Why is objective medical proof essential in pre‑existing condition claims?
An old back injury shouldn’t disqualify someone from seeking help if their job exacerbates it. Still, many injured workers hesitate to file a claim when an existing condition is involved. There's a common misconception in Ohio that if an injury isn’t completely new, it doesn’t qualify for workers' compensation. But that’s not how the law works.
Ohio’s workers’ compensation system does allow coverage for pre-existing conditions, but only when there’s clear evidence that work activities substantially aggravated the condition. For injured workers across Dayton, Cincinnati, Springfield, Troy, and beyond, understanding how the system handles these situations can make the difference between receiving benefits and getting denied.
How Ohio Law Treats Pre-Existing Conditions
A pre-existing condition can be anything from a past injury to a chronic illness or degenerative disease. This could include prior back surgery, joint problems, arthritis, or a repetitive stress injury that existed before the current job.
Under Ohio Revised Code § 4123.01(C)(4), a pre-existing condition may be covered by workers’ compensation if it was substantially aggravated by a work-related event or activity. The law does not require a worker to be in perfect health before an injury occurs, but it does require objective medical evidence that the condition measurably worsened due to the job.
This means that general pain, soreness, or temporary discomfort isn’t enough. There must be documented proof—such as an MRI, imaging report, or physician’s evaluation—demonstrating a structural or functional change caused by job duties.
Certain conditions are more commonly accepted in aggravation-related workers’ compensation claims, especially when supported by clear medical records and workplace documentation. Some of the most frequently qualifying conditions include:
- Degenerative Disc Disease: Often aggravated by heavy lifting or repetitive bending.
- Herniated or Bulging Discs: These conditions can worsen with physical labor, vibration, or impact.
- Arthritis (Osteoarthritis or Rheumatoid): May be aggravated by prolonged standing, kneeling, or repetitive motion.
- Old Knee or Shoulder Injuries: Prone to reinjury through falls, lifting, or overuse.
- Carpal Tunnel Syndrome: Can flare or worsen with repetitive hand and wrist movement.
- Chronic Back or Neck Pain: Often aggravated by physical strain, poor ergonomics, or trauma.
- Joint Replacements: Including knees, hips, or shoulders, which can be compromised by continued physical labor.
These conditions don't disqualify a worker from receiving benefits — in many cases, they are the very reason a claim exists. But proving that work caused a measurable aggravation is essential. That’s where strong medical documentation — and legal support from an experienced workers' compensation lawyer — can make the difference.
Aggravation vs. Flare-Up: Why It Matters
There’s a legal difference between an aggravation and a flare-up, and it matters. A flare-up refers to a temporary increase in symptoms without a lasting or structural change. A substantial aggravation, on the other hand, is a documented and measurable worsening of the underlying condition.
For example, a factory worker with existing knee arthritis who suffers a fall at work may need surgery or experience a permanent increase in pain and loss of function. That could qualify as a substantial aggravation—if there is medical evidence to support it. Without that, the claim is likely to be denied as a natural progression of the existing condition.
Insurance companies often use this distinction to deny claims, arguing that the injury would have gotten worse anyway. That’s why documentation — and the right legal guidance — can be so important.
What Types of Injuries Are Not Covered?
While many workers’ comp claims involving pre-existing conditions are legitimate, not every injury qualifies. Ohio law excludes certain injuries from coverage, particularly those that are not directly related to job duties.
Some of the most common non-compensable injuries include:
- Injuries Caused by Drug or Alcohol Use: Claims are typically denied if impairment contributed to the accident.
- Injuries Resulting from Policy Violations: Misconduct or violation of workplace rules can result in a claim being disqualified.
- Unrelated Pre-Existing Conditions: If the condition wasn’t worsened by work, it isn’t covered.
- Short-Term Illnesses: Common colds, the flu, or non-occupational viruses don’t qualify.
- Self-Inflicted Injuries: Injuries caused intentionally are excluded.
- Off-Site Injuries Unrelated to Job Duties: If an injury happens outside of work and isn’t job-related, it may not be covered.
In some cases, an injured worker may also have a third-party claim, particularly if faulty equipment or negligent contractors were involved. These claims may allow for additional compensation beyond workers' compensation, but determining eligibility often requires a legal review.
Proving That Work Caused the Aggravation
Claims involving aggravated conditions depend heavily on medical evidence. It’s not enough to say that a condition worsened — there must be proof that the work directly caused the worsening.
To support this kind of claim, injured workers typically need:
- A clearly documented incident or identifiable work activity that caused the aggravation.
- Medical imaging or testing (e.g., MRI, X-rays) showing a change from the baseline condition.
- Physician support that connects the aggravation to job duties.
- Evidence that the worsening was not due to natural progression alone.
The opinions of treating doctors, independent medical examiners, and specialists can all play a role in determining the outcome. However, inconsistencies in documentation or vague statements from physicians are often used by insurers to deny benefits. That’s why a well-prepared, fact-driven claim is key.
Why These Claims Are Often Denied
Claims involving pre-existing conditions are more likely to face resistance from insurance companies. Adjusters may argue that:
- The condition was not worsened by work.
- The worker had these symptoms before.
- The change was due to aging or natural progression.
- The medical records don’t support the claim.
Many valid claims are denied simply because of poor documentation or a lack of a clear legal strategy. That doesn’t mean the case is over. With the right medical support and legal help, a denied claim can often be appealed and approved.
We Help Injured Ohio Workers Get The Benefits They're Entitled To
If you have a pre-existing condition that’s been made worse by your job, you may still be entitled to workers’ compensation benefits. Ohio law allows for claims based on the substantial aggravation of an existing injury; however, proving such a claim isn’t simple. These cases often require strong medical evidence and a clear connection between your job duties and the worsening of your condition.
At Hochman & Plunkett Co., L.P.A., our workers' compensation attorneys represent injured workers in Dayton, Cincinnati, Springfield, Troy, and throughout Ohio in fighting for the benefits they’re owed. Our team knows how to build strong aggravation claims, challenge denials, and collaborate with your doctors to obtain the necessary documentation for your case.
If your job has made an old injury worse, don’t try to handle the workers' compensation process on your own. Contact us for a free consultation. We’ll take your claim seriously — and fight for the outcome you deserve.
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