Resourceful. Experienced. Contact Attorney Simon
Businessman Sitting at Table and Giving Paper Sheet to Worker with Broken Arm

How Pre-Existing Conditions Affect a Workers’ Comp Claim

Mark A. Simon, Attorney at Law May 9, 2023

Roughly 87% of Colorado’s civilian workforce is covered by workers’ compensation insurance. On average, more than 21,000 work-related injury claims are filed every year. Now, consider the fact that 20% of adults in the United States ages 18-24 have a diagnosed significant pre-existing health condition. That percentage rises to 50% by age 55.  

What this data mean is that thousands of people are injured on the job in Colorado every year, and there is a significant likelihood that many of them will suffer from a diagnosed pre-existing injury before their work injury. That gives workers’ compensation insurers thousands of reasons to deny claims.  

At Mark A. Simon, Attorney at Law, our workers’ compensation attorney represents injured employees in Denver, Arvada, Aurora, Centennial, Englewood, Lakewood, Commerce City, Wheatridge, or Thornton, Colorado. We can help you claim the benefits you deserve. Pre-existing injury or not, we will use every tool at our disposal to help you win your case.  

Which Employees Are Covered Under Workers’ Comp? 

Worker’s compensation is a no-fault insurance program mandated by the State of Colorado and designed to provide medical and wage benefits to employees if they are injured or killed in the course and scope of their employment. Colorado requires every employer of one or more people to carry workers’ compensation insurance. Covered employees include the following: those working full- or part-time; their family members; and, in Colorado, even undocumented workers.  

Workers’ compensation exclusions include independent contractors, casual workers earning less than $2,000 a year, realtors whose compensation is based solely on commissions, and companies that lease vehicles to others, such as a truck-leasing company, and certain domestic workers who work less than 40 hours and five days per week.  

Any employee injured while on the clock is entitled to seek medical care, must notify their employer of their injury or illness, and file a claim with the Colorado Division of Workers’ Compensation. What benefits are available through workers’ comp include:  

  • the cost of medical treatment related to the injury or illness,  

  • temporary or permanent disability pay,  

  • time off work for medical treatment, medical case management, and  

  • the cost of an independent medical examination.   

What Injuries Are Covered Under Workers’ Comp? 

Any injury or illness suffered while in the scope of your employment or as a result of your job can be covered under workers’ comp benefits. For example, if you are required to operate a motor vehicle for your job and you get injured in an auto accident, you can file a workers’ compensation claim. However, if you’re injured while driving to work to begin your job, that injury does not qualify for workers’ comp benefits. But in that case, you may be eligible to seek compensation through a personal injury or car accident claim

It's also important to note that not all injuries or illnesses happen right away. Some of them occur over time, such as repetitive motion injuries like carpal tunnel syndrome or lung damage due to consistent inhalation of toxins. These qualify for workers’ comp benefits as long as you can prove that they were caused by workplace conditions.  

What Qualifies as a Pre-Existing Condition? 

Any illness or condition you have been diagnosed with prior to a work-related injury or illness is considered to be a pre-existing condition. The diagnosis must be in your medical records. In other words, just because you have had back pain before or sprained your ankle as a child but didn’t see a doctor, those do not qualify as pre-existing conditions.  

Pre-existing conditions must also be relevant to the work injury. For example, a previously diagnosed bulging lumbar disc is unrelated to a head injury you suffered when an object struck you in the head at work.  

How Might a Pre-Existing Condition Affect My Workers’ Compensation Claim? 

The effect of a pre-existing condition on workers’ compensation claims will vary. At worst, the work comp insurer will use it to deny your claim, asserting the injury was not work-related. At best, it may lower the amount of compensation you receive under the program.  

A case for compensation can be made if there is evidence you re-injured or aggravated a pre-existing condition as the direct result of your work. It can be quite complicated to distinguish how much of an injury is related to current employment and how much is related to the pre-existing condition. Your employer, and their insurer, is only responsible for the aggravation or re-injury.  

For example, let’s say your doctor previously diagnosed a bulging disc in your lumbar spine. The condition causes you pain from time to time, but not enough to undergo a microdiscectomy. Instead, your orthopedic specialist administers periodic steroid injections to relieve pain. However, one day at work, you lift a heavy box and experience searing low-back pain that becomes constant. You get diagnosed with a herniated disc which presses on the surrounding nerves. Surgery is the only way to stop the pain.  

In this example, your injury would qualify for workers’ compensation because you would not have needed surgical intervention had it not been for lifting the box at work.  

Can I Appeal a Denial of My Workers’ Comp Claim? 

Colorado’s program includes a process for appealing a workers’ comp decision, including denials and compensation at lower rates based on the premise of a pre-existing injury.  

The process can be complex, especially because it will involve the opinions of medical professionals. The process may also take a long time, during which you receive no compensation. If you are unable to work for any period, denial for compensation can cause significant financial hardship.  

Will Hiring an Attorney Help? 

Workers’ comp claims are often challenging even under the best of circumstances. Workers’ comp insurance companies will do whatever they can to not pay claims. Employers also don’t want their insurance rates to go up. But don’t let these obstacles stop you from securing the financial support you deserve.  

If you have a pre-existing condition when injured on the job, you should retain the services of an experienced workers’ compensation attorney. Your attorney will have access to medical experts and will know how to use expert opinions to increase the compensation you receive. Your attorney fully understands the workers’ compensation claims process and will use that knowledge to pursue the best results possible for you.  

Don’t Hesitate to Ask for Help 

Technically, Colorado’s workers’ compensation program is designed for injured employees to navigate on their own. In some cases involving extremely minor injuries that heal rapidly, representing oneself may be fine. However, moderate injuries and those involving pre-existing conditions move to a much higher level. Don’t be afraid to ask Mark A. Simon, Attorney at Law, for help.  

If you have been injured on the job in Denver, Colorado, or the surrounding area, call us now to schedule a free case consultation. We welcome the challenge.