Work injuries rarely happen on an empty canvas. Most adults carry some history in their bodies — an old ACL tear from a weekend league, a herniated disc that quieted down years ago, a shoulder that aches after long days. Then a pallet falls, a ladder slips, or a repetitive task finally tips something over the edge. That intersection where a workplace event meets a pre-existing condition is where many claims get complicated, and where the advice of a seasoned workers compensation attorney often makes the difference between a fair recovery and a frustrating denial.
Over the years, I’ve walked warehouse workers, nurses, line cooks, machinists, and office staff through this maze. The legal rules vary by state, but the practical moves that protect your health and claim are consistent. Here’s how to think about pre-existing conditions in the workers’ compensation context, what steps to take the day you’re hurt, and how to navigate the nuances that insurers use to minimize or delay claims.
Why pre-existing conditions matter — and why they don’t bar your claim
Workers’ compensation is fault-blind. In most states, if a job-related incident causes an injury, the claim is compensable without proving negligence. Pre-existing conditions do not disqualify you. The law generally recognizes that employers take employees “as they find them.” If the work event aggravates, accelerates, or lights up a prior condition, the resulting disability is often covered.
The dispute usually centers on how much of your current limitations stem from the workplace incident versus your prior health history. An insurer will lean on phrases like “degenerative changes” or “pre-existing pathology” to argue the event was incidental. That’s where the quality of your medical documentation, timeline, and job description weighs heavily. The law doesn’t require you to be pain-free before the incident; it requires you to show that work made you worse in a real, demonstrable way.
Here is the plain-language rule most states apply: if a work incident permanently or temporarily aggravates a pre-existing condition to the point you need medical treatment or lose time from work, the aggravation is compensable. Some states add a requirement that work be a “major contributing cause” or “predominant cause.” Others accept that even a small acceleration is enough. Your state’s standard will shape how aggressively the insurer fights and how detailed your proof must be.
The first hours: what to do the day you’re hurt
Act with the assumption that every detail counts. Start with your health, then build the record that your claim will rest on months later.
- Report the injury promptly to a supervisor in writing, even if you hope the pain will fade overnight. Include specifics: date, time, task performed, body parts affected, and any witnesses. Seek medical care right away from an employer-approved provider if your state requires it, or from urgent care if you need immediate attention. In either setting, make sure the clinician records the work-related mechanism of injury. Ask for and keep copies of your initial report, incident forms, and any text or email exchanges about the event. Photograph the scene or equipment if relevant and safe to do so.
Those three steps often decide the fight over causation. I once represented a hospital cleaner with a quiet lumbar disc bulge she’d lived with for years. After she slipped on a wet floor and felt a sharp midline pinch, she sent a short email to her manager that evening, naming the time, the hallway, and the body part. That email was a life raft months later when the insurer tried to rewrite the facts. Without it, her claim would have struggled.
Talking to doctors when you have a history
Your words to the first provider echo throughout your case. When pre-existing conditions exist, consistency is vital. Be honest, but precise.
Describe your baseline before the event. “I had occasional stiffness after long shifts, maybe a two out of ten, and no numbness. Since the ladder slip, the pain is constant, six out of ten, with tingling into the left calf.” That contrast — before versus after — turns a vague pre-existing condition into a clear aggravation.
Bring the details the doctor rarely gets: the weight of what you were lifting, the repetitive frequency of your task, whether you twisted or heard a pop, the immediate symptoms, how long you had to sit or lie down before returning to work. Medical notes that capture a concrete mechanism of injury carry far more weight than a generic line reading “back pain at work.”
Do not minimize or omit your prior issues. Insurers obtain old records and surveillance far more often than most people expect. If you downplay prior care and they find a chiropractor’s note or MRI, your credibility becomes the issue instead of your injury. A straightforward timeline works best: “MRI in 2019, improved with PT, returned to full duty, no treatment for the last two years, new injury on April 12, 2025.” Straight, clear, verifiable.
The difference between a new injury and an aggravation
Some states treat “new injury” and “aggravation of a pre-existing condition” differently for benefits and apportionment. Even where the benefits are similar, insurers try to characterize injuries as a mere “flare” to narrow coverage. From a practical standpoint:
- A new injury is a distinct event causing new damage — for example, a previously normal shoulder sustains a rotator cuff tear while restraining a patient. An aggravation is a work event that worsens a known condition — for example, a line worker with prior mild carpal tunnel develops constant numbness and needs surgery after months of increased production quotas.
