At its most basic, workers compensation is designed to cover injuries an employee may sustain on the job. This means that any injuries or conditions an employee may suffer off the clock or away from work will not be covered. However, this doesn’t mean that all pre-existing conditions are excluded. It simply means that workplace injuries caused by pre-existing conditions will not be covered.
What Qualifies as a Pre-Existing Conditions?
Pre-existing conditions can be a number of injuries, illnesses or other injuries that occur before you are covered under an employer’s workers compensation policy. Most pre-existing conditions refer to old injuries such as a back injury or knee injury the individual has suffered for an extended period of time. To know if you have any pre-existing conditions, it is important to know whether you have a pre-existing condition so that you are prepared for a workers compensation claim possibly being denied.
If one of your injuries is not related to a pre-existing condition but still occurs in the course of your work, you may be covered under workers compensation.
Examples of pre-existing conditions include:
- Sleep apnea
For example, say an employee has a seizure at work and hits their head after seeing flashing lights. They are rushed to the hospital for a concussion. Because the injury was related to the pre-existing epilepsy, a workers compensation claim may not be approved.
Exclusions and Exceptions
There are certain exclusions under this rule, however. For example, if you can prove that a work-related injury has made a pre-existing condition worse instead of vice versa, you may receive workers compensation. This is tricky to prove, however. You must be able to show that your injury directly relates to your job. For example, say you develop worsening carpal tunnel during your job, which requires continues repetitive movement of your hands and fingers. In some policies, this may be covered.
On the other hand, say you have carpal tunnel and accidentally break your wrist after a fall at work. While the broken wrist should be covered under workers compensation, any bills related to your carpal tunnel would not be covered, as this would be a pre-existing condition unrelated to the workplace injury.
It is important to ask your employer (or potential employers) about their workers compensation policy. Not all of these are created equally, and you may want a larger scope of coverage than offered.