Workers bring their whole health history to the job. Old injuries, chronic pain, degenerative changes on an MRI, or a prior surgery do not reset simply because a person clocks in. When something at work aggravates a pre-existing condition or lights up a dormant issue, the law in most states still provides a path to benefits. The route is narrower and the scrutiny tougher, but the door is not closed. As a workers compensation lawyer, I’ve watched claims succeed or fail not on whether a worker had a prior problem, but on how well the new work event and its impact were documented, explained, and linked.
This article unpacks how pre-existing conditions interact with workers’ compensation claims, where insurers tend to push back, how medical evidence carries the day, and what a careful strategy looks like. Whether you call the advocate you need a workers compensation attorney, a work injury lawyer, a workplace accident lawyer, or an on the job injury lawyer, the fundamentals do not change: you must prove a work-related injury or material aggravation, and you must do it with credible, timely evidence.
What “pre-existing” actually means
“Pre-existing” covers a spectrum. Some workers arrive with diagnosed conditions like diabetes, arthritis, or a herniated disc from a car crash years earlier. Others have degenerative changes that appear on imaging for thousands of people over 40, which never caused symptoms. In both scenarios, if a work incident or cumulative job exposure causes a new injury or accelerates, aggravates, or lights up a condition to the point it becomes disabling, most state laws say the employer takes the worker as they find them.
Lawyers and judges often sort pre-existing conditions into a few practical buckets:
- Symptomatic and documented. Records show active symptoms or treatment before the work event. For example, weekly physical therapy for chronic low back pain. Asymptomatic but identifiable. Imaging taken for another reason reveals disc degeneration, osteoarthritis, or prior tears that caused no pain. Resolved prior injury. A prior condition was treated and quiet for a meaningful interval, with no restrictions or treatment, before the new work exposure.
Why does this parsing matter? Because the legal test usually turns on change. You do not have to prove your spine was pristine. You do have to show something at work made your condition materially worse or turned a silent finding into a disabling problem. If your new pain, swelling, loss of range of motion, or functional limits are different in kind or degree from your baseline, you may have a compensable claim even with a loaded history.
The core legal standard: aggravation, acceleration, or causation
The phrase you will hear in hearings and depositions is “substantial contributing factor” or “major contributing cause,” depending on the state. The flavor varies:
- Many states compensate an aggravation or acceleration of a pre-existing condition when work is a substantial factor in the need for treatment or disability. A minority impose a higher bar for combined conditions, requiring the work injury to be the major contributing cause of the disability and need for treatment. Others draw a line between a temporary exacerbation, which may yield limited benefits, and a permanent worsening, which carries broader entitlement.
I’ve seen back claims hinge on whether a doctor can credibly separate the old from the new. If a roofer with known lumbar degeneration lifts bundles and feels a sharp onset, followed by objective findings like new radicular symptoms and a positive straight-leg raise that were absent before, many judges find that work substantially contributed to a new injury or permanent worsening. If, on the other hand, the medical file shows identical symptoms and work restrictions month after month before the reported incident, the insurer will argue nothing new happened.
The medical record tells the story
Medical documentation, not the lawyer’s rhetoric, wins these cases. The first treating notes after the event should show:
- A clear mechanism of injury tied to work. “Felt pop in right shoulder while overhead stocking at warehouse” reads very differently than “shoulder pain, onset unknown.” A comparison to baseline. If you had occasional back soreness before, say so, and describe the new symptoms. “Previously intermittent ache, now constant pain radiating to left calf with numbness.” Objective findings. Range-of-motion limits, swelling, muscle spasm, neurological deficits, positive orthopedic tests, and imaging comparisons matter. A new tear on MRI, a worsened disc protrusion, or fresh edema on T2 sequences draw a bright line. Functional impact. “Unable to lift over 10 pounds,” “must alternate sitting and standing every 20 minutes,” and “can’t climb ladders” are not flourishes, they are currency in the claim.
