For a few workers’ compensation insurance carriers, the pattern is simple. Deny most claims. Assert some general reason such as a “preexisting” condition. Maybe you’ve heard this denial. These bad insurance carriers figure it’s an easy denial. After all, who was “perfectly” healthy prior to an accident.
I’ve seen the denial letters claiming a “preexisting” condition. It’s like the insurance company has a form letter and process. Just a few simple assembly line steps and your claim is denied: Insert the injured person’s name and address. Hit print. Mail the denial letter. Move to the next claim!
While a few carriers seem to use a quick form denial for these claims, a few others play a different game. These carriers simply ignore the claim indefinitely asserting it is under “investigation.” In some cases, the insurance carrier makes more and more requests to continue its “investigation” while refusing to provide benefits. Whether denied or under an endless investigation, the result is the same. The injured person sits without the medical care needed to recover and return to work.
What happens to these claims wrongfully denied (or wrongfully ignored) on the grounds of a “preexisting” condition? Many severely injured workers give up. They accept the insurance company’s excuse. Some of these workers never receive needed medical care. Those workers often suffer chronic pain and disability. They cannot return to work. Other workers get medical care elsewhere – often through taxpayer-funded sources like Medicare. The work comp insurance company should have picked up the tab. Instead, the rest of us do.
I’ve been handling Alabama work comp claims for years. I’m not writing to bash all work comp carriers. Some carriers and their adjusters act quickly to provide necessary medical care. It’s their duty under Alabama law and they understand that legal responsibility. I can tell you it is the same few carriers who always wrongly deny or ignore claims. Isn’t it the same for every business or profession — A few bad apples!
Were you injured at work in Alabama? Don’t just accept a denial of your work comp claim by some insurance carrier asserting a “preexisting” condition. Under the Alabama Workers’ Compensation Act, the meaning of this term is very different than you might think. How does the meaning differ under Alabama law?
Normally, “preexisting” simply means something that existed before the time (or event) at issue. OK. Under that meaning, if you hurt your back in an accident but had EVER suffered prior back trouble, you might be considered to have some preexisting condition. Face it, that’s probably all of us if we live long enough! A recent government report indicates 129 million Americans have a preexisting health condition under this broad non-legal definition.
But, the term “preexisting” has a very different meaning under Alabama work comp laws. Let’s think again about a person who hurts their back at work but may have experienced some back problems prior to the work-related injury. How is “preexisting” understood by our work comp laws? Under Alabama’s work comp laws, the prior back problems are not considered a preexisting condition that would prevent the worker from obtaining benefits if the worker was able to perform fully his job at the time of his injury. The issue is not whether you suffered a prior medical problem. Maybe you did. Maybe you even suffered some ongoing pain or problems. The issue is whether you suffered problems performing your actual job at the time of injury. This is what Alabama’s courts have to say about the issue of preexisting conditions impacting a claim for workers’ compensation benefits:
The law presumes that there is no preexisting injury or infirmity when the employee is able to fully perform his or her job duties in a normal manner prior to the subject injury.
What does this mean? It means you do NOT have to be in perfect health prior to your accident. It means you can be a normal person with normal health problems. It means you can even have some prior health conditions. Our workers’ compensation benefits are not limited to people in perfect health prior to their injuries. The focus of workers’ compensation benefits is, and should be, on a person’s ability to work and how an injury impacts that ability. If a prior condition did not keep you from performing fully your job, then you should receive full benefits for any current injury. This is true even if you had some ongoing issues. Keep in mind, even if you had a prior condition that kept you from performing your job fully when injured, you’re still entitled to benefits for any increased disability. That insurance denial for some “preexisting” condition may be completely wrong and unjust!
I’ve seen client after client who deserves better than a form letter simply denying their claim based on some generic “preexisting” problem. Even if you had problems, you are probably still entitled to benefits.
I’m always reminded of a client I helped years ago as a young lawyer. The client suffered an accident and injury to his back at work. Then, he received a form letter denying his claim. The insurance carrier claimed he had preexisting back problems and should not receive work comp benefits. Truthfully, he had suffered some back issues from time to time prior to the accident. And, he had even received prior medical treatment for those issues. Was he in perfect health prior to the work-related accident? Absolutely not. Because of this, some other lawyers had turned down his case. But, he was working his job fully at the time of his accident. I’ll never forget watching the defense lawyer try to explain at trial how my client suffered some preexisting back disability when his timesheets showed him routinely working 60 to 70 hours a week doing heavy manual labor. It was laughable. We won at trial and on appeal.
If you are hurt on the job in Alabama, it is important to remember a couple things:
- Legally, you do NOT have a preexisting condition if you were fully able to perform your particular job at the time of your injury.
- In Alabama, workers’ compensation benefits are NOT limited to those in perfect health prior to their injury.
Do not accept an insurance company denial without consulting a skilled attorney. In many cases, you are entitled to compensation. Our work comp laws were written to protect workers. That means all workers, not just those in perfect health before their accident.
The Blackwell Law Firm represents injured workers across Alabama. We have tried personal injury and workers’ compensation cases to verdict in counties across our state. If you have questions, let us know. We are happy to discuss your concerns.