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Articles Tagged with preexisting

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Alabama Accident & Injury LawyersHurt 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.

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In a past article, I discussed a study that revealed work related illnesses and injuries cost at least $250 billion a year. My prior post raises the question — Why does our system not focus on safety? A small investment in safety would pay huge returns.

Our current system fails to invest in safety. While workers are penalized for some unsafe conduct, the system does nothing to the few reckless employers who cause most of the injuries. The most reckless and dangerous employers suffer no penalties under Alabama workers’ compensation laws. They suffer no penalties causing them to lose lucrative government contracts. They suffer almost no penalties from OSHA which is overstressed, understaffed and rarely inspects unsafe worksites. Unless we focus on real safety by penalizing reckless employers, we will continue to see far too many work related injuries.

What is the cost of occupational accidents and injuries to reckless and unsafe employers? At worst, the injury may result in some type of premium increase for work comp coverage? A recent UC Davis study showed that the majority of workplace injury and illness costs are not even paid through workers’ compensation insurance. Instead, these costs are simply shifted to the government. Think taxpayers like us! When it comes right down to it, reckless and unsafe employers dispose of their workers by shifting the costs of accidents and disabilities to the taxpayer.

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Why do people call a lawyer after a work-related accident? What reasons lead to calling an attorney? While sitting in court on a recent workers’ compensation case, I started thinking about this issue.

For me, former clients are the best source of referrals. Work hard for your clients. Care for your clients. Do the best job you can. But, let’s set aside referrals for this post. Let’s talk about injured workers who do not know any attorney. What reasons would lead an injured worker to consult any attorney at all? A serious accident or injury presents many issues that can be helped by competent legal advice. Most personal injury attorneys provide a free consultation. We do. We are happy to answer legal questions.

What are some of the most frequent problems encountered by injured workers that lead them to call an attorney? Here are a few frequent reasons that might lead to calling an attorney:

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Alabama Workers Compensation AttorneysFor 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.

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It’s a scenario repeated frequently by callers to our office. First, the caller tells us he suffered a work-related accident and injury. Then, the caller tells us the workers’ compensation carrier has simply denied his claim on the basis he had a “pre-existing” injury or condition. Often, these denials involve some prior injury that occurred years ago or some prior condition that did not prevent the person from working his current job.

How does Alabama’s Workers’ Compensation Act treat the issue of “pre-existing” conditions? I learned long ago that every case presents unique facts and issues. But, here are two general principles in Alabama:

  1. A pre-existing condition that did NOT affect the employee’s work performance before the disabling injury is generally NOT considered a pre-existing condition under Alabama’s Workers’ Compensation Act.
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