Do Workers Compensation Benefits Cover Preexisting Conditions?

Recent reports indicate that as many as half of Americans younger than 65 suffer from a preexisting condition that insurance companies cite to either deny or limit health benefits. Indeed, some workers compensation carriers have a pattern of denying claims on the ground that the injured worker suffers a preexisting problem. Injured workers should not accept such denials. While prior health conditions can complicate your claim for benefits, they do not necessarily prevent coverage.

A workers compensation preexisting injury is different

The meaning of “preexisting” under New Jersey workers compensation law is quite different than in other insurance contexts. Typically, preexisting means something that existed before the event at issue. For example, if you suffered back pain prior to a work-related accident in which you injured your back, then your medical insurance might preclude you from receiving full medical benefits. For purposes of a workers compensation claim, however, preexisting conditions are those in which a new work injury aggravates a prior work injury involving the same body part or parts.

Preexisting work injury condition aggravated by the current injury

If your new injury aggravates an injury from a previous work place accident, then your benefits can be reduced slightly to account for the prior claim. Your employer should pay for your medical treatment related to this new work-related injury and for temporary disability benefits if you are unable to work.

Preexisting condition unrelated to prior work injury

Some preexisting conditions stem from people’s natural aging processes or a prior injury unrelated to work. If your current work injury aggravates a non-job-related preexisting condition, workers compensation may still cover you to the extent that your worsened condition can be attributed to the new work-related injury.

Preexisting condition unaffected by current work injury

If your current work injury does not affect your preexisting condition, then it should have little or no impact on your claim for benefits. Your private insurance should continue coverage for your treatment of your preexisting condition, and your employer should cover your medical bills related to your work injury.

A New Jersey workers compensation attorney can help you determine whether you should complete a claim for an aggravated condition or a new workers compensation claim.


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