Can Pre-Existing Conditions Affect Your Workers' Compensation Claim?
Whether it’s a bad back from years ago, an old knee surgery, or chronic asthma, many people hesitate to file a claim because they think their past medical history disqualifies them. But the truth is, having a pre-existing condition doesn’t automatically block your claim—it just means the process may involve a few more steps and require strong documentation.
If you're dealing with a workplace injury that aggravated or worsened a previous medical condition, you still have rights. Workers' compensation laws in California are designed to protect employees from work-related injuries, even when those injuries interact with existing medical conditions.
At The Law Office of Cezar J. Torrez, we’ve spoken to many clients in Sacramento, California, who worry that a prior injury or chronic health issue might prevent them from receiving benefits through workers' compensation. With guidance, preparation, and persistence, we can help you pursue the benefits you deserve.
How Workers' Compensation Applies to Pre-Existing Conditions
When we file a workers' compensation claim, the insurance company will almost always ask if we’ve had any similar injuries in the past. This isn’t unusual—it’s how they determine whether the injury is new or an aggravation of a previous condition. In California, benefits are available even if the work incident only aggravated or accelerated an existing injury.
The legal term for this is “aggravation of a pre-existing condition.” If work made a prior injury worse, that worsening can still be covered. However, proving it requires showing that the job duties contributed significantly to the decline or flare-up.
Common Pre-Existing Conditions That May be Aggravated By Work:
Chronic back pain or herniated discs
Arthritis in the knees, hips, or shoulders
Old fractures or joint injuries
Asthma or respiratory problems
Repetitive strain injuries like carpal tunnel
These conditions are not a disqualifier. They're just part of a bigger picture we help build when filing your workers' compensation claim.
What Insurers Often Argue About Pre-Existing Conditions
Insurance companies often use pre-existing conditions as a defense to reduce or deny claims. They may argue that our current symptoms aren’t work-related but stem entirely from a past injury. This is one of the most common pushbacks we face, but it’s not insurmountable.
We work to gather evidence that shows how your condition changed after the workplace injury. If you were managing your arthritis just fine until a job-related incident worsened it, that change is key to proving your case.
Tactics Insurers Use When Dealing With Pre-Existing Conditions:
Claiming the condition existed long before the current injury
Requesting older medical records to find evidence of prior treatment
Hiring independent medical examiners to dispute your diagnosis
Arguing that work activities didn’t significantly contribute to the issue
It’s frustrating, but we don’t have to face this alone. With the right documentation and legal approach, we can push back and prove what happened.
Transitioning From Medical History to Medical Evidence
To successfully argue a claim that involves a pre-existing condition, we need to focus on what changed medically after the workplace event. Doctors, imaging tests, and medical records become essential tools in this part of the process.
A doctor’s opinion can carry a lot of weight if it explains how work worsened an existing condition. For example, if your physician states that a fall at work made a previously stable back injury unstable, that kind of statement supports a workers' compensation claim even if your injury wasn’t brand new.
Evidence That Can Support Your Claim:
Recent MRI or X-ray results
Doctor’s progress notes describing new symptoms
Testimony from your treating physician
Witness accounts of the work incident
Job duty descriptions that show physical strain
When these details are laid out clearly, they help show how the workplace played a role in the worsening of your condition.
How Benefits May Be Adjusted
California law requires doctors to “apportion” the cause of a disability between the work injury and any non-work-related causes, including pre-existing conditions. Apportionment means dividing the blame, in percentages, between the job and your past condition.
This doesn’t mean you won’t get benefits—it just means your workers' compensation payout might be adjusted. For example, if a doctor believes that 70% of your current injury is due to a work incident and 30% is due to an old injury, your benefits may reflect that breakdown.
Key Points About Apportionment:
It only affects permanent disability benefits
Temporary disability is generally not reduced
Doctors must clearly explain how they determined percentages
Disputes over apportionment can be challenged
We often help clients challenge unfair apportionment reports. If we believe a doctor’s opinion doesn’t reflect the reality of your condition, we can seek a second opinion or take legal action to correct the record.
