Does Workers’ Compensation Cover Pre-Existing Conditions in Washington?

Workers' compensation in Washington State generally covers pre-existing conditions when they are aggravated or worsened by a workplace injury.

The Department of Labor and Industries (L&I) must consider both new injuries and the aggravation of pre-existing conditions when evaluating claims. However, the process can be complex and often requires careful documentation.

What Is a Pre-Existing Condition?

A workers’ compensation pre-existing condition is any medical condition you had before a workplace injury or occupational disease.

These can include:

• Congenital conditions present since birth.
• Previous injuries from accidents outside of work.
• Age-related conditions and degenerative issues.
• Chronic medical conditions diagnosed before the work injury.

What Are Common Pre-Existing Conditions?

Common pre-existing conditions that may affect workers' compensation claims include:

Workers' Compensation and Pre-Existing Conditions: How Are They Interrelated in Washington State?

Washington State law provides important protections for injured workers with pre-existing conditions. WAC 296-27-01103 allows employees to file workers' compensation claims for worsening a pre-existing condition if that aggravation happens on the job.

When evaluating your claim, L&I must consider your complete medical situation, including pre-existing conditions. If your workplace injury combines with pre-existing conditions to cause disability, L&I must consider these combined effects when determining your benefits.

This applies to both:

• Symptomatic conditions (those causing symptoms before the work injury).
• Asymptomatic conditions (those without symptoms before the work injury).

Pre-Existing Condition and Workers' Compensation: Who Is Eligible?

In Washington State, the extent of coverage often depends on the relationship between a person's current injury and their pre-existing condition.

If your pre-existing condition came from a previous work injury for which you already receive workers' compensation, you may qualify for additional benefits under a new claim. However, you can still receive benefits even if your pre-existing condition wasn't work-related — the key factor is proving that your current workplace incident made the condition worse.

Here are some typical scenarios:

• A warehouse worker with an old sports-related back injury experiences increased pain and limited mobility after lifting heavy boxes at work.
• An office employee with arthritis finds their condition significantly worsens after a slip-and-fall accident at work.
• A construction worker with pre-existing asthma develops more severe symptoms after exposure to workplace dust and chemicals.

When your pre-existing condition isn't work-related, L&I typically covers only the portion of disability or treatment needed for the new work-related aggravation. For example, if you had mild back pain before, but it became severe after a workplace incident, L&I would cover treatment for the increased severity, not the underlying condition.

To receive benefits, you'll need to demonstrate through expert medical evidence and testimony how the workplace incident worsened your condition. Medical documentation comparing your condition before and after the work injury is essential for establishing your claim.

Our knowledgeable worker’s compensation attorneys have recovered millions of dollars of comp benefits for injured Washington workers. We have successfully handled just about every type of comp injury and fought against all of the state's workers’ comp insurance companies. When average legal representation isn’t going to be enough, call us!

Documenting and Disclosing Pre-Existing Conditions

Honest disclosure and thorough documentation of pre-existing conditions are essential for a successful L&I claim. Hiding or downplaying these conditions can lead to claim denial and damage your credibility.

Here's how to properly document and disclose:

• Medical provider communication: Be upfront with your doctor about all pre-existing conditions, detailing symptoms before and after the injury, providing a complete medical history, and sharing prior treatment records.
• Personal documentation: Maintain a symptom diary noting pain levels and limitations, tracking pre- and post-injury differences, documenting impacts on daily life, and noting medication/treatment changes.
• Supporting evidence: Gather statements from family and coworkers who observe changes or witness the injury. Keep all medical records, including pre-injury records and therapy/treatment notes.
• Timeline documentation: Record symptom onset/worsening, new limitations, and job duty changes, and track appointments/treatment responses.

This documentation serves your medical providers and your L&I claim, demonstrating the work injury's impact on your pre-existing condition.

IMEs and Pre-Existing Conditions in Washington Workers' Comp Claims

Independent Medical Examinations (IMEs) are a common part of the L&I claims process. IME reports often conclude that the workplace incident neither caused nor worsened pre-existing conditions.

When this occurs, it's crucial to present L&I with an opposing medical opinion. Ideally, your attending physician (AP) will be a strong advocate for your case, reviewing the IME report and potentially submitting their own disagreement with its findings.

However, not all claimants have supportive attending providers. If you find yourself in this situation, consulting with our skilled workers' compensation attorneys is highly recommended. We can provide valuable assistance in navigating this challenging aspect of the L&I process.

How to File a Pre-Existing Injury Claim in Washington

A pre-existing condition doesn't mean you can't receive workers' compensation benefits. Here are key strategies to strengthen your claim:

1. Get a Medical Assessment

One of your workers' comp rights is to receive medical treatment from the doctor you choose. If they have expertise in your pre-existing condition, their assessment of how the workplace injury affects it can be extremely valuable in showing the accident's impact on your current symptoms.

2. File Your Claim Promptly

Ask your medical provider to file your L&I claim application. This allows for your application to be accompanied by the necessary medical evidence supportive to your claim.

3. Secure Legal Counsel to Maximize Your Chances

If your claim is denied, partnering with a seasoned workers' compensation attorney significantly boosts your chances of success and securing benefits.

4. Gather Your Medical Records

It's crucial to gather all your medical records, including those related to your pre-existing condition. This documentation provides essential context, helping to establish that your current injury resulted from the accident, not just your pre-existing condition.

5. Be Honest and Transparent

Honesty is paramount throughout the entire claims process. Any exaggeration of symptoms or withholding relevant information will severely damage your credibility and could ruin your claim.

Don’t Take On This Fight Alone. Let Our Decades of Experience Work for You.

At Lehmbecker Law, we understand the challenges of pursuing workers' compensation claims involving pre-existing conditions and have successfully handled hundreds of these cases. Our skilled Seattle workers' compensation attorneys can help protect your rights and maximize your benefits. Contact us today for a free consultation about your case.