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Can a worker seek benefits for a pre-existing condition

Businesses in New York have specific responsibilities to their employees. New York law requires that employers either carry workers’ compensation insurance coverage or they self-insure. Only some businesses with a history of successful operations and sufficient capital can self-insure.

Regardless of whether a company has an outside insurance company or self-insurers, large claims for certain types of benefits can prove expensive for a company. As a result, businesses may be eager to find ways to limit their responsibility to pay for worker treatment. For example, a company may seek to defend against a claim by pointing out the pre-existing nature of an injury reported by a worker. This approach, however, is only appropriate under certain circumstances.

Companies should evaluate injuries on a case-by-case basis

According to a review of domestic Medical records, as many as one in two people may have some kind of pre-existing condition that affects their health. Pre-existing conditions are chronic or persistent medical issues that existed before someone’s employment at a company or their date of acquiring a health insurance policy.

For the purposes of workers’ compensation coverage, pre-existing injuries are conditions that workers had before they accepted a specific job or new role with a business. Pre-existing conditions do not automatically entitle a worker to workers’ compensation benefits. A worker would need to establish that their condition has worsened because of their employment. If all they have are the same symptoms they previously reported, they may not be able to seek benefits accordingly.

Employers can, therefore, sometimes challenge workers’ compensation claims by raising questions about whether a pre-existing condition qualifies for coverage or not. Responding appropriately to a claim for benefits related to a pre-existing condition could help New York employers avoid unnecessary expenses when raising a defense is truly warranted.

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