Workers’ Compensation for Pre-Exisiting Injuries in Missouri

What Happens When a Pre-Existing Injury Is Made Worse by a Workplace Accident?

Getting hurt at work is complicated enough when you were completely healthy before the accident. Things can become much more confusing when the workplace accident affects a part of your body that was already injured.

Maybe you hurt your lower back several years ago and occasionally dealt with pain, but you were still able to work. Then you lifted something heavy at work and suddenly your back became much worse.

Perhaps you had knee surgery in the past, returned to your normal activities, and later fell at work and damaged the same knee again.

Or maybe you had an old shoulder injury that had not bothered you for years until a workplace accident caused the symptoms to return.

One of the first concerns workers have in these situations is whether the old injury prevents them from receiving workers’ compensation benefits.

A pre-existing injury does not automatically prevent you from having a Missouri workers’ compensation claim. What matters is what happened at work, the medical evidence, and the relationship between the new workplace accident and your current condition.

The existence of an old injury can make a claim more complicated, however. Employers and insurance companies may closely examine your previous medical history and question how much of your current condition was actually caused by the workplace accident.

Understanding how these claims work can help you avoid assuming that an old injury means you have no case.

A Pre-Existing Condition Does Not Automatically Disqualify You

Workers do not arrive at a job with brand-new bodies.

People have old sports injuries, previous surgeries, arthritis, back problems, knee problems, prior car accident injuries, and countless other medical conditions. Some workers have previously filed workers’ compensation claims. Others have conditions that developed outside of work.

Having a medical history does not automatically mean that a later workplace injury is irrelevant.

Missouri workers’ compensation law focuses on whether there is a compensable work-related injury and what disability or need for treatment results from it.

Under Section 287.140 of the Missouri Revised Statutes, an employer is required to provide medical, surgical, chiropractic, hospital, and other treatment that may reasonably be required to cure and relieve an employee from the effects of a covered injury.

The important issue in a pre-existing condition case is often determining what effects are attributable to the new workplace injury.

That question can become heavily dependent on medical records and medical opinions.

What Does It Mean to Aggravate a Pre-Existing Injury?

An aggravation occurs when something happens that makes an existing condition worse.

Consider an employee who injured his lower back five years ago. He completed physical therapy, returned to work, and had occasional stiffness but no major limitations.

One day at work, he is moving a heavy piece of equipment when he feels a sudden sharp pain in the same area. Over the next several days, the pain becomes severe and begins radiating into his leg.

The fact that his back had been injured before does not answer whether the workplace incident caused a new problem or worsened the existing one.

The medical questions might include:

• What was the employee’s condition immediately before the accident?
• What symptoms existed before the workplace incident?
• Did the employee have work restrictions before the accident?
• Did the symptoms change after the accident?
• Do new diagnostic tests show a change in the condition?
• Did the employee require new or additional treatment?
• Is the employee now unable to perform work that he could perform before the accident?

These details can help distinguish an old medical problem from the effects of a new workplace accident.

Your Condition Before the Accident Can Be Extremely Important

In many cases, the most useful comparison is not simply between an old MRI and a new MRI.

It is the difference between what you could do before the accident and what you can do now.

Suppose you had a herniated disc diagnosed six years ago. That sounds significant when someone reads it in a medical record.

But what if you had not received treatment for your back in four years? What if you were working 50 hours a week in a physically demanding job? What if you regularly lifted heavy objects and had no work restrictions?

Then a workplace accident occurs, and afterward you cannot sit for more than 20 minutes, cannot lift more than 10 pounds, need injections, and eventually require surgery.

The old diagnosis is still relevant, but it is not the entire story.

Your actual functioning before and after the accident may provide important context for the medical evidence.

This is one reason a workers’ compensation case involving a pre-existing condition should be evaluated based on the complete history rather than a single line from an old medical chart.

Expect the Insurance Company to Look at Your Previous Medical Records

If you claim that a workplace accident injured your back and records show you received treatment for back pain before the accident, the workers’ compensation insurer will likely want to know about it.

That should not come as a surprise.

Previous medical records may show the nature of the original injury, how it was treated, whether you recovered, what symptoms continued, and whether doctors imposed any permanent restrictions.

The insurer may compare those records with your treatment after the workplace accident.

For example, an insurer might argue that an MRI shows degenerative changes that existed before the workplace incident. It might point to an old doctor’s visit involving pain in the same body part. It could also argue that some or all of your current symptoms are related to the earlier condition rather than the new accident.

Those arguments do not automatically determine the outcome.

Medical records can sometimes help an injured worker as much as they help an insurance company. Records showing that you completed treatment years ago, returned to full-duty work, or went a long period without treatment can provide important context when a new accident produces significantly different symptoms.

Do Not Hide an Old Injury When Seeking Workers’ Compensation

Some injured workers worry that telling a doctor about an old injury will destroy their claim.

That can lead to a much bigger problem.

If you previously hurt the same part of your body, be truthful about it.

Do not tell a treating doctor that you have “never had back problems before” if you went through months of treatment for a back injury several years earlier.

Insurance companies can request relevant medical records during a workers’ compensation claim. If those records contradict what you told your doctor, the inconsistency may become an issue.

Being honest does not mean you have to describe your condition inaccurately.

If you had an old injury but fully recovered, say that.

If you occasionally had mild pain before the workplace accident but the new pain is substantially worse, explain the difference.

If the old injury affected a different part of your back or produced different symptoms, explain that too.

Details matter.

“My back hurt before” and “I had occasional stiffness twice a month but never missed work, and after this accident I have constant pain running down my left leg” describe very different situations.

What If I Was Still Receiving Treatment Before the Workplace Accident?

These cases can be more difficult, but they are not automatically excluded from workers’ compensation.

Imagine that you were already receiving treatment for a knee problem when you slipped on a wet floor at work and landed directly on that knee.

There may now be questions about what symptoms existed before the fall, whether the fall caused structural damage, whether it accelerated the need for treatment, and what portion of your current limitations are associated with the workplace injury.

Medical evidence becomes particularly important when the pre-existing condition was actively symptomatic immediately before the accident.

That is different from a situation where an employee injured the same knee 15 years ago, recovered completely, and had no problems until the workplace accident.

Both cases involve a pre-existing condition, but the evidence surrounding them is very different.

Who Pays for Medical Treatment After the New Injury?

When an employee sustains a compensable Missouri workplace injury, the employer is generally responsible for providing medical treatment reasonably required to cure and relieve the employee from the effects of that injury.

Missouri generally gives the employer the right to select the authorized healthcare provider.

This is important if you already have a doctor who treats your pre-existing condition. You should not assume that you can simply continue seeing that physician and automatically have the workers’ compensation carrier pay the bills.

Our guide on choosing your own doctor in a Missouri workers’ compensation claim explains the medical treatment process in more detail.

The Missouri Division of Workers’ Compensation also provides information for injured employees about obtaining authorized medical treatment after a workplace injury.

If you believe your work accident made an old condition worse, report the workplace incident promptly and ask your employer how to obtain authorized medical care.

What If the Insurance Company Says I Was Already Injured?

This is one of the biggest concerns in these cases.

An insurer might point to your prior medical history and argue that your current problems were already there.

That is not necessarily the end of the analysis.

Suppose you had a previous shoulder injury but were able to lift your arm normally before your workplace accident. After falling from a ladder at work, you cannot raise the arm above your shoulder and an orthopedic surgeon recommends surgery.

The existence of an old shoulder injury is relevant.

But so is the fact that your condition changed after the accident.

The medical evidence may need to address whether the new workplace accident caused additional injury, aggravated the prior condition, or created a new need for treatment.

These disputes can become particularly important when expensive medical treatment, surgery, significant time away from work, or permanent disability is involved.

What About Degenerative Conditions Such as Arthritis?

Not every pre-existing condition comes from a previous accident.

Many people have degenerative changes in their spine, knees, shoulders, or other joints. Some know about them before getting hurt at work. Others first learn about them when an X-ray or MRI is performed after the workplace accident.

For example, an MRI after a lifting accident might show degenerative disc disease.

An insurance company may focus heavily on the word “degenerative” and argue that the problem developed over time rather than from the work accident.

But an imaging finding does not tell the entire story by itself.

There may still be questions about whether the workplace event produced new symptoms, caused a new injury, worsened an existing condition, or created a need for treatment that did not previously exist.

This is why medical causation can become one of the central issues in a disputed workers’ compensation case.

What If the Workplace Accident Causes a Permanent Disability?

Some workers recover fully after treatment. Others are left with lasting limitations.

A serious workplace injury may result in permanent restrictions, reduced mobility, chronic pain, an inability to return to the same occupation, or other permanent effects.

When the worker already had a permanent disability before the new accident, Missouri’s workers’ compensation system can become more complicated.

Missouri has a Second Injury Fund that exists, in part, to address certain situations involving workers who had qualifying pre-existing disabilities before suffering a later work-related injury.

The Missouri Department of Labor explains that the fund may apply when a current work-related injury combines with a prior disability to create an increased combined disability. The rules depend on factors such as the date of injury and the nature and severity of the prior and current disabilities.

For injuries occurring after January 1, 2014, Missouri law significantly limits the types of Second Injury Fund disability claims that are available. Under Section 287.220, permanent partial disability claims for post-2014 injuries are not filed against the Second Injury Fund. Certain permanent total disability claims may still qualify if the statutory requirements are satisfied.

The Second Injury Fund rules are technical, so workers with significant prior disabilities and a serious new work injury may benefit from having their individual circumstances reviewed rather than assuming they either qualify or do not qualify.

What Evidence Can Help Show That My Condition Became Worse?

A workers’ compensation claim involving a pre-existing injury may require more documentation than a straightforward accident involving a previously healthy body part.

Useful evidence can include medical records from before and after the accident, diagnostic imaging, physician opinions, work restrictions, physical therapy records, employment records, and testimony about your ability to perform your job.

Your work history can also provide valuable context.

If you performed a demanding job without restrictions for years before the accident, that may be relevant when evaluating the effect of a new injury.

Coworkers, supervisors, friends, and family members may also have knowledge about what you were physically capable of doing before the accident compared with afterward. The goal is not to pretend the previous condition never existed. The goal is to accurately establish what changed.

Can I Receive Workers’ Compensation and Have Another Injury Claim?

Sometimes a workplace accident involves someone other than your employer.

For example, you could be driving for work when another motorist causes a crash. You could be injured by defective equipment. A delivery driver might be hurt in a collision caused by an unrelated driver.

Depending on the circumstances, there may be a workers’ compensation claim and a separate claim involving a third party.

Ortwerth Law discusses this issue in more detail in its article about workers’ compensation claims for Amazon delivery drivers in Missouri, where a work-related driving accident may involve workers’ compensation benefits as well as a potential claim against another responsible party.

These situations can create additional issues involving medical expenses, disability benefits, settlements, and reimbursement, so it is important to evaluate all potentially available claims.

What Should You Do If a Work Accident Aggravates an Old Injury?

The first step is to report the workplace accident.

Do not avoid reporting it simply because the injured body part has bothered you before.

When you receive medical treatment, give your doctors an accurate history. Explain what your condition was like before the workplace accident and exactly how it changed afterward.

It can also be helpful to keep track of practical differences in your daily life and ask yourself a few simple questions like:

• Could you lift 50 pounds before but now struggle with 10?
• Could you stand for an entire shift before but now need to sit after 20 minutes?
• Were you able to climb stairs without difficulty before the accident?
• Had you gone years without seeing a doctor for the old condition?
• Did you previously have occasional discomfort but now experience constant pain?

Specific examples can communicate the change much more clearly than simply saying you feel “worse.”

You should also keep copies of work restrictions, medical records available to you, accident reports, correspondence from the insurance company, and other documents related to the claim.

When Should You Contact a Missouri Workers’ Compensation Lawyer?

A minor workplace injury that heals quickly may not turn into a major dispute.

A pre-existing condition can make things more complicated, particularly when an insurance company questions whether the new workplace accident is responsible for your current medical problems.

Consider speaking with a workers’ compensation attorney if treatment is being denied, the insurer claims your symptoms are entirely pre-existing, you need surgery, you cannot return to your previous job, you have permanent restrictions, or you had a significant disability before the new injury.

Ortwerth Law handles workers’ compensation and other personal injury cases in St. Louis and throughout Missouri. The firm has also handled cases in which workers’ compensation and other personal injury claims overlap, including a reported resolution involving a St. Louis police officer injured in a workplace vehicle accident. (gatewayinjurylaw.com)

An Old Injury Does Not Mean a New Workplace Injury Should Be Ignored

A pre-existing injury can affect a Missouri workers’ compensation claim, but its existence does not automatically answer whether you are entitled to benefits.

The important questions are often more specific.

What was your condition before the workplace accident? What happened at work? What changed afterward? What treatment do you now require? What does the medical evidence say about the relationship between the workplace injury and your current condition?

An employee who had occasional back pain but worked full duty for years is in a very different position from someone whose back condition already prevented him from working before the new incident.

Those distinctions matter.

If a workplace accident has made an existing injury or medical condition worse, contact Ortwerth Law to discuss what happened. A St. Louis workers’ compensation attorney can review your medical history, the circumstances of the new injury, and the insurance company’s position to help determine what options may be available under Missouri law.