Although not simple, you can file a workers’ compensation claim for a pre-existing injury or medical condition your job has worsened. This article will help you understand:
- How pre-existing injuries impact a workers’ compensation claim
- The medical evidence you need
- And how to get fair compensation for your loss.
Pre-existing Injury Meaning
For a work-related personal injury claim, a “pre-existing injury or medical condition” is defined as an injury or medical condition that was present during the employment process and that a person suspects or (ought reasonably to suspect) would be aggravated, as per Section 571A of the Workers’ Compensation and Rehabilitation Act 2003 (Qld).
This definition is essential to understanding how a pre-existing injury can affect a worker’s compensation claim.
How A Pre-Existing Injury Impacts Workers’ Compensation Claims
The Queensland workers’ compensation scheme is a mandatory system that protects employees who suffer injuries or illnesses due to work-related activity. However, things are more complicated when a pre-existing injury is involved. Sadly, many working Australians already have a pre-existing injury, whether it’s from their birth, a car accident, or an incident on a sporting field.
A pre-existing condition does not usually prevent you from receiving benefits such as weekly payments and a lump sum payout. However, it does complicate the WorkCover claim process. So, it’s critical to have compelling evidence linking your work activities to worsening your condition.
Workers Compensation Benefits for a Pre-existing Injury
In Queensland, workers’ compensation benefits cover:
- Medical and related expenses
- Lost income
- Rehabilitation costs
- A lump-sum payment for permanent impairments.
However, WorkCover claims don’t just cover new injuries; they also protect against the recurrence or aggravation of existing conditions due to work-related activities.
NOTE: Employers must be informed of incidents exacerbating a pre-existing condition to maintain eligibility for a WorkCover claim. If you have a new or aggravated work injury, seek legal advice from Splatt Lawyers to learn about your right to claim WorkCover. It’s free to know your entitlements, and all our legal services are 100% no win, no fee. Call 1800 700 125
Can I Make a Workers’ Compensation Claim for a Pre-existing Injury?
Eligibility to make a workers’ compensation claim is outlined in the Workers Compensation and Rehabilitation Act 2003. Consequently, you can lodge a WorkCover claim for worsening a pre-existing condition when you can prove a clear connection between your work activities and the aggravation of your medical condition. The insurer will question the following:
- Was the employee’s employment a significant contributing factor in the aggravation of your injury?
- Did you lodge within the required time frame?
- Were you considered an employee of the employer when you were harmed?
- Do you meet the insurer’s definition of a worker?
- Did you have an initial claim for the same condition (in which case the first claim may continue)?
For a valid workers’ compensation claim, you must promptly report any incidents exacerbating a pre-existing condition. Critical factors in assessing an aggravation claim include factual and medical information regarding the severity of the condition and the required medical treatment. Furthermore, to have an approved work-related compensation claim, it must be shown that your employment was a significant contributing factor to the aggravation.
Disclosure of a Pre-Existing Condition to an Employer
Disclosure of pre-existing conditions to a prospective employer is a legal obligation and essential for accurately evaluating new or aggravated injuries. Queensland legislation mandates that workers are truthful about any pre-existing conditions during the hiring process.
You can risk the approval of a compensation claim by failing to properly disclose a previous injury or medical condition. For instance, if an employee fails to inform their employer about a pre-existing back injury, a new claim for an aggravated back injury due to a work-related incident may be denied.
However, employers must also be truthful. They can do this by:
- Providing accurate job descriptions will inform prospective employees about potential risks related to a previous injury or condition.
- Asking applicants to disclose any medical conditions that might affect their job performance.
What is Aggravation of a Pre-Existing Injury or Condition?
Aggravation of a pre-existing injury occurs when a work-related incident causes the symptoms of a pre-existing condition to worsen or intensify. This aggravation doesn’t necessarily require physiological changes; an increase in symptoms alone can qualify as an aggravation. For example, an employee with a pre-existing back problem might experience severe back spasms after lifting a heavy object.
How Do I Know If I Have an Aggravated Injury?
An independent medical examination will evaluate symptoms and medical treatment to determine if an aggravation has occurred. Key considerations include differentiating between a medical condition’s natural progression and one worsened by work-related activity.
NOTE: Changes in symptoms do not automatically prove an aggravation; they may reflect natural changes in the injury or condition over time.
Medical Evidence and Documentation
Thorough medical documentation is the backbone of a workers’ compensation claim for pre-existing conditions. Collecting thorough medical evidence indicating how the injury has deteriorated due to work activities supports your claim. This evidence includes comprehensive medical reports from your treating doctor that link your job responsibilities to the escalation of your condition.
Treating physicians provide WorkCover medical certificates identifying the new injury and any pre-existing conditions. A thorough medical history that outlines the pre-existing injury and its aggravation can significantly strengthen your existing claim.
Apportionment of Liability
Apportionment of liability is a crucial aspect of workers’ compensation claims for pre-existing injuries. When a work-related incident aggravates a pre-existing condition, determining the employer’s liability involves assessing how much the work incident contributed to the overall impairment or incapacity.
When determining liability, several factors are considered:
- Contribution of the Work Incident: The extent to which the work-related incident has aggravated the pre-existing condition.
- Pre-existing Impairment: The level of impairment or incapacity caused by the pre-existing condition before the work-related incident.
