We hear a lot about preexisting conditions in the news. We hear debate about whether health insurance has to cover them.
But, what about Georgia workers compensation insurance? Does it cover preexisting conditions?
What is a preexisting condition?
Basically, it is a medical condition that you already had. It could be diabetes, high blood pressure, a bad back, or any number of things. The preexisting part looks at the timing of when you developed the medical condition.
If you had diabetes before your injury at work, it is a preexisting condition from a workers compensation standpoint. If you developed diabetes after your work injury, it is not a preexisting condition.
Often, preexisting conditions in workers compensation claims focus on the parts of the bodies where work injuries most commonly occur such as:
- Back
- Neck
- Shoulder
- Knee
- Elbow
- Ankle
But, any medical condition in any part of your body can be preexisting. It just depends on whether the condition existed before your workers compensation injury.
What if I did not know I had the preexisting condition?
Sometimes you know about the preexisting condition. You may have received medical treatment for the condition in the past.
Other times, you do not know about the preexisting condition. You find out about the condition after your injury.
This often happens after diagnostic testing like an MRI or x-ray. Your doctor may tell you that you have arthritis or some other degenerative condition. If the condition was “asymptomatic” before your injury, you probably will not even know you had it.
The preexisting condition receives the same treatment under the workers compensation law whether you knew about it or not. However, if you did not know you had it and have not received any treatment for it, the insurance company may have more difficulty proving that the condition was “preexisting” .
Does Georgia workers’ compensation law cover preexisting conditions?
Technically, Georgia law does not cover the preexisting condition itself. However, it does cover aggravations of preexisting conditions.
What does that mean? An aggravation of a preexisting condition covers when you have an injury that makes a preexisting condition worse.
Suppose you had a preexisting back condition. Maybe it causes you problems. Maybe it does not.
Then, you suffer an injury an injury at work to your back. Your injury at work makes the back condition worse. Georgia law covers that “aggravation of your preexisting condition”
What’s the difference between covering the aggravation and covering the preexisting condition itself?
What’s the difference between covering the aggravation and covering the preexisting condition itself?It comes down to what the insurance company has to pay. They have to pay workers compensation benefits due to the aggravation of the condition. In other words, they are responsible for the worsening caused by the injury at work.
So, suppose you did not need any medical treatment for your back condition before your injury. If your back injury at work causes you to need medical treatment, the workers compensation insurance company should pay for that treatment.
The same rationale applies if you have to miss work because of the work injury. If the work injury causes your inability to work, the insurance company should have to pay you temporary total disability benefits
The big difference between covering the preexisting condition itself and covering the aggravation is that the insurance company can get off the hook if they can prove that your aggravation resolved. How does the insurance company try to do that?
They will try to show that your medical condition returned to “baseline”. If you had a preexisting condition, the insurance company will try to prove that your work injury was just temporary and that you have returned to the same place you were before you got hurt.
If they successfully prove this, they may show that your aggravation injury has resolved and your case may end. However, the insurance company often has difficulty proving your aggravation injury has resolved. It usually will come down to a question of what your workers compensation doctor says.