The Value of Full Disclosure
Some people think it’s better not to mention a prior injury when filing a claim, but withholding information can backfire. If the insurer discovers a past injury you didn’t disclose, it could damage your credibility and hurt your case.
That’s why we encourage full transparency from the beginning. Pre-existing conditions don’t disqualify a workers' compensation claim, but leaving them out or trying to hide them can make things worse.
Why Honesty Is Critical During Your Claim:
Your medical records will reveal previous treatment
Insurance companies investigate claims thoroughly
Doctors need to know your history to give accurate diagnoses
Courts look more favorably on claimants who are upfront
Being open allows us to build a stronger case—one that’s backed by truth and supported by evidence.
Working With the Right Medical Providers
Your treating doctor plays a central role in your workers' compensation case, especially when a pre-existing condition is involved. In California, injured workers are often assigned to a Medical Provider Network (MPN), but in some cases, we can help you select a physician who understands how to document changes in your condition.
The key is having a doctor who knows how to distinguish between a baseline level of pain and the worsening caused by your job. This medical insight is often what tips the scales in a case involving pre-existing conditions.
What to Look For in a Treating Doctor:
Experience with workers' compensation cases
Willingness to review past and current medical records
Ability to clearly explain causation and apportionment
Strong communication skills with legal firms
We work closely with medical providers who understand how to support a valid claim, especially when the case isn’t black-and-white.
How Job Duties Can Expose Weak Points
Even if you’ve lived with a condition for years, some job duties can push your body beyond its limit. Lifting, climbing, repetitive motions, or standing for long hours can all cause flare-ups of old injuries.
That’s why describing your job accurately is so important. If your tasks aggravated a prior injury, we want to show exactly how and why. Workers' compensation law recognizes that a job can turn a manageable condition into a disabling one.
Physical Tasks That Commonly Worsen Old Injuries:
Lifting heavy boxes
Operating vibrating machinery
Repetitive typing or mouse use
Standing or walking for extended periods
Bending, twisting, or reaching overhead
We can help you put together a clear narrative that connects the dots between what you do at work and how your condition worsened.
When to File and What to Expect
Timing matters in workers' compensation claims. California requires that you report a workplace injury within 30 days, and you must file a claim within one year of the injury. Even if your injury developed over time, that one-year clock typically starts when you first notice symptoms.
If you wait too long or don't report your injury properly, the insurer may deny your claim outright. That’s why it’s important to take action as soon as possible—even if you're unsure whether the condition qualifies.
Filing Tips for Claims Involving Pre-Existing Conditions:
Report symptoms to your employer right away
Keep a copy of the report for your records
Visit a doctor promptly and describe both your job and your condition
Be honest about your medical history
Contact a workers' compensation attorney to guide you through the process
Being proactive can make all the difference between a claim that's approved and one that's denied.
How an Experienced Attorney Can Help You
We’ve helped countless clients in Sacramento whose claims were questioned or denied because of pre-existing conditions. At The Law Office of Cezar J. Torrez, we know how insurance companies operate—and we know how to push back.
From reviewing your medical records to challenging apportionment reports and representing you in court, we’re here every step of the way. Cezar J. Torrez brings both skill and compassion to every case, and we’re committed to fighting for the benefits you deserve.
What We Do to Support Your Case:
Gather and organize your medical evidence
Worked with doctors to develop accurate reports
Challenge unfair denials or reductions
Represent you at hearings or depositions
Guide you through each stage of the claims process
You don’t have to figure this out alone. We’ll stand by your side and help you understand your rights—and how to protect them.
Contact The Law Office of Cezar J. Torrez Today
Pre-existing conditions can add a layer of challenge to a workers' compensation claim, but they don’t eliminate your right to seek benefits. If your job made a past injury worse or turned a manageable condition into a disabling one, we can help. We proudly serve clients in East Sacramento, Oak Park, South Natomas, North Sacramento, West Sacramento, North Natomas, Arden-Arcade, Rosemont, Lemon Hill, Pocket, and Riverview. Call The Law Office of Cezar J. Torrez today.