An injured worker is eligible for workers’ compensation benefits if the on-the-job injury is an aggravation of a prior injury or condition (both are called pre-existing conditions).
A worker is not eligible for workers’ comp benefits if the only injury is the pre-existing one; he must have sustained a new injury.
Pre-existing injuries can include herniated disks, broken bones, torn ligaments, and other relatively obvious injuries. Other conditions may be more closely related to general physical health, such as age-related spine degeneration or arthritis.
It’s not uncommon for an insurance company to wrongfully deny a legitimate claim because of a pre-existing medical condition. Many times, an injured worker simply gives up on the claim; however, insurance companies cannot immediately deny an on-the-job injury claim based solely on a pre-existing condition.
Workers’ compensation laws were enacted to make the employer-worker injury claim process less adversarial. Over time, insurance companies responsible for compensating injured workers became huge corporations with stockholders to answer to, profit margins to meet, and executive salaries to pay. As a result, the once non-adversarial system has become more adversarial than ever.
Insurance companies look for any means to deny your injury claim. The insurance adjuster assigned to your claim will thoroughly investigate your medical background and look for any evidence of falsehoods concerning pre-existing conditions.
Trying to be greedy in a claim ultimately backfires. It’s better to tell the truth. If questions on the doctor’s admitting form ask if you have any pre-existing medical conditions, you must answer truthfully. If the medical staff or doctors ask you, you must be honest with them. Failing to disclose a pre-existing condition can be grounds for denial of your claim.
Be clear when discussing your current pain and discomfort with the doctors that it’s very different from any residual pain and discomfort you may have from a pre-existing injury. Let them know you did not have symptoms before your current injury. If you tell the doctors your current symptoms are no different than those you’ve been experiencing since your previous injury, your claim will likely be denied.
Giving detailed information during your medical exams is very important. Clearly explain that you weren’t having pain or discomfort from a prior injury when your new injury occurred. Describe any changes in the type of pain you’re feeling, including its frequency, intensity and duration. Tell the doctor how the new injury is affecting your daily activities in a way it hasn’t since your prior injury.
Most important don’t give up. Get a workers’ compensation lawyer with experience to help you.
Call today for a free consultation and explore your options - (910) 341-3202
Our attorneys specialize in workman's comp, personal injury, and dispute resolution services.
Prior, Criner & Edwards Law, PLCC. have a long history of building long-term client relationships founded on trust and mutual respect.
With over 25 years of experience in civil litigation and thousands of cases mediated, Frank specializes in the fields of workers compensation and personal injury law.
Sherman is Licensed to Practice Law in North and South Carolina. He has extensive education in law and the mediation practice, professional experience and impressive memberships in many noteworthy political, civic and business organizations.
Ashley M. Edwards
Ashley is a NC attorney and certified mediator in North and South Carolina, Ashley has represented hundreds of clients and mediated thousands of cases for attorneys, insurance carriers and private companies.
“These guys are awesome and care about their clients very much. I would suggest anyone hurt on the job to contact them. Cannot express my appreciation enough to them!"
“Ashley Edwards genuinely cares about his clients and holds himself to the highest standards in all of his professional interactions. I am happy to recommend him to anyone who needs help navigating the workers compensation process."
“Ashley has been practicing compensation law in the greater Wilmington area for 15+ years. I have often turned to him for advice and counsel. He knows the law, is trustworthy, listens to his clients, and fights to do the right thing for them. He is my first call!"
“Mr Edwards made my case feel like it was his most important case. He is so caring and attentive."
“This was the first and only law firm I contacted after being injured. Everyone there has been on point concerning my case and extremely professional. I highly recommend contacting workers comp first if injured. It will be as if it's the most important case they have and they will not disappoint. Thank you to the entire team."
“Wonderful Experience under difficult circumstances. They helped me understand my rights and options under the law. Mr. Edwards took the time to help and meet with me whenever I had questions. He is highly recommended for his expert advice and service. "
“This is the place to go if you get hurt on the job Ashley and his paralegal Janet are really nice and super easy to talk to and they take the time to really listen to your problems and get you the help you need and deserve."
“They came out took out time to listen very smart he knows what he's talking about he heard me out and took my case under difficult sircumstances and i highly advise this is the law firm to consider."
“Sherman is one of the best mediators that I know---he is extremely proficient in Workers' Compensation Law and he is an outstanding communicator. I give Sherman my highest rating!"
“Great Experience with a caring lawyer who took the time to actually meet with me. He handled my case to the end and explained everything. Highly recommended."
“Ashley is very knowledgeable and relatable to his clients, to opposing counsel, and to all parties when acting as mediator. "
“Ashley didn't always tell me what I wanted to hear but he always told me the truth. He is very knowledgeable and professional... I would highly recommend Ashley if you feel the need to hire an attorney. "
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