Workers’ compensation claims involving pre-existing conditions are among the most challenging cases attorneys face in New York. Insurers frequently attempt to minimize or deny benefits, arguing that an injury is unrelated to workplace duties. However, with the right strategy, your clients can still secure the compensation they deserve.
How Insurers Use Pre-Existing Conditions Against Claims
Many workers have pre-existing health issues—conditions like arthritis, prior back injuries, or repetitive strain disorders that may predate a workplace accident. Unfortunately, insurance companies often exploit these conditions to justify claim denials or reductions.
Why Pre-Existing Conditions Still Qualify for Workers’ Comp
New York law protects employees when a workplace injury aggravates an existing condition. This means your client may still be entitled to benefits in cases such as:
- A prior back issue worsens due to heavy lifting.
- Repetitive tasks accelerate an existing joint problem.
- Workplace exposures aggravate respiratory conditions.
These cases rely on clear medical documentation and expert testimony to establish that work activities made the condition worse.
Overcoming Insurer Pushback: The Key Challenges
Insurance companies will often argue:
✔️ Symptoms stem from a pre-existing condition, not the workplace.
✔️ Injury would have occurred anyway due to age or prior health issues.
✔️ The worker had a pre-existing disability, limiting their claim.
Without a comprehensive medical and legal strategy, clients risk reduced benefits—or outright denials.
How Attorneys Can Strengthen These Claims
To build a strong case, attorneys should:
- Partner with specialized professionals – A mutual referral system connects clients with medical experts who can provide accurate diagnoses and reports detailing workplace-related aggravations.
- Gather robust medical evidence – Secure comprehensive medical records proving the injury exacerbated an existing condition.
- Use the “Eggshell Worker” Rule – New York law holds employers accountable for worsening conditions, even if a worker was already vulnerable.
By collaborating with medical experts, occupational specialists, and legal professionals, attorneys can present a clear, evidence-backed case for compensation.
Need Support for Complex Workers’ Comp Cases?
We specialize in navigating pre-existing condition claims and can provide the medical evidence and expert testimony needed to support your clients. Together, we can advocate for their rights, ensuring they receive maximum benefits and restored quality of life.
