Key Takeaways
- A workers' compensation claim can still succeed even if you have a preexisting condition, such as arthritis.
- In Missouri and Kansas, your work accident or job duties generally must be the prevailing factor in causing your injury and need for treatment.
- Insurance companies often deny repetitive trauma claims by blaming preexisting conditions, but additional medical evidence can change the outcome.
- If your workers' compensation claim has been denied, obtaining a second legal opinion may uncover options you didn't know you had.
Why Workers' Compensation Claims Are Often Denied
One of the most common reasons workers' compensation claims are denied in Missouri and Kansas is that the insurance company argues that a worker's pain is caused by a preexisting condition rather than the job itself. While that argument may sound convincing, the presence of arthritis or another existing condition does not automatically prevent someone from receiving benefits.
Under both Missouri and Kansas law, work accidents or repetitive work activities generally must be the "prevailing factor," or primary cause, of the injury and the need for treatment. Just because arthritic changes or another preexisting condition exists, however, does not mean a worker cannot suffer a new work-related injury. This is often where experienced workers' compensation attorneys can make a significant difference.
One Firm Punted, But We Scored for Our Client
We recently wrapped up a claim where our client had originally hired a different firm that is often seen on television ads. He performed repetitive and strenuous work for years and eventually developed tremendous shoulder pain. He was diagnosed with rotator cuff tears in both shoulders along with advanced arthritis.
His workers' compensation claim was denied and, after the initial evidence didn't go in his favor, the original law firm simply withdrew from the case and returned his file. Our client then underwent both shoulder replacement surgeries while relying on expensive health insurance and using valuable sick leave to cover his recovery.
Looking Beyond a Preexisting Condition
When our client brought his file to us, we decided to dig deeper.
Just because someone has significant preexisting arthritis does not mean strenuous work did not also cause legitimate injuries. We worked closely with our client's treating surgeon, carefully outlining the medical history and asking the right questions. Ultimately, the surgeon agreed that our client's repetitive work activities likely caused the bilateral rotator cuff tears.
Even without the arthritis, these work-related injuries required medical treatment and supported permanent partial disability benefits. Armed with stronger medical evidence, we continued negotiating with the insurance company as the claim moved closer to trial.
The Result
Ultimately, the insurance company agreed to pay an appropriate settlement for our client's work injuries. The recovery more than covered his medical co-pays, deductibles, and lost wages during his time away from work.
Had our client accepted the conclusions of the first law firm, he likely would have been left paying thousands of dollars out of pocket. Instead, he trusted his instincts, sought a second opinion, and obtained the compensation he deserved.
We're grateful he didn't give up, and we're honored we had the opportunity to help make things right.
Frequently Asked Questions
Can I receive workers' compensation benefits if I already have arthritis?
Yes. Having a preexisting condition such as arthritis does not automatically prevent you from receiving workers' compensation benefits. If your work activities caused a new injury or significantly contributed to your condition, you may still have a valid claim under Missouri or Kansas law.
What does "prevailing factor" mean in a workers' compensation case?
The prevailing factor is the primary cause of your injury and need for medical treatment. Insurance companies often argue that a preexisting condition is responsible for a worker's symptoms, but medical evidence may show that the work injury was actually the prevailing factor.
Should I get a second opinion if my workers' compensation claim has been denied?
Absolutely. A denial does not always mean your case lacks merit. As this case demonstrates, additional medical evidence and a different legal strategy can completely change the outcome of a workers' compensation claim.
A Denied Claim Doesn't Have to Be the Final Answer
Our client refused to give up after another law firm walked away from his case, and that decision made all the difference.
If you've been told your workers' compensation claim isn't worth pursuing, let us take a second look. Our team has experience handling complex workers' compensation claims involving preexisting conditions, repetitive work injuries, and disputed medical evidence. Contact Haight Stang, LLC today to discuss your case and explore your legal options.