Has Your Claim Been Denied Based on a Preexisting Disability?

With a few workers’ compensation carriers, the pattern of simply denying most claims on the basis of a “preexisting” problem must be habit.  It’s as if these carriers had a form letter where nothing changes but the dates and names.  I am convinced that these carriers simply take most of their claims and either ignore them indefinitely asserting they are under “investigation” or simply deny them outright on some general claim that the condition was “preexisting.”  Unfortunately, I am afraid that many severely injured workers accept the excuse given by these carriers.  Some of these workers never get the medical care they need and never return fully to work.  Others may get the care.  However, someone else (like us as taxpayers) picks up the tab that should have been paid by the insurance carrier.

Before I go too far, I’m not bashing all workers’ compensation carriers.  I am impressed with adjustors who respond quickly with necessary medical care to help the injured worker.  The pattern of taking most claims and simply ignoring them is one followed by the same few carriers rather than an industry-wide practice.

Don’t just accept a denial of your claim by a carrier asserting that you have a “preexisting” condition.  The meaning of this term under Alabama’s Workers’ Compensation Act is very different than what you might think.  The term “preexisting” typically means something that existed before the event at issue.  Under the normal definition, if you hurt your back in an accident, but had suffered prior back problems, then you would have a preexisting back condition.  Indeed, a recent government report indicates that 129 million Americans have a preexisting health condition as the term is typically defined.

However, the term has a very different meaning under our workers’ compensation laws.  Let’s again think about the person who hurts their back at work but may have experienced some back problems prior to the work-related injury.  Under Alabama’s workers’ compensation laws, the prior back problems are not considered a preexisting problem that would prevent the worker from obtaining benefits if the worker was able to perform fully his job at the time of his injury.  The issue is not whether you suffered a prior medical problem, but rather, whether you suffered problems performing your job at the time of injury.  This is what Alabama’s courts have to say about the issue of preexisting conditions impacting a claim for workers’ compensation benefits:

the law presumes that there is no preexisting injury or infirmity when the employee is able to fully perform his or her job duties in a normal manner prior to the subject injury.

This means that workers’ compensation benefits are not limited to only those people in perfect health prior to their injuries.  It means that the focus of workers’ compensation benefits is, and should be, on a person’s ability to work and how an injury impacts that ability.  If a prior condition did not keep you from performing fully your job, then you should receive full benefits for any current injury.  However, even if you had a prior condition that kept you from performing your job fully when injured, you may still be entitled to some benefits for any increased disability.

In my practice, I see client after client who deserves better than a form letter simply denying their claim because they had some physical problem in the past.  Each time I see one of these clients, I am reminded of a man who contacted me a number of years ago after suffering a severe back injury at work.  He received one of those standard denial letters.  In truth, he had suffered some back issues from time to time prior to his work injury.  What sticks with me about that case is seeing the defense counsel try to explain at trial how my client suffered a preexisting back condition when his wage records showed that he routinely worked not just the normal 40 hours a week but often 60 to 70 hours a week doing heavy manual labor for the employer.

If you are hurt on the job in Alabama, it is important to remember a couple things:

  1. Legally, you do NOT have a preexisting condition if you were fully able to perform your particular job at the time of your injury.
  2. In Alabama, workers’ compensation benefits are NOT limited to those in perfect health prior to their injury.
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