One recurring pitfall: doctors who write “degenerative changes” without addressing whether work aggravated those changes. A workers comp attorney will often send a concise letter to the provider with the legal standard, the accident mechanism, and specific questions. For example: Was the lifting event at work a substantial contributing factor to the patient’s current disability and need for treatment? How does the current presentation differ from prior records? Are there new objective findings?
The insurer’s playbook on pre-existing conditions
Expect an early denial or at least a request for more information. Insurers commission independent medical examinations, comb through prior records, and look for gaps that allow them to claim the condition is purely degenerative or unchanged. A few common moves:
- They argue the timeline does not fit. If you waited two weeks to report, they suggest the injury happened at home. They highlight prior complaints, even minor ones, to say the new problem was not new at all. They seize on equivocal doctor notes. “Chronic shoulder pain, degenerative cuff changes” becomes Exhibit A. They label the event “idiopathic,” meaning not related to employment but to an internal condition.
None of these end the claim by themselves. Workers prevail when they tighten the timeline, clarify the mechanism, and obtain focused medical opinions. When a work injury lawyer anticipates the defense and builds the record early, many denials reverse.
Reporting early, accurately, and consistently
Timing and consistency are credibility. I once represented a distribution center employee who lifted a misloaded box and felt immediate elbow pain. He told his supervisor, who shrugged it off. He went home, iced it, and returned to light duty the next day. Two weeks later, an MRI showed a partial distal biceps tear. The insurer argued the tear must have occurred elsewhere since he did not go to the ER. What saved the case was the contemporaneous report in the shift log and a text he sent his wife from the break room: “Tweaked elbow on big box, hurts bad.” That breadcrumb trail made the later imaging persuasive.
Tell your supervisor what happened as soon as you can. Provide specifics, even if brief: date, time window, task, and immediate symptoms. Then make sure your initial medical visit mirrors that description. Insurers put the first report under a microscope. A workplace injury lawyer’s first advice to a client is simple: do not guess, do not embellish, and do not withhold the fact that you had prior issues. A half-truth becomes a credibility problem. Full truth, coupled with a clear change in symptoms, often strengthens the claim.
Cumulative trauma and the slow burn
Not every compensable aggravation involves a single pop or fall. Carpal tunnel syndrome, tendinopathy, disc injuries, and knee degeneration often build over months or years of repetitive tasks. These are harder cases, but very winnable with the right medical narrative.
Here, the key is exposure evidence. What motions does the job demand, how often, for how long, and at what force? A job injury attorney may obtain a job analysis that quantifies grip force in packaging work, torque in carpentry, or the sheer count of squat-lift cycles in warehouse picking. Pair that with charts of symptoms escalating over time and objective tests, like nerve conduction studies, and you can show that work significantly accelerated a condition that might have remained quiet for years. Degeneration on a scan does not tell the whole story, function does.
The light-duty fork in the road
Employers sometimes offer light duty. Accept it if you can safely perform it while following restrictions. Declining suitable light duty can limit wage-loss benefits. That said, forced “modified” jobs that ignore a doctor’s restrictions lead to reinjury and claim damage. A workers comp lawyer routinely negotiates specific written restrictions with the treating physician and insists the employer confirm the actual tasks match. When light duty is a sham, document the mismatch. A note such as “assigned to repetitive overhead reaching despite 10-pound limit and no overhead work” can change the trajectory in a hearing.
Apportionment, or who pays for what
In some states, when a pre-existing condition and a work injury combine, doctors must assign apportionment percentages. For example, a surgeon might say 60 percent of the need for a rotator cuff repair stems from the acute tear suffered during a machine jam, and 40 percent relates to degenerative changes. Insurers then pay 60 percent of certain benefits. In other jurisdictions, apportionment applies to permanent disability ratings but not to medical treatment. A workplace injury lawyer’s role is to ensure that apportionment