If you’ve been through the Workers’ Compensation process, you know it’s anything but perfect. One of the biggest issues facing the Workers’ Compensation industry is injured workers that have pre-existing conditions. This has become a complex situation for injured workers, employers and insurance companies. If you were injured in 2001 and had left knee surgery, then re-injured your left knee in 2017, the newer injury should be considered a completely separate event. Being honest about pre-existing conditions or injuries is the right thing to do. Any other approach can cause serious problems later. However, that should not be a reason to deny your claim. Many insurance carriers will try to fight these cases or at least apportion the case. This should not deter injured workers from filing claims when they reinjure a previously injured body part.
*Apportionment can be good for the employers of injured workers. This means they will not be liable for the full extent of the injured worker’s injury and costs associated with the injury. If an *Occupational Disease claim is filed for hearing loss due to working with loud machinery, or for Carpel Tunnel Syndrome after years of computer work, these cases will likely be apportioned. This should not have an impact on the claimant, but can have a dramatic consequence for their employers. Apportionment cases ultimately help lower the cost bearing for the injured workers most previous employer, potentially saving them thousands in Workers’ Compensation premiums.
Apportionment cases can be very hard for insurance companies. First they must find out the claimant had a previous accident or condition which may impact their current injury/condition. Once the insurance carriers learn of a pre-existing condition they must secure a HIPAA Release from the injured worker and request their medical records. This can be a lengthy legal battle for insurance carriers as many medical facilities will not easily release medical records, even when a HIPAA Authorization has been secured.
Overall, pre-existing conditions can have major impacts on various aspects of a Workers’ Compensation claim and all parties involved.
* Apportionment – Spreads the claims costs among multiple injuries and/or claims.
* Occupational Disease (OD) – Any chronic ailment that occurs because of work or occupational activities.