Doctors can struggle with this distinction when symptoms and imaging overlap. The question isn’t only what the MRI looks like, but how functional capacity changed and whether treatment you now need was unnecessary before the incident. A well-informed work injury lawyer will guide treating physicians on the legal definitions in your jurisdiction, so their charting speaks to the right standard.
Proving that work caused a meaningful change
Insurers love the phrase “degenerative changes consistent with age.” They’re not wrong that many adults have age-related changes on imaging. The key is showing that those changes were quiet, then became symptomatic or disabling because of work.
The tools that help most:
- A carefully documented pre-injury baseline. If you ran, biked, lifted your kids, or worked double shifts without issue, say that in medical visits. Objective findings after the incident: new weakness on exam, reduced range of motion, positive nerve tests, swelling, bruising, or surgical findings that match the mechanism. A tight timeline. Symptoms that begin immediately or within a short window after the event carry more weight than complaints that appear weeks later without documentation. Conservative care that fails in a predictable way: six to eight weeks of physical therapy with persistent deficits, or injections that provide partial, temporary relief before surgery becomes necessary. Work restrictions that weren’t needed before. A physician’s light-duty note shows real functional impact.
No single data point wins the day, but together they paint a picture that a claims adjuster, judge, or medical reviewer can’t easily dismiss.
Common traps and how to avoid them
I see the same pitfalls again and again. They’re easy to fall into when you’re in pain and juggling work, family, and appointments.
- Gaps in treatment. If you miss appointments for weeks, insurers argue that symptoms resolved. Call and reschedule promptly. If you can’t afford time off or lack transportation, say so to your provider so the record reflects the obstacle. Vague body part descriptions. If you report “back pain,” then months later add “hip and leg numbness,” the insurer may claim a new, unrelated issue. Name all affected areas early: low back centered at L4-L5 with radiation into the left hip and posterior thigh, for instance. If the pain pattern evolves, note when and how in your visits. Social media. Harmless photos can be misread. A picture of you holding a nephew for a minute becomes “lifting children at a party.” Adjusters and defense attorneys use this. Lock down your accounts and post with caution. Recorded statements without preparation. Adjusters are trained interviewers. They ask about prior injuries broadly and speed past the specifics of the workplace mechanism. You may give imprecise answers. It’s smarter to consult a workers compensation lawyer before any recorded statement. Returning to full duty too fast. Many dedicated workers push through pain. If your provider recommends restrictions, follow them. Working beyond restrictions risks both your health and your claim.
How prior medical records get used
Insurance carriers request and scrutinize years of your medical history. They look for anything that resembles the current injury, then argue this is the same issue. That doesn’t mean prior care hurts you. In many cases it helps to show a clean gap in treatment or a low baseline of symptoms before the new event.
What matters is context. If you had intermittent neck stiffness five years ago, treated with a few PT sessions, and were fine until a ceiling tile fell and caused cervical radiculopathy, the old chart can sharpen the contrast. A workers comp attorney can frame that narrative and ensure the doctors address it directly in their charting and reports.
Independent medical exams: what to expect
Sooner or later, most claimants face an “IME” — an independent medical examination, though “insurance medical exam” would be more honest. The physician is paid by the insurer and often examines you once. Many are fair, but a subset produce boilerplate opinions denying causation or downplaying impairment.
Approach the IME like a deposition. Be polite, consistent, and specific. Know your timeline: when symptoms began, what worsens them, what you could and couldn’t do before the incident. Bring a friend if permitted to witness the length and content of the exam. Afterward, write down what was asked and how long it took. If the IME report contains inaccuracies — for example, claiming you denied symptoms you clearly reported — your work injury attorney can confront it with records and, if needed, a rebuttal from your treating doctor.
Apportionment: dividing responsibility between old and new
Some states allow apportionment, which means splitting your permanent disability between pre-existing and current causes. Others don’t apportion to asymptomatic degenerative disease. When apportionment is in play, two strategies help:
- Emphasize that you were fully functional before the work event. If you had a documented release to full duty or years of symptom-free living, say so. Highlight the specific changes measured after the incident. New nerve conduction deficits, strength losses, or a surgical finding of acute tissue changes give doctors a factual basis to minimize apportionment to old, silent degeneration.
