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How Do Pre-Existing Conditions Affect My Claim? 

The Winter Law Group  Jan. 11, 2023

If you are a worker in the state of California, you may qualify for workers’ compensation benefits if you become injured or ill while performing your job duties. If you’re considering filing a workers’ compensation claim in California, it’s important to understand what is considered a pre-existing condition and how it can affect your claim.  

Discuss your unique case with our workers’ compensation attorney at the Winter Law Group. With an office in Fresno, California, we provide clients with attentive and personalized service in other parts of the state, including Visalia, Clovis, Madera, Merced, and throughout Merced and Madera counties.  

Qualifying for Workers’ Compensation   

In order to qualify for workers’ compensation benefits in California, an individual must be classified as an employee of the company they are working for and not an independent contractor. Additionally, the injury or illness must have been sustained while on the job and must not have been caused by serious misconduct on behalf of the employee.  

If you believe that you meet all of these criteria and would like to file a claim, it is crucial to understand the process and timeline associated with workers’ compensation claims in California. Generally speaking, an individual has up to one year from the date of their injury or illness to submit a claim. However, if a claim is not submitted within this time frame, individuals may lose their right to receive benefits altogether. Therefore, it is important that individuals act quickly when submitting a claim so that they can ensure they are able to receive the full amount of their benefits should they be approved. 

What Qualifies as a Pre-Existing Condition?  

Pre-existing conditions are medical conditions or injuries that existed before the injury for which you are filing the claim. In California, a pre-existing condition can have an impact on whether you qualify for workers’ compensation benefits. 

Pre-existing conditions include any medical conditions that have been diagnosed by a doctor and are actively being treated with medication or other forms of treatment. They also include any physical injury, such as sprains and strains, muscle tears, fractures, etc., that may have occurred prior to the current injury. 

How a Pre-Existing Condition Can Affect a Claim  

Having a pre-existing condition does not automatically disqualify you from receiving workers’ compensation benefits if you sustain an injury on the job in California. However, it does mean that your employer may be required to pay less in benefits than they would otherwise have been obligated to pay if there were no pre-existing conditions involved.  

The amount of benefits may be reduced based on the extent to which your current injury was caused by your pre-existing condition. If your current injury is found to be entirely unrelated to your pre-existing condition, then you should receive full benefits under California law.  

Why You Should Hire an Attorney If You Have a Pre-Existing Condition  

When filing a workers’ comp claim due to a pre-existing condition, one of the biggest issues is proving that the injury or illness was caused by work activities rather than something else. This can be especially difficult if your employer or insurer disputes your claim because they argue that your medical history indicates another cause of injury or illness.  

An attorney will be able to build evidence to support your claim and argue on your behalf against any attempts by employers or insurers to deny it. They will also ensure that all deadlines are met so that you don’t miss out on any potential benefits you may be entitled to receive through workers’ comp coverage. 

Insurance companies are focused on minimizing costs and maximizing profits, so they may not always offer you the full amount of compensation you deserve for your injuries or illness due to a pre-existing condition. An experienced attorney will work hard to maximize your settlement amount by negotiating with insurance companies and ensuring that all applicable benefits are included in your settlement package.  

They can also represent you if there is an appeal or court case related to your claim, giving you peace of mind knowing that a professional is handling everything on your behalf.  

Understand Your Case With Our Guidance 

Filing a workers’ compensation claim when you have suffered an injury due to a pre-existing condition requires knowledge of California state laws and regulations as well as experience dealing with insurance companies who might want to minimize their costs. Our workers’ compensation attorney at the Winter Law Group can help ensure maximum compensation while providing guidance throughout every step of the process. Reach out to our office in Fresno, California, for a free case evaluation.