BOSTON PRE EXISTING CONDITIONS AND WORKERS COMPENSATION

If you’ve been injured at work and have a pre-existing condition, you may be wondering if you’re eligible for workers’ compensation benefits. The good news is that Massachusetts law allows employees to recover benefits even when a workplace injury aggravates a prior condition.

At Markey Law Partners, our experienced Boston workers’ compensation attorneys specialize in helping clients navigate these complex cases. Whether your claim was denied or you’re unsure how to proceed, we’re here to fight for the benefits you deserve.

A pre-existing condition is any injury, illness, or medical issue that existed before your workplace accident. This could include chronic conditions like arthritis, degenerative disc disease, or even prior surgeries. Many employees worry that their pre-existing condition will disqualify them from receiving workers’ compensation benefits, but this isn’t necessarily the case.

Under Massachusetts law, you may still qualify for benefits if your work injury worsened or aggravated your pre-existing condition. The key is proving that your job was a significant factor in causing your current disability or need for medical treatment.

Massachusetts workers’ compensation law includes a specific provision, Section 1(7A), that addresses pre-existing conditions. According to this law, if a workplace injury combines with a pre-existing condition to cause disability or the need for medical treatment, the injury must be a “major cause” of the disability or need for treatment.

• What Does “Major Cause” Mean?
  The term “major cause” doesn’t mean the workplace injury has to be the primary or predominant cause. Instead, it must be a significant contributing factor. For example, if your job duties contributed 40% to your current disability, you may still qualify for benefits.
• Case Example:
  In Goodwin v. National Grid, the court ruled that a workplace injury that contributed 40% to the employee’s disability met the “major cause” standard. This case highlights how even partial contributions from work can lead to successful claims.

One of the biggest challenges in pre-existing condition cases is proving that your workplace injury aggravated your condition rather than it worsening due to natural progression.

• Aggravation:
  If your job duties caused your pre-existing condition to worsen, you may be eligible for benefits. For example, if you have a prior back injury and heavy lifting at work exacerbates your pain, this could qualify as an aggravation.
• Natural Progression:
  If your condition worsens due to aging, genetics, or unrelated factors, it may not be compensable. Insurers often argue that the injury is unrelated to work, which is why strong medical evidence is critical.

Not all pre-existing condition cases are the same. Here are some common scenarios where employees may qualify for workers’ compensation benefits:

1. Workplace Accidents Exacerbating Pre-Existing Injuries
   • Example: A slip and fall at work worsens a prior knee injury.
   • Example: Repetitive stress from typing aggravates carpal tunnel syndrome.
2. Occupational Diseases Linked to Pre-Existing Conditions
   • Example: Exposure to loud noise at work worsens pre-existing hearing loss.
   • Example: Chemical exposure aggravates a prior respiratory condition.
3. Secondary Conditions
   • Example: Chronic pain from a work-related back injury leads to depression or anxiety.

To succeed in a pre-existing condition case, you’ll need strong evidence to show that your workplace injury was a major cause of your disability or need for treatment. Here’s what you’ll need:

1. Medical Documentation
   • Emergency room records from the time of the injury.
   • Treatment notes from doctors linking the workplace injury to the aggravation of your pre-existing condition.
   • Imaging studies (X-rays, MRIs) showing changes in your condition after the workplace injury.
2. Employment Records
   • Job descriptions proving the physical demands of your role (e.g., lifting requirements, repetitive motions).
   • Incident reports documenting the workplace accident.
3. Expert Testimony
   • Independent medical exams (IMEs) to establish the connection between your work and your condition.
   • Testimony from occupational specialists or vocational experts.

Insurance companies often use tactics to deny or minimize claims, but with the right legal representation, you can overcome these obstacles.

1. Insurer Tactics
   • Combination Injury Defense: Insurers may argue that your disability is due to a combination of your pre-existing condition and the workplace injury, making it harder to prove the “major cause” standard.
   • Blaming Natural Progression: They may claim your condition worsened due to aging or unrelated factors, not your job.
2. Appealing Denied Claims
   • If your claim is denied, you have the right to appeal. The process involves filing with the Department of Industrial Accidents (DIA) and presenting evidence to support your case.
   • Our attorneys at Markey Law Partners have extensive experience handling appeals and can help you build a strong case.
3. Maximizing Benefits

We’ll fight to ensure you receive all the benefits you’re entitled to, including wage replacement, medical coverage, and permanent disability benefits.

Don’t let a pre-existing condition stop you from getting the workers’ compensation benefits you deserve.  Contact us today at Markey Law Partners for a free consultation at 877-488-2667. Let our experienced Boston workers’ compensation attorneys evaluate your case and guide you through the process.