When a prior diagnosis was symptomatic close in time to the work event, expect an apportionment argument and fight it with precise timelines and credible medical analysis.
Restricted duty, job offers, and your paycheck
Once you’re on restrictions, your employer may offer modified work. Take it seriously, but do not accept tasks that violate medical limits. If you’re pushed to do more than allowed, put the request in writing and ask for clarification. If no suitable work exists, you may be eligible for temporary total disability benefits at a portion of your average weekly wage. The percentage and caps vary by state, but many systems pay around two-thirds of your pre-injury average up to a statutory maximum.
Average weekly wage calculations can be a battleground. Include regular overtime, shift differentials, and bonuses when the law permits. I’ve seen claims jump by several hundred dollars a week after correcting a miscalculated wage. A workers compensation law firm that lives in this space will spot these errors quickly.
When surgery enters the picture
Pre-existing conditions muddy surgical decisions. A surgeon may hesitate if imaging shows old and new issues blended together. Your job is atlantametrolaw.com to connect the dots. If conservative care failed and your symptoms match the mechanism of injury, ask the surgeon to address causation explicitly in the record. “In my opinion, within reasonable medical probability, the work event of June 3 aggravated the patient’s existing degenerative disc disease, causing radiculopathy that necessitates L4-L5 microdiscectomy.” That sentence, properly supported by exam and imaging, can carry a case.
Insurance utilization review may deny recommended surgery as “not medically necessary” or “not related.” Appeals exist in every state, with strict deadlines. A workers comp firm versed in utilization review can package the medical evidence tightly and escalate to an independent reviewer when allowed.
Light duty that isn’t light
Employers sometimes design “light duty” that satisfies policy but not your body. A common example: a desk assignment with no lifting, but hours of seated work without breaks for a lumbar injury. If restrictions specify positional changes every 30 minutes, enforce them. Ask for a written task list. If the job deviates from restrictions, notify HR and your treating provider in writing. Documented friction between job tasks and restrictions supports both additional care and wage loss if the assignment fails.
Settlements, timing, and medical rights
Most claims resolve by agreement at some point, either after reaching maximum medical improvement or earlier if uncertainty is high. Consider the trade-offs:
- Lump sum versus open medical. Some states allow closing out future medical rights for a higher lump sum; others keep medical open. If your condition likely needs intermittent care, future medical has real value. If surgery is still on the table, be wary of giving up medical rights unless the settlement truly covers probable costs. Vocational factors. Age, transferable skills, language proficiency, and physical restrictions affect settlement value, especially when returning to similar work isn’t realistic. Medicare interests. If you are a Medicare beneficiary or reasonably expect to become one within 30 months, Medicare’s interests must be considered. That often means a Medicare Set-Aside for future injury-related medical costs. A reputable workers compensation lawyer will walk through this and avoid settlements that jeopardize coverage.
The best settlements arrive after the medical picture stabilizes. Rushing to settle while still bouncing between therapies and opinions tends to reward the insurer’s uncertainty strategy.
When you need a workers comp lawyer
Not every claim requires counsel, but the ones involving pre-existing conditions often benefit from early representation. A good workers comp attorney is part translator, part strategist, part bulldog. Here’s where I’ve seen a work injury attorney make a decisive difference:
- Framing causation to fit your state’s legal standard and coaching treating doctors to address it. Managing competing medical narratives between prior providers and current specialists. Securing accurate wage calculations and pushing back on lowball temporary disability rates. Navigating utilization review, IMEs, and panel lists to keep care moving. Protecting against overbroad recorded statements and intrusive medical record fishing. Timing settlement to maximize value and preserve medical coverage where needed.
Cost worries keep some workers from seeking help. In most states, fees are contingency-based and require approval by a judge or agency, typically a capped percentage of the recovery. Consultations are often free. If your claim involves a pre-existing condition and a contested denial, waiting tends to widen the insurer’s advantage.
Real-world examples that mirror common disputes
A school custodian with a history of mild knee osteoarthritis slips on a freshly mopped hallway and hears a crack. The ER X-ray shows arthritis, and the adjuster denies an MRI, calling it “pre-existing.” Her attorney obtains a detailed note from the treating orthopedist describing new effusion, joint line tenderness, and a positive McMurray sign, then secures an MRI showing a meniscal tear. The record now distinguishes between chronic OA and an acute tear from the slip. The claim reverses course. Surgery is approved, and temporary benefits are paid for time off.
A delivery driver with intermittent low back pain adds a new route with double the stair climbing. After six weeks, he develops numbness down the right leg and foot weakness. Imaging shows multilevel degeneration and a new disc herniation at L5-S1. The insurer argues “degenerative.” The timeline, objective motor deficit, and task increase create a straight line from work to symptoms. A well-drafted treating note using the phrase “major contributing cause” matches the state standard, tipping the scales.
An assembly worker with prior mild carpal tunnel controlled by night splints begins mandatory overtime. Within two months, she can’t button shirts, drops items, and wakes nightly. Nerve studies reveal worsened median neuropathy. The insurer wants to apportion most impairment to the prior diagnosis. Her attorney highlights the long symptom-free period and the spike in repetitive hours, arguing limited apportionment because the prior condition was stable and minimally symptomatic. The judge agrees, apportioning a small fraction and awarding permanent partial disability largely to the new aggravation.
Documentation that earns respect
Your claim is a story told through records. Make sure the story is coherent and supported.
- Keep a simple injury journal for the first three months: pain levels, activities that provoke symptoms, missed workdays, and any tasks you can no longer perform. Short entries beat long essays. Save every work restriction note and any emails about modified duty. If your supervisor assigns tasks outside restrictions, note date, time, and task. Track mileage and out-of-pocket costs for medical travel and prescriptions, if your state reimburses them. If language is a barrier, insist on interpreters in medical appointments and keep the interpreter’s name in your notes.
These mundane details become persuasive when a claim drifts into “he said, she said.”
State differences that affect your path
The workers’ compensation system is state-specific. A few variables that change your strategy:
- Causation standard. Some states require work to be the major contributing cause; others accept material contribution. The stricter the standard, the more important objective findings and explicit medical opinions become. Choice of physician. In some places you can select your own doctor; elsewhere you must choose from a panel. Independent, experienced occupational medicine or orthopedic specialists who understand workers comp can make or break a claim. Waiting periods and wage caps. Temporary disability benefits often start after a short waiting period unless you miss more than a set number of days. Maximum weekly rates can cap your benefits even if you earned more. Permanent disability systems. Some states use impairment ratings; others use wage-loss models. If you have a pre-existing impairment, apportionment rules vary widely.
A local workers compensation lawyer or workers compensation law firm brings the nuance that a general overview can’t, especially when pre-existing issues are front and center.
When returning to work isn’t straightforward
Some injuries don’t neatly resolve. Maybe you can perform lighter tasks but not your old job, or only part-time. Many states offer vocational rehabilitation or retraining benefits when a work injury prevents you from returning to your prior occupation. Don’t ignore these resources. A modest course in CAD software, forklift certification, or medical coding has moved clients from dead ends into sustainable roles. Once you reach maximum medical improvement and restrictions look permanent, ask your work injury attorney about vocational options before signing any settlement that closes doors.
The human side of a contested claim
A denied claim weighs on people. I’ve seen the frustration of being called a malingerer when you’ve never missed a shift. I’ve also watched careful, steady claimants earn credibility over time. Consistent attendance at appointments, respectful communication with supervisors and adjusters, and patience with the slow pace of the system all add up. Judges and independent reviewers notice when the record reflects a worker doing everything right in the face of hurdles.
Pre-existing conditions complicate, but they don’t erase your rights. The law recognizes that degenerative spines and shoulders are the norm, not the exception. What matters is whether work turned the dial — and how well your records, providers, and advocates capture that change.
A compact roadmap you can follow
- Report the incident in writing the same day, naming the task and body parts. Seek prompt care and ensure the notes tie symptoms to the work event. Describe your pre-injury baseline and the post-injury changes with specifics. Follow restrictions, avoid treatment gaps, and document modified-duty issues. Consult a workers comp lawyer early if you have any history in the affected area or if the insurer hesitates on authorization.
If you’re navigating this now, you don’t have to do it alone. A seasoned workers comp attorney or work injury attorney will help you line up the facts, speak the system’s language, and keep medical care moving. The goal is simple, even if the path isn’t: the right treatment, fair wage support while you recover, and a return to safe work or a settlement that respects what you’ve lost.