Can I Get South Carolina Workers’ Comp for a Pre-Existing Condition?
A guide to help you understand your right to
workers’ comp benefits when a work injury makes
your pre-existing condition worse
If you’ve been hurt on the job in South Carolina and have a history of medical issues, you might be worried about your eligibility for workers’ compensation benefits. While this is understandable, a pre-existing condition doesn’t have to stand in the way of getting the help you need after a workplace injury.
The path to recovery after any work injury can be filled with uncertainty, and the added layer of a pre-existing condition can make it even more challenging, but we’re here to help make the process easier. This guide is intended to help you understand your rights, navigate potential obstacles, and recover the compensation you deserve.
Whether your injury aggravated an existing condition or triggered a new one, we’re here to empower you with the knowledge you need for a successful workers’ comp claim.
If you have individual questions or want personalized advice, reach out to our experienced Columbia work injury attorneys to schedule a free consultation.
What is considered a pre-existing condition?
A pre-existing condition is any medical condition or injury that existed before a worker sustains a new injury on the job. These conditions can be chronic or long-term health issues that the worker had prior to the work-related incident.
In the context of a workers’ compensation claim, these conditions can impact the evaluation and outcome of the claim, especially if the new injury aggravates or exacerbates the pre-existing condition.
Common examples of pre-existing conditions in a workers’ comp claim include:
- Degenerative conditions. These are conditions you had before employment that worsen over time, such as arthritis, degenerative disc disease, or osteoporosis.
- Previous injuries. These can include old injuries, like sprains, strains, or fractures, that may not have fully healed or are prone to recurring problems.
- Chronic illnesses. These include conditions like diabetes, heart disease, asthma, or high blood pressure, which are usually linked to genetics or lifestyle.
- Congenital conditions. These are medical conditions present at birth, such as scoliosis or a heart defect.
Understanding how pre-existing conditions can interact with or aggravate new work-related injuries is crucial for navigating a workers’ compensation claim.
What is aggravation of a pre-existing condition?
Aggravation of a pre-existing condition occurs when a new injury or work-related activity worsens or intensifies an existing medical issue. In the context of workers’ compensation, this means that the worker’s pre-existing condition has become more severe due to a work incident or repetitive job duties.
For example, if an employee with a history of back pain sustains a new spinal cord injury while lifting heavy objects at work, and this results in increased pain or disability, it’s considered an aggravation of the pre-existing condition.
Can I get workers’ comp if I have a pre-existing condition?
Yes, workers’ compensation may cover pre-existing conditions, provided it can be demonstrated that the work activities directly contributed to the worsening of the condition.
According to Section 42-9-35 of the South Carolina Code of Laws, injured workers are entitled to workers’ comp benefits for a pre-existing condition as long as they can prove that:
- The new injury made the pre-existing condition or impairment worse; or
- The pre-existing condition or impairment made the new injury worse.
Essentially, this means that you may be eligible for workers’ compensation benefits if your work-related duties or injury either worsened your pre-existing condition or if your pre-existing condition made your new work injury more severe.
Understanding the Types of
Workers’ Compensation Benefits
Learn about the different types of benefits you’re entitled to under workers’ comp so you can estimate how much your claim is worth.
How can a pre-existing injury affect compensation for new injuries?
While South Carolina workers’ compensation law allows for benefits if a workplace injury aggravates a pre-existing condition, it’s important to acknowledge that the process of obtaining those benefits can be more complex and challenging than for a new injury.
Here are some of the ways a pre-existing injury can affect compensation:
- Increased scrutiny. Insurance companies are likely to scrutinize claims involving pre-existing conditions more closely. They may try to argue that the current disability or need for medical treatment is solely due to the pre-existing condition rather than the workplace injury.
- Causation challenges. Proving that the workplace injury directly aggravated or worsened the pre-existing condition can be difficult. The burden of proof rests on the injured worker to provide medical evidence demonstrating a causal link.
- Apportionment of benefits. If the insurance company accepts that the workplace injury aggravated the pre-existing condition, they may seek to apportion benefits. This means they might only offer to cover the portion of your disability or medical expenses that are directly attributable to the work-related aggravation, rather than the full extent of your current condition.
- Delayed benefits. The increased scrutiny and potential disputes over causation can lead to delays in receiving benefits as the insurance company investigates and challenges your claim.
Due to the increased challenges associated with these types of claims, it’s highly recommended that you discuss your case with an experienced workers’ compensation attorney before filing a claim, as they can help gather necessary evidence, connect you with medical experts, and advocate on your behalf to ensure you receive the benefits you deserve.
Dealing with Workers’ Compensation Claim Denials
Learn the most common reasons for a denied claim and the steps to take to appeal in SC.
Top tips for navigating a workers’ comp claim when you have a pre-existing condition
While the path to obtaining compensation may be more challenging with a pre-existing condition, it’s definitely not impossible. With the right strategy and support, you can successfully navigate the system and secure the benefits you deserve.
Here are some tips for a successful workers’ comp claim when you have a pre-existing condition:
- Report the injury immediately. Inform your employer about your injury as soon as it happens, even if you think it’s minor or related to a pre-existing condition. Delaying reporting can raise suspicions and weaken your claim.
- Seek medical attention promptly. See a doctor as soon as possible and provide a complete medical history, including your pre-existing condition. Make sure the doctor documents the connection between your work injury and the aggravation of your pre-existing condition.
- Be thorough and honest. When describing your injury and symptoms, be as detailed and honest as possible. Never downplay your pain or discomfort, but don’t exaggerate your symptoms either.
- Don’t hide your pre-existing condition. It’s important to be upfront about any pre-existing conditions. Trying to hide them can hurt your credibility and jeopardize your claim.
- Keep detailed records. Keep a record of all medical appointments, treatments, medications, and any time missed from work due to your injury. This documentation will be crucial evidence for your claim.
- Follow medical advice. Follow your doctor’s treatment plan and attend all recommended appointments. Non-compliance can be used against you by the insurance company.
- Don’t give recorded statements. Never give a recorded statement to the insurance company without first consulting an attorney. These statements can be used against you later.
- Don’t sign anything without legal advice. Don’t sign any documents from the insurance company, such as settlement agreements, without first reviewing them with an attorney to make sure they’re in your best interest.
- Consult a workers’ compensation attorney. An attorney specializing in workers’ compensation can help you navigate the complexities of your claim, gather evidence, and negotiate with the insurance company. They can also protect your rights and ensure you receive fair compensation.
By following these tips and working closely with a knowledgeable attorney, you can improve your chances of successfully filing a workers’ comp claim involving a pre-existing injury and securing the benefits you deserve.
Was your SC workers’ comp claim denied because of a pre-existing condition? We can help!
We understand the frustration and stress that come with a denied workers’ compensation claim, especially when a pre-existing condition is involved. If your claim was denied in South Carolina due to a pre-existing condition, don’t lose hope.
At Smith, Born, Leventis, Taylor & Vega, our knowledgeable Columbia workers’ compensation attorneys are here to help. We have a proven track record of successfully appealing denied claims and securing the compensation our clients deserve. We’ll connect you with medical experts and help you gather the necessary evidence to prove your workplace injury aggravated your pre-existing condition and entitles you to benefits.
