How Pre-Existing Conditions Impact Workers' Compensation Claims in New Jersey
Having a pre-existing condition does not disqualify you from workers' compensation in New Jersey. If your job duties or a workplace accident aggravates or worsens your old injury, you are fully entitled to medical treatment and benefits for that exacerbation.
One of the most common tactics insurance companies use to deny workers' compensation claims in New Jersey is blaming the injury on a pre-existing condition. If you hurt your back lifting a box at work in Elizabeth, Hackensack, or Edison, the insurer might dig through your medical records, find a chiropractor visit from five years ago, and claim your current pain is just an old problem. This is a deliberate strategy to save money. New Jersey law fiercely protects workers with prior injuries, but successfully fighting an insurer's denial requires the help of an experienced attorney from our US Lawyers Directory.
Aggravation and Exacerbation of Prior Injuries
In New Jersey, you take the employee as you find them. This legal concept means an employer cannot avoid liability simply because a worker had a weak back or old sports injury. If a workplace accident-or the repetitive physical stress of your daily job duties-aggravates, accelerates, or exacerbates a pre-existing condition, the claim is compensable. The landmark decision in Verge v. County of Morris, 272 N.J. Super. 118 (NJ App. Div. 1994) solidified that employers are responsible for the worsening of a condition, even if the underlying condition was non-work-related.
Understanding Apportionment by Insurers
While you are entitled to treatment, the financial payout for permanent disability is handled carefully. Under N.J.S.A. § 34:15-12(d), New Jersey applies a rule called apportionment. If a judge determines that you currently have a 40% disability in your knee, but medical records prove you already had a 15% disability in that same knee before the work accident, the current employer's insurance company only has to pay you for the 25% difference. Insurers will fight aggressively to prove your previous disability was as high as possible to reduce their payout.
The New Jersey Second Injury Fund
If a new workplace injury combines with a severe pre-existing condition to render you completely and permanently unable to work, it would be unfair to force the current employer to pay for total lifetime disability. To solve this, the state created the Second Injury Fund under N.J.S.A. § 34:15-95. In these rare cases, the current employer pays a portion, and the state fund steps in to pay the remaining weekly benefits for the rest of your life. Your lawyer will need to file a Form SIF-1, New Jersey, Division of Workers' Compensation, Verified Petition for Second Injury Fund Benefits with the New Jersey Department of Labor and Workforce Development, Trenton.
Degenerative Disc Disease and Spinal Injuries
Almost everyone over the age of 40 has some level of Degenerative Disc Disease (DDD) visible on an MRI, even if they have zero back pain. Insurance adjusters frequently use DDD to deny back injury claims, calling the injury simply "the natural aging process." To win, your attorney will rely on your treating doctors to testify that the specific workplace accident was the trigger that made the previously silent DDD symptomatic and painful.
Arthritis in Aging Manual Laborers
Similar to DDD, arthritis is common among manual laborers, construction workers, and warehouse employees. If you suffer a joint injury, the presence of arthritis does not kill your claim. The legal standard is whether the workplace incident materially worsened the arthritic condition beyond its normal, natural progression. If it did, you are entitled to physical therapy, surgery, and compensation at the New Jersey Division of Workers' Compensation, Elizabeth.
Proving Your Current Injury is Work-Related
Defeating a pre-existing condition denial requires strong medical evidence.
- Step 1: Be Honest. Never lie to the workers' comp doctor about prior injuries. If you hide an old injury, the judge can deny your entire claim for fraud.
- Step 2: Highlight the Change. Explain exactly what you could do before the accident (e.g., "I played softball every weekend") versus what you can do now.
- Step 3: Secure an Independent Medical Exam (IME). Your attorney will hire a neutral doctor to examine you and write a report confirming that the workplace accident caused the current aggravation.
- Step 4: Subpoena Old Records. Your lawyer will use your old medical records to prove that your prior condition was stable and not requiring treatment before the work accident occurred.
Costs and Timeline
As with all New Jersey workers' compensation cases, there are no upfront attorney fees. Lawyers take a maximum of 20% of your permanent disability award. Cases involving complex medical histories and apportionment arguments often take longer than straightforward cases. You can expect the litigation process to take 12 to 24 months, as doctors for both sides will need to review years of medical history before reaching a conclusion.
Frequently Asked Questions (FAQ)
Will workers' comp pay to treat my old injury?
They will not pay to treat the original baseline injury, but they are fully responsible for all medical treatments-including surgeries-necessary to fix the aggravation or worsening caused by your job.
What if my old injury was from a previous employer?
It does not matter where the old injury occurred. Whether it was from a car crash, a sports injury, or a previous job, your current employer is responsible for any new aggravation.
Can they fire me because I have a pre-existing condition?
No. Firing an employee simply because they have a pre-existing condition or because they filed a workers' compensation claim for an aggravation is illegal and constitutes retaliation under New Jersey law.
Do I need to sign a medical release for the insurance company?
While you generally must allow the insurer access to medical records related to the injured body part, you should never sign a blank authorization form. Have your attorney review it to ensure they don't improperly access unrelated medical history.
No reviews yet. Be the first to share your experience!