When you've sustained a workplace injury, you might feel uncertain about filing a workers' compensation claim if you already have a pre-existing condition. Vermont's workers' compensation system offers protections for injured employees, but understanding how your claim may be impacted by a pre-existing condition is essential for maximizing benefits. This guide covers what you need to know about how Vermont's workers' compensation system evaluates pre-existing conditions and provides practical steps for building a strong case.

Understanding Pre-Existing Conditions in Workers' Compensation

A pre-existing condition is any injury, illness, or medical condition that you had before sustaining your work-related injury. Common examples of pre-existing conditions that could impact a workers' comp claim include:

• Previous back injuries or degenerative disc disease
• Arthritis
• Heart conditions
• Respiratory issues, such as asthma or COPD
• Carpal tunnel syndrome or other repetitive strain injuries

While a pre-existing condition does not automatically disqualify you from receiving workers' compensation benefits in Vermont, it can complicate the process. In some cases, insurers may argue that your current symptoms are due to the pre-existing condition rather than the workplace incident, potentially leading to a denied or reduced claim.

Vermont Workers' Compensation Laws and Pre-Existing Conditions

Under Vermont law, workers are entitled to compensation for injuries sustained on the job, regardless of prior health conditions. However, the claim process can be more complex when a pre-existing condition is involved.

Aggravation vs. Recurrence

Vermont workers' compensation law differentiates between an aggravation and a recurrence of a pre-existing condition. This distinction is critical in determining eligibility for benefits:

1. Aggravation: This occurs when a work-related injury exacerbates a pre-existing condition. For example, if an employee with arthritis sustains a back injury at work that worsens their arthritis symptoms, it may be classified as an aggravation. Aggravations are generally covered under workers' compensation.
2. Recurrence: If the symptoms stem from a natural progression of a pre-existing condition rather than a new work-related injury, it's considered a recurrence. In these cases, workers' compensation may not cover the condition, as it is not directly caused by a workplace incident.

The Vermont Department of Labor provides guidance on distinguishing aggravations from recurrences, with the burden of proof often on the employee to demonstrate that a workplace incident directly worsened their condition.

How Pre-Existing Conditions Can Impact Your Claim

Having a pre-existing condition can influence several aspects of your workers' comp claim, including:

• Eligibility for Benefits: If the insurance company deems your condition as a recurrence rather than an aggravation, you may be ineligible for benefits.
• Benefit Amounts: In cases where benefits are awarded, the amount may be adjusted if the pre-existing condition significantly contributes to your symptoms.
• Length of Benefits: Some employees may receive benefits for a shorter period if their recovery is impacted by a pre-existing condition.

Key Statistics on Pre-Existing Conditions and Workers' Comp

• According to the National Council on Compensation Insurance (NCCI), claims involving pre-existing conditions typically result in a 60% higher cost for insurers compared to cases without pre-existing conditions.
• A study by the Workers Compensation Research Institute (WCRI) found that approximately 10-15% of workers' compensation cases involve pre-existing conditions.

Steps to Strengthen Your Workers' Comp Claim in Vermont

If you have a pre-existing condition, here are some steps you can take to improve the strength of your claim:

1. Report the Injury Promptly: Timely reporting is essential. In Vermont, you are required to notify your employer as soon as possible, ideally within 72 hours. Failure to report promptly may lead to claim denial.
2. Provide Detailed Medical Documentation: Medical records play a crucial role in substantiating that a workplace injury aggravated your condition. Collect documents from all relevant healthcare providers, including:
   • Medical reports showing the state of your condition before the incident
   • Recent test results (X-rays, MRIs, etc.) that demonstrate the change in condition post-incident
   • Statements from medical professionals indicating that the workplace injury caused or worsened your symptoms
3. Seek a Second Medical Opinion: Workers' compensation insurers may require you to see a physician of their choosing. Consider obtaining a second opinion from an independent medical provider who can objectively assess whether your workplace injury aggravated your pre-existing condition.
4. Be Consistent in Your Statements: Inconsistencies between what you report to healthcare providers and insurance adjusters can weaken your claim. Ensure that you provide accurate and consistent information about your condition, symptoms, and how the workplace injury affected you.
5. Hire an Experienced Workers' Compensation Attorney: Navigating Vermont's workers' compensation process with a pre-existing condition can be challenging. An attorney specializing in workers' comp claims can help gather necessary documentation, communicate with insurers, and strengthen your case.

How Insurers May Respond to Claims Involving Pre-Existing Conditions

Insurance companies frequently challenge claims involving pre-existing conditions to reduce or deny benefits. Common tactics used by insurers include:

• Requesting Independent Medical Examinations (IMEs): Insurers may request that you undergo an IME with a doctor they select. The purpose of an IME is to assess whether your current symptoms are related to your pre-existing condition rather than the work injury.
• Requiring Extensive Documentation: Insurers may ask for comprehensive medical records to identify any prior history of the condition. Missing or incomplete records can give insurers grounds to dispute your claim.
• Claiming the Injury Was Inevitable: If the insurer argues that your pre-existing condition made your injury inevitable regardless of the workplace incident, they may attempt to deny the claim.

Insights for Managing Insurer Tactics

• Prepare for an IME: If an IME is required, review your medical records and be ready to describe how the injury affected your condition. Be honest but concise in your responses.
• Keep Detailed Personal Records: Record any symptoms you experience daily and how they impact your ability to work. These records can be valuable if an insurer challenges your claim.
• Stay Proactive with Medical Appointments: Regular check-ups with your healthcare provider can help demonstrate a clear timeline of your condition's progression post-injury.

Conclusion

While a pre-existing condition can complicate your Vermont workers' compensation claim, it does not disqualify you from receiving benefits. Understanding the distinction between an aggravation and recurrence is essential for building a strong case. By taking proactive steps, such as gathering detailed medical documentation, seeking consistent medical care, and consulting an attorney, you can enhance your claim's chances of success.

If your workers' comp claim is initially denied due to a pre-existing condition, don't hesitate to seek legal assistance. 

Need Legal Help? Brandon J. Broderick, Attorney at Law is One Phone Call Away

Navigating Vermont Workers’ Compensation claims can be challenging. Fortunately, you don't need to do it alone. The experienced lawyers at Brandon J. Broderick, Attorney at Law, are available 24/7 to help you understand your legal options, gather necessary evidence, and build a strong case to secure the settlement you deserve.

Contact us now for a free legal review.