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Workers’ comp. claim denied due to pre-existing condition?

On Behalf of | May 30, 2019 | Workers' Compensation

You’re a butcher at the local WalMart. One day as you are carrying a loaded tray of meat back to the freezer, you slip down in a pool of coolant from a leaking refrigerator. When you fall, you are dismayed to learn it’s your right knee that bore the brunt of the fall.

That’s the knee with the ACL that took a direct hit in a high school football game tackle. It was surgically repaired more than 10 years ago, but this newest fall has significantly re-damaged your old injury. You try to file for workers’ compensation but WalMart denies your claim, alleging you never told them of your pre-existing condition.

Do you have recourse?

You do indeed. Your legitimate workplace injury aggravated the pre-existing injury that was previously repaired many years ago. Had it not been for the fall you suffered at work, your surgically-repaired knee would still be serving you quite well at this point.

A similar situation played out in another state’s appeals court — Hyatt Regency Crystal City v. Spencer, Court of Appeals of VA, No. 1007-10-4, 1/25/11. The plaintiff was a cook at a hotel who was injured in a fall in the men’s room. When he sought workers’ compensation benefits, the hotel chain giant blocked his efforts to gain compensation because he had previously sought treatment for an injury in the same location.

The case wound through the courts but the man eventually prevailed and the injury was ruled compensable.

Denied claims more common than people realize

Not every employer will deny a legitimate claim, but it happens more often than it should, with pre-existing injuries cited often in the denials. They try to argue that were it not for that initial injury, the claimant would otherwise be fine.

That is simply not the case for many injuries. For instance, an injured right knee can easily be re-injured in a fall many years after the original injury was surgically corrected. Ditto for a broken wrist on the dominant hand, as that would typically be the arm thrust out automatically to break a fall.

Was your workers’ comp complaint denied?

If your employer denied your legitimate workers’ compensation claim due to a pre-existing condition, don’t take that as your final answer. A Tom’s River workers’ comp. attorney can appeal your denial and get you the compensation you seek.