Typical areas impacted are the hands, wrists, knees, hips and shoulders.
Workers with pre-existing arthritis are at an increased risk of aggravating this condition if their work involves repetitive motions or high-impact activities or if they’re sedentary for extended periods of time.
Jobs involving repetitive motion include typing and assembly line work. High-impact activities can include construction work or other kinds of manual labor. Sedentary jobs include desk jobs, such as receptionists and clerks.
A herniated disc occurs when the disc (which serves as a cushion between your bones in your spinal cord) tears or slips out of place. It often results in pain—which is typically described as a burning and/or stinging sensation frequently felt throughout the lower body.
Workers with pre-existing herniated disc injuries are at an increased risk of aggravating this injury if they have a physically demanding job that requires heavy lifting, pulling or pushing of merchandise or equipment.
A torn ligament is the result of a sudden, sharp twisting motion involving 1 of the body’s joints. This type of injury is often preceded by an audible popping sound and severe pain at the point of injury.
A ligament tear may result in either an incomplete or total tear, depending on the severity. The pain of an incomplete tear is often comparable to a severe strain, while the pain from a total ligament tear is comparable to that of a broken bone.
Workers with a pre-existing torn ligament injury are at an increased risk of aggravating this injury if they perform duties that require repetitive movements, twisting or frequent bending.
Depression is a mental health condition that may be caused by biological, psychological, environmental and/or genetic factors, among other causes. It’s a condition more often seen in women, including in the form of postpartum depression following pregnancy and the birth of a child. In the U.S., depression affects more than 19 million adults and teens and can occur at any age.
Depression presents with symptoms that can include feelings of extreme sadness or hopelessness, insomnia and suicidal thoughts. It can also manifest in physical symptoms such as headaches, digestive issues, cramps, and other body aches and pains.
Among the jobs where workers report the highest rates of depression include public and private transportation, real estate, social services, manufacturing and personal services.
Anxiety is a condition that is characterized by feelings of uneasiness, nervousness, dread, restlessness and fear. These symptoms often get progressively worse over time and may become debilitating, affecting every aspect of a person’s daily life, including their job and personal relationships.
There are a number of different types of anxiety disorders. The most common are panic disorder, generalized anxiety disorder (GAD) and phobias. The exact cause of anxiety disorders is unknown, but it is believed that brain chemistry, genetics, stressors and environmental factors may be involved.
Workers with pre-existing anxiety are at an increased risk of aggravating this condition if they work in high-pressure or fast-paced jobs or jobs in which they’re exposed to traumatic events. Among the jobs where workers report the highest rates of anxiety include health care workers, first responders, firefighters, police officers, politicians, servers and wait staff, cashiers and managers.
Are pre-existing conditions covered by workers’ compensation?
Yes, workers’ compensation insurance may provide coverage for aggravated pre-existing conditions. If you have a pre-existing condition, it’s important to be aware of how your work is impacting your condition. For example, if your arthritis is exacerbated by work and you continue your tasks, then you may be extending your recovery time and worsening your condition.
To be covered by workers’ compensation for a pre-existing condition, a worker must be able to show that their condition was aggravated, accelerated or reactivated by work-related activities. It’s not necessary to prove the work-related activity exclusively caused exacerbation of the condition. However, the work-related activity must be a material factor in exacerbating the condition.
In addition, the resulting disability must interfere with your ability to continue working, at least for a time. Also, workers are required to notify their employers that they’ve been injured at work within a defined period.
What if I didn’t tell my boss about my pre-existing condition before I was hired?
North Carolina Code Section 42-9-35 indicates that failing to inform your employer of a pre-existing condition has no bearing on your legal right to workers’ compensation benefits.
However, you will be required to have proof of the pre-existing condition, such as medical records, a list of prescribed medications and treatments, doctor’s statements, etc., if your workers’ compensation claim involves an injury or illness that occurred on the job.
This is the case whether your injury exacerbated your pre-existing condition or whether your pre-existing condition exacerbated your injury.
Filing a workers’ comp claim
The process of qualifying for workers’ compensation can be complex. It includes timely reporting of the injury to the employer, gathering sufficient evidence to support the claim, and being evaluated by an appropriate medical provider, among other procedural and substantive steps. The extent of the injury must be evaluated to determine if the disability is temporary or permanent and whether it’s complete or partial.
A successful workers’ compensation claim will award time off from work with two-thirds pay to allow for recovery. In addition, many relevant medical expenses will also be covered. It’s possible to be compensated for costs such as doctor’s appointments, prescriptions, surgeries and physical therapy through a successful claim.
The Columbia workers’ compensation lawyers at Chappell, Smith & Arden, P.A. advocate for workers in South Carolina suffering from aggravation injuries due to pre-existing conditions.
If you have a pre-existing condition that has been aggravated at work, it’s important to properly document your injury and file a claim. If successful in your claim, you’ll be able to obtain the recovery time and medical attention you need to properly care for your health.