You have an old back injury, or your knees have been giving you trouble for a while. You showed up, did your job and then something happened at work that made it worse. Now your employer is saying your injury is not covered because it was already there before. Here is what you need to know.
A pre-existing condition does not cancel your claim
Under the Pennsylvania Workers’ Compensation Act, your employer cannot deny your claim simply because you had a prior injury or medical condition. What matters is whether your job made that condition worse. If your workplace duties aggravated, accelerated or worsened a pre-existing condition, that worsening counts as a work injury and you may still qualify for benefits.
Pennsylvania law also recognizes that employers take their workers as they find them. If you are more vulnerable to injury because of an existing condition, that does not diminish the validity of your claim.
What your employer and their insurance company will try to do
The insurance company may scrutinize your medical history, looking for a reason to deny your claim. They may argue your current symptoms are just a continuation of your old injury or send you to their own physician, who downplays the connection to your work. This is one of the most common ways legitimate claims get denied in Pennsylvania.
What you can do to protect your claim
One of the most important steps you can take is getting medical treatment right away and making sure everything is documented. Your doctor needs to understand what your condition was like before the workplace incident and how it changed afterward. That before-and-after picture is often what makes or breaks a claim like this.
Reporting your injury promptly is also critical. In Pennsylvania, you must give notice within 21 days of your injury for benefits to retroactively begin from the date of the injury. If you delay beyond 21 days but give notice within 120 days, benefits are only payable from the date you give notice. Waiting beyond 120 days can bar your claim entirely.
Protect your rights with experienced legal counsel
If your employer or their insurance company is challenging your claim because of a pre-existing condition, that is not necessarily the end of the road. You have the right to appeal a denial, and many of these cases can be won with the right medical evidence and legal representation.
Speaking with a workers’ compensation attorney can help you understand where your claim stands and what your options are.