- Overall Impairment: The degree to which the employee’s overall impairment or incapacity is due to the work-related incident versus the pre-existing condition.
Typically, a medical expert will evaluate the employee’s medical history and the circumstances of the work-related incident. They will create a detailed report demonstrating how the work incident exacerbated the pre-existing condition.
In some cases, the employer or the insurer may dispute the apportionment of liability. When disputes arise, the matter may be referred to a court or tribunal for a final determination.
How Pre-Existing Injuries Impact Compensation Payouts
Pre-existing injuries can significantly impact workers’ compensation payouts because of a more complex evaluation of the compensation payment an employee is entitled to receive. Several factors can influence how previous injuries affect compensation payouts:
- Employer’s Argument: Employers may argue that the pre-existing injury caused impairment or incapacity before the work-related incident, thus reducing the compensation owed.
- Insurer’s Argument: Insurers might claim that the pre-existing injury contributed to the overall impairment or incapacity, thereby limiting the employer’s liability for the total compensation amount.
- Court’s Apportionment: Courts may determine liability between the employer and the employee based on how much the work-related incident aggravated the pre-existing injury.
Reopening a Workers’ Compensation Claim
Sometimes, an employee may need to reopen a workers’ compensation claim if their condition has worsened or new symptoms have developed. To reopen a previous claim, the employee must provide new medical evidence demonstrating a significant change in their condition. This evidence may include:
- Medical Reports: Detailed reports from a treating doctor or specialist outlining the changes in the employee’s condition.
- Test Results: Updated test results, such as X-rays or MRI scans, that show the progression or worsening of the injury.
- Witness Statements: From colleagues or supervisors who can corroborate the employee’s account of the work-related event and its impact.
Furthermore, the employee must show that the worsening condition is linked to the original claim. Once the necessary evidence is gathered, the employee can file a request to reopen the claim with WorkCover.
Seek Legal Advice for Complex WorkCover Claims
A workers’ compensation claim that involves a pre-existing condition or injury can be particularly complex and challenging. So, claiming WorkCover can be fraught with pitfalls.
It helps if you keep detailed medical records of pre-existing and new injuries. This documentation supports your case by proving your eligibility. People with work injuries often think disclosing a pre-existing condition will automatically lead to a claim denial. However, the opposite is usually true because it can add credibility to your personal injury case.
Seeking legal advice can help you:
- Understand the complex aspects of your case
- Ensure you take the necessary steps to secure fair compensation for employer negligence.
Knowing your legal rights is free when employer negligence exacerbates a previous condition. Call Now: 1800 700 125
How WorkCover Disputes a Workers’ Compensation Claim
When assessing claims, the Queensland work injury insurer frequently challenges cases by arguing that the pre-existing condition is the primary cause of the injury (and not an exacerbation).
Another common defence is that the person’s employment did not contribute to the exacerbation of their condition to a significant degree. Instead, the employee’s medical condition would have developed to the same extent regardless of the tasks involved in their employment.
That’s why you need solid medical documentation linking work-related activity to worsening the condition. This evidence helps establish the extent of the employer’s responsibility and ensures that the injured worker receives appropriate compensation.
Common Misconceptions About Pre-Existing Conditions
There are several common misconceptions about pre-existing conditions and workers’ compensation claims. Many people mistakenly believe that pre-existing conditions are not covered under workers’ compensation claims. However, this is not true; aggravation of a pre-existing condition due to work-related activities can be eligible for workers’ compensation benefits.
Unfortunately, not recognising how workplace conditions can aggravate a pre-existing condition may lead to disputes over who is to blame for worsening an original injury or condition. For instance, verbal abuse at work may exacerbate an employee’s major depressive disorder, making them eligible for compensation.
Lawyers for Pre-Existing Injuries and Workers Compensation
When a pre-existing injury or condition worsens due to your employment, you might have significant medical expenses and lost wages. In this case, a workers’ compensation lawyer can advise on how to prove that your employment significantly contributed to problems with your health.
Furthermore, a work injury lawyer can help determine your eligibility to make a common law claim because of your employer’s negligence.
As always, an employee’s health is the priority, followed closely by knowing your legal rights. Contact Splatt Lawyers now for free advice. All our legal services are funded on a 100% no win, no fee basis. Pay when you win and zero if you lose. Call Now: 1800 700 125
WorkCover Claims with Pre-existing Condition FAQs
Why was my WorkCover aggravation of injury claim declined?
When the Queensland work injury insurer declines a WorkCover claim for an aggravation injury, it’s often because the workplace accident was not the primary cause of the condition.
How long after a work injury can you claim compensation?
In Queensland, you have six months to lodge a workers’ compensation claim for a work injury, regardless of whether it is a new personal injury or an aggravated medical condition.
What should I do if my pre-existing condition worsens due to work?
If a pre-existing condition worsens due to work, promptly report the incident to your employer and obtain medical documentation to support your claim. Doing this helps protect your legal rights.
How important is disclosing pre-existing conditions to my employer?
Disclosing pre-existing conditions to your employer is essential, as failing to do so may result in complications and potentially a denial of compensation.
Will disclosing a pre-existing condition automatically lead to a claim denial?
Disclosing a pre-existing condition will not automatically lead to a claim denial; in fact, being transparent can enhance your credibility and support your compensation claim.