Doctor looking a spinal injury x-ray

Workers' Compensation Denied My Claim - Called it a Preexisting Condition

Kevin Holmes Aug. 22, 2019

If you got hurt at work, you've probably been told that you were covered. Your employer's Workers' Compensation Insurance plan is there to provide you with medical coverage and treatment for your injuries, money for your missed time at work, and compensation for any permanent injury you suffered.

Your employer wants you take care of. Your employer wants you to be back at work as soon as possible so you can get back to doing the job you were hired to do. That's why your employer buys Workers' Comp insurance and pays the premiums.

The problem, though, is that your employer's Workers' Compensation Carrier does not want you taken care of.

Insurance companies make money by taking in premiums. They lose money when they have to pay money out for claims. The math is simple, and so are the incentives. Pay fewer claims, pay less on those claims, make more profit.

One common way Workers' Compensation insurance carriers deny claims wrongfully is by claiming a worker's injury is a preexisting condition. This is especially common in back injuries. Everyone has a small amount of congenital or "ordinary" degenerative change in their spine. But when that MRI comes back to the doctor showing a little of those "expected" changes along with the actual injury you suffered at work, the insurer sees an opportunity for a denial.

The problem, though, is that a claim like that should not be denied.

Workers' Compensation insurance must cover workplace injuries that are causally related to the workplace accident. That obviously means the injury you can tell was caused by the accident. But that also means that if you have a preexisting condition (like a bad knee, a bad back, or a bad hip) and the workplace accident makes that preexisting condition worse or makes it start to hurt when it didn't hurt before (or hurt more than it used to), the claim should still be covered.

Most workers don't know that, of course, because most workers don't know the law for Workers' Compensation.

Workers' Compensation insurance companies are counting on that fact, and they use it to unfairly deny claims so they don't have to pay what the worker is entitled to by law.

The way to fix this unfair denial is to aggressively push back against the insurance company and gather the medical evidence needed to prove your claim. That often means deposing doctors under oath, reviewing complicated medical records, and seeking testimony or documents from the insurance company's adjuster.

All of those actions should be done by a trained New Mexico workers' compensation attorney.

If the insurance company has denied your claim by calling it a preexisting condition, you should contact us immediately.

We know the law, and we know what to do to evaluate your case, gather up the medical evidence to prove your claim, and win in court.

If workers' comp denied your claim due to a preexisting condition, reach out now to schedule a free initial consultation with a New Mexico Workers' Compensation lawyer. Your appointment will be with a lawyer, not an intake specialist, and you'll have the chance to explain your claim and see if we can help.

There's no fee for the consult, no fees up front, and no fee unless we get you benefits. And under certain circumstances, a Workers' Compensation Judge may order the insurance company to pay 100% of your lawyer's fee. That means you may owe nothing for legal services.