Hurt on the job? If so, the insurance carrier may look for a reason to deny your claim. One of their favorite reasons (and usually a wrong one) is to claim you had a pre-existing condition. On a weekly basis, we listen to injured workers who were (wrongly) denied benefits by the insurance company. What makes this wrongful denial so bad — Many lawyers advertising for injury cases simply accept the denial and refuse to help their clients. Many times, the insurance company denial is wrong.
How Should We View Workers’ Compensation Benefits In Alabama?
Alabama courts have stated over-and-over again that workers’ compensation benefits are “not limited to those in perfect health.” Of course they are not limited. Working men and women deserve a system that provides medical care and basic benefits following a serious accident. If the system required anyone over the age of 35-40 with a history of heavy labor work to have a perfect back, benefits would be worthless. Nobody would be covered.
How Do We Define Pre-Existing For Alabama Work Comp Claims?
In Alabama, the proper question is whether or not the injured worker could perform the normal job duties of his or her employment before the work-related injury at issue. If so, that worker is entitled to full benefits. Alabama’s appellate courts have used the following language to discuss this issue:
[I]f the previous injury has not demonstrated itself as disabling and has not prevented the employee from performing his job in a normal manner [at the time of the accident at issue], then the previous injury will not disqualify the claim.
Pre-existing injury is defined in terms of its effect on the employee’s ability to earn. The existence of an infirmity that does not prevent an employee from performing his duties without modification, or from working ‘as a normal man,’ does not affect a compensation award.
Oberkor v. Central Alabama Home Health Care Services, Inc., 716 So.2d 1267, 1270 (Ala.Civ.App. 1998)
At our office, we have won this issue on appeal numerous times for our injured clients. We have helped clients who underwent prior back surgeries but returned fully to work before their accident. We have helped clients who suffered periodic back and neck flareups but continued to work fully before their accident. Time after time, we have fought this defense. A prior problem, condition or injury that did not prevent you from working fully when you had your accident, should not be an obstacle to benefits. Don’t let the insurance company tell you it is.
Don’t expect the insurance company to tell you this truth. Instead of simply writing-off claims because the person had a prior problem in the same area, the question should be whether this issue impacted your ability to work at the time of your accident. That question should decide whether or not the problem is pre-existing.
How Do We Determine If Benefits Are Owed?
The issue is not whether your pre-injury health was perfect. No. The issue is whether the work-related accident for which you are seeking benefits, contributed to your condition. Did your injury cause your current problems? Did your injury aggravate your condition, worsen your condition, or contribute to your condition? If your accident worsened you, you are probably entitled to work comp benefits. And, you should certainly seek advice rather than listen to an insurance company trying to profit at your expense.
Does this law mean it’s easy to overcome a wrongful denial by the insurance company? No, it does not. Insurance companies know that many people will simply go away after a denial. Other denied workers will consult a lawyer unwilling to fight or go to trial for his or her clients. Our highways are littered with billboards for these settlement lawyers. These cases often require a fight. Insurance companies know the outcome depends upon the doctor’s medical testimony. If denied, you need to consult an attorney who understands the law and has experience preparing these cases for trial.
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At the Blackwell Law Firm, we represent injured workers across Alabama. We have tried workers’ compensation cases to verdict in counties across the state.
