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  1. #1
    Join Date
    Aug 2008

    Red face Pre-Exisiting and W/C

    Injured back on job in 2/08, filed a w/c claim, going thru all the motions as dictated by w/c. received lttr 6 months later that the issue with my back was a pre existing issue and that I had falsified my application. This issue has been resolved, however w/c is denying any further treatment, which is eventually going to be a 3 level fusion. Apparently, in 1/07 when I had to go to the er for something not even pretaining to a back issue, the neuro dr. decided to do an mri on my back, checking to see if I had MS. She told me I had a bulging disc, never hurt b/4 that time, during or until I was injured on the job. Never treated for the bulging disc issue either, nor was I told that my back was a mess. W/C pulled all previous medical records, which is fine, but they say that because the MRI done in 1/07 shows my back being as bad as the MRI done thru w/c in 2/08 that the matter is pre-existing. Like I stated earlier, the bulging disc never hurt and I was not told that I would eventually need a 3 level fusion. Even if I was aware that this was pre-existing, I have never received treatment for the issue nor did I ever file a w/c claim. What can I do about having w/c reinstate my case? I am trying to hold off on the surgery for as long as possible, but.... Please advise what I should do.

  2. #2
    Join Date
    Oct 2006

    Default Re: Pre-Exisiting and W/C

    You have to appeal to the work comp commission. They have a website with the correct forms and information. You'll have to get a report from your doctor showing it's from recent work activity.

  3. #3
    Join Date
    May 2008

    Default Re: Pre-Exisiting and W/C

    Kellycap, I have the same exact situation (in Pa) not sure of your laws, but w/me..I got hurt at work, 2/08 severe pain down my arm, long story short needed surgery for 3 levels. I went to the w/c dr. who temp.approved for 3 weeks.
    they sent me for an mri which showed the herniations, but had a comparative view date of 10/07 which was totally un-related to my neck. I was sent for it regarding an infection. since they saw I had disc problems 4 months prior, they dropped me. I had no systems at all, turned out it was pre-existing.
    But, I have an attorney, and he said it does not matter, aggravation of pre-existing conditions are compensable in pa. (not sure in your state) but I would check your websites out and see if that's the case.
    I have a hearing coming up and I'll let ya know. But I would think you should get an attorney and find out the laws in your state if aggravation of pre-existing conditions are compensable.
    good luck to you. I just went to my own dr and had the surgery done, and thought I'll fight w/them later. sometimes you just have to get out of pain and do what you need to do so you don't make things worse for yourself.
    Good luck to you.

  4. #4
    Join Date
    Feb 2007

    Default Re: Pre-Exisiting and W/C

    It's typical for the ER/IC/TPA to attempt to find a reason to deny treatment/benefits on an injury..

    Here is a benefit delivery process for FL WC...
    Follow your way through the process...if you do this, you'll get an idea of the system and how to proceed.

    Here is the procedure for what to do where there are benefits/treatment being denied...

    While there may or may not have been a pre exsisting condition as the basis of the denial...where there is a work related injury, EVEN if the 'injury' is an aggrevation of the pre exsisting condition, the ER/IC is liable to the treatment to the condition/injury.
    Even though there was/is a 'bulging disk' in your spine, IF the injury caused the disk to rupture/herniate, or additional disks to 'bulge'... the ER is liable for treatment/surgery

    If there is a determination of PD due to this injury, the doctors will have to decide HOW MUCH PD is/may be caused by the pre exsisting condition...the ER is only liable for PD indemnity that is a direct result of your current work injury.
    Here is a FAQ for FL IW's...
    Here are the rules and forms you'll need...

    You can also contact the ombudsman..
    If you are an injured worker and have questions regarding your claim, you may contact the Employee Assistance Office by telephone at (800) 342-1741 or by e-mail

  5. #5
    Join Date
    May 2008

    Default Re: W/C and Pre-Existing Condition

    well it seems to me that if your back was hurt before you starte working for your new job, and then you got hurt at your new job my question is, was your injury at your job have anything to do with your BACK???

    If it doesnt, then the wc is not required to pay for treatment for your back, regardless if you have never had any treatment for it or not.

    now if in the course of your injury and it made your back worse, then there is a possible claim there

    I was injured at work about 2 1/2 months ago and have a very bad back to begin with (on chronic pain meds)(2 ruptured disk), anyway, i have noticed that since my injury(which was no way related to my back) i have noticed that my back has gotten worse.

    and my attorney advised me to go back to my spine doc(ortho) and be re evaulated, and then present it to wc if they feel that when i hit the floor that the blow caused my back to get worse.

    so if you dont have an attorney, it might pay you to retain one. i wouldnt sign any papers giving up your rights on this until you consult an attorney.

  6. #6
    Join Date
    Dec 2007

    Default Re: W/C and Pre-Existing Condition

    This pre existing tactic is fairly routine. If you fell off your bike and scraped your knee when you were 6 years old the insurers attempt to deny coverage for anything related to that knee for the rest of your life. It's bullshit!
    If you hurt your back at work and a MRI reveals a bulging disc the insurers are quick to say that a large percentage of adult Americans have some level of bulging disc or "degenerative disc disease" and so they aren't at fault. They basically feel that bulging discs are normal among older Americans. In your case they seem to want it both ways and so your failure to report what they wish to consider normal is now a falsification of an employment application. Another example of trying to escape liability for a claim by any means possible.
    It is clear that they are going to attempt to deny your claim and that you will undoubtedly need an attorney to secure any benefits you are due. I would develop a defensive posture and find legal representation who should be present at any and all meetings.
    You will find that the opposition is shameless when they beleive they can escape their rightful responsibility because they have dug up something from your past.
    The above poster is absolutely correct in that if a pre existing condition is aggravated or exacerbated by a new traumatic event, you are entitled to benefits for the worsening of the condition.
    In a meeting they will attempt to get you to acknowledge that you were aware of this bulging disc and lied when filling out you application. Deny them this opportunity because it doesn't seem that black and white to me.
    Ultimately any medical evidence will be evaluated to determine what if any effect your work injury may have had on a pre existing condition. What concerns me is their immediate attempt to paint you as a liar.

  7. #7
    Join Date
    May 2008

    Default Re: W/C and Pre-Existing Condition

    Well Said! like I said in a prev post in this thread, if your accident caused you to aggravate a pre-existing condition, like they told me as well, who are they to say it was going to happen sooner or later down the road. Well, it didn't, and we'll never know if it would of or not will we. they are ruthless, curel and mean!

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