Georgia’s workers’ compensation system is designed to provide benefits to employees who suffer job-related injuries or illnesses. However, pre-existing conditions can complicate these claims, raising important questions about the extent of benefits an injured worker can receive. In Georgia, the system covers medical treatment, wage replacement, rehabilitation services and disability benefits and operates on a no-fault basis, meaning employees do not need to prove employer negligence to receive benefits. Instead, they must demonstrate that the injury or illness occurred in the course of their employment.
A pre-existing condition is any health issue that existed before the work-related injury or illness. Common examples include chronic conditions such as arthritis, back pain, heart disease or previous injuries and can make it more challenging to determine the cause and extent of the injury.
Under Georgia law, an employee with a pre-existing condition is still eligible for workers’ compensation benefits if a work-related injury aggravates that condition. This is known as the “aggravation rule.” According to the Georgia State Board of Workers’ Compensation, an aggravation of a pre-existing condition is considered a new injury, making the employee eligible for benefits. However, the employee must prove that the workplace incident exacerbated the pre-existing condition.
Key factors in aggravation claims
Topping the list of critical elements to successfully proving an aggravation claim is timeliness. Any delay in reporting an injury or illness to an employer or in seeking medical treatment can adversely affect an aggravation claim. Medical evidence and documentation also are crucial. Employees must provide detailed medical records that clearly distinguish between the pre-existing condition and the new injury. Ongoing medical treatment and follow-ups are necessary to demonstrate the progression and impact of the work-related aggravation on the pre-existing condition.
Common challenges
Even the simplest of workers compensation claims can be difficult to prove and it’s made all the more complex by pre-existing conditions. Defense attorneys and their employer clients know this and will undoubtedly rely on several common challenges.
- Employer and insurer skepticism: Employers and insurance companies may be skeptical of claims involving pre-existing conditions, often arguing that the pre-existing condition, not the workplace injury, is the primary cause of the employee’s current health issues.
- Proving aggravation: Demonstrating that a workplace incident significantly aggravated a pre-existing condition can be challenging. It requires comprehensive medical evidence and often the testimony of medical experts.
- Changes in condition: An aggravation of a pre-existing condition can return to baseline after treatment. When this happens, benefits may be stopped due to a change in condition.
Legal protections for injured workers
Georgia law provides protections for workers with pre-existing conditions to ensure they receive fair compensation. Employers cannot deny workers’ compensation benefits solely because the employee has a pre-existing condition. As long as the employee can prove that their work exacerbated a pre-existing condition, they are entitled to full workers’ compensation benefits for the new injury.
Given the complexities involved in workers’ compensation claims with pre-existing conditions, securing experienced legal representation is vital. A knowledgeable attorney can help gather all the necessary incident and medical evidence documentation to support the claim, expertly negotiate with insurance companies or opposing counsel and effectively represent your interests in court hearings or at trial.
At Farrar, Hennesy, and Tanner, we specialize in handling complex workers’ compensation claims, including those involving pre-existing conditions. If you’ve suffered a work-related injury that aggravated a pre-existing condition, we can help. Call 912-384-2287 or visit our website to schedule your free case review online today.
SEE ALSO:
The Importance of Legal Representation in Workers’ Compensation Cases