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Navigating Workers’ Compensation with a Pre-Existing Condition: Your Rights

December 4, 2023

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Workplace injuries can make it hard to support yourself and your family. And for most Ohioans, this is a reality, especially for those in dangerous occupations. But did you know the concept of workers’ compensation was born from a 19th-century labor movement? The original purpose was to protect workers like you from injuries and accidents in the workplace.

If you sustain an injury at work in Ohio, you may be entitled to workers’ compensation benefits. However, if you have a pre-existing condition at the time the injury takes place, it may be difficult to get the compensation you deserve. Ohio workers’ compensation attorneys can offer a roadmap to understanding your rights and securing the support you deserve after suffering a job-related injury.

Injured Worker Rights in Ohio

Workers’ comp is a system that provides medical and financial benefits to workers when they suffer an injury due to their work. In Ohio, the Bureau of Workers’ Compensation (BWC) and the Industrial Commission of Ohio (IC) oversee workers' comp.

The Ohio Workers’ Compensation Act, Chapter 4123 of the Ohio Revised Code, governs Ohio workers’ comp law. The law explains what employers and employees must do when someone gets sick or hurt at work. The statute also puts forward the legal grounds for creation of the BWC as the primary State agency responsible for handling workers’ compensation claims.

If you are an injured worker in Ohio, the act grants you the right to:

  • File a workers’ compensation claim for your work-related injury or illness, regardless of fault. Ohio operates under a no-fault workers’ comp rule, meaning you don’t have to prove the employer caused illness or injury to get compensation. 
  • Receive medical treatment from a doctor of your choice.
  • Receive compensation benefits for injuries experienced during work.
  • Appeal any decision made by the BWC or the IC regarding your claim.
  • Hire a lawyer to represent you in your claim.

Workers’ compensation attorneys in Ohio can help you recover the following benefits if you’re injured during work:

  1. Medical benefits.
  2. Temporary total disability benefits.
  3. Permanent partial disability benefits.
  4. Permanent total disability benefits.
  5. Wage loss.
  6. Death benefits.

What is a Pre-Existing Condition?

A pre-existing condition is any medical condition you had before your work-related injury or illness occurred.

Some examples of pre-existing conditions are:

  • Arthritis
  • Diabetes
  • Asthma
  • Depression
  • Back pain

Generally, BWC will not issue compensation for a pre-existing condition as part of a workers’ comp claim. There are two exceptions:

  1. When a pre-existing condition impacts the treatment or outcome of an injury covered by workers’ comp, it is referred to as a comorbid condition. In these situations, your pre-existing condition must be addressed first so you can then recover from the work-related injury.
  2. The work injury “substantially aggravates” the pre-existing condition. If your pre-existing condition is exacerbated by your work injury, treatment may be covered by workers’ comp benefits.  

To receive benefits for a 'substantially aggravated' pre-existing condition, you must show that the work injury made your injury much worse. Courts rely on objective diagnostic findings, test results, and clinical findings to grant orders for substantial aggravation. Therefore, an increase in symptoms doesn’t necessarily qualify as aggravation. You must prove your case through empirical changes in the condition, such as swelling, positive orthopedic findings, or other objective indicators.

The Workers Compensation Claim Filing Process in Ohio

You can avoid many “out-of-pocket” costs with a successful workers’ comp package. Therefore, you must follow all necessary steps to ensure the Ohio Industrial Commission expedites your hearing.

The steps to apply for workers’ compensation in Ohio are as follows:

  1. Report the illness or injury to your supervisor or employer immediately. Prepare an incident report outlining the details of your injury or illness. Include the date, time, place, cause, and witnesses to your injury.
  2. Seek medical care. Inform the BWC-certified doctor that your injury is work-related. Your doctor will help you file a claim with the BWC. Your healthcare provider can file the claim online or submit it to a Managed Care Organization (MCO).
  3. Do you want to file the claim yourself? Fill out a First Report of Injury (FROI) form and submit it to the BWC within one year of your injury or illness. The Ohio statute of limitations doesn’t allow you to file a claim after one year.
  4. Receipt of claim number. When they receive your claim, BWC will assign you a claim number and send you a letter confirming receipt. Keep this letter for future reference and correspondence with your employer or BWC.
  5. BWCs review. Your claim will undergo BWC review, and you will receive a decision within 28 days. Decisions will be mailed to your employer and MCO. If your claim is approved, you will receive a notice of allowance listing the conditions your claim covers. Conversely, if denied, you’ll receive a notice of denial with a reason for the denial.

If you disagree with BWC’s decision, you can appeal to the Ohio IC. The IC is an independent agency that listens to and reviews workers’ comp decisions. By consulting with workers’ compensation attorneys,injured workerscan ensure their case receives full representation at the hearing. An attorney is your best chance of getting the compensation you deserve.

How Workers Compensation Attorneys Can Help You

A pre-existing condition can make it difficult to prove the causal relationship with the work injury or illness. You may also face resistance from your employer, insurance companies, or the BWC. These are all great reasons to seek the advice of an experienced attorney. An attorney can help you:

  • Gather and present evidence to support your claim.
  • Negotiate with the BWC, your employer, or their insurance company on your behalf.
  • Appeal any unfavorable decision made by the BWC or the IC regarding your claim.
  • Protect your rights and interests throughout the process.

Get Your Workers' Comp Claim Started

In Ohio, if you have a pre-existing condition, you can still receive workers' compensation benefits. However, the condition may complicate your claim and require more evidence and legal assistance. If you were hurt at work and have a pre-existing health condition, contact Nurenberg, Paris, Heller & McCarthy workers compensation attorneys in Ohio. We can help you get the compensation you deserve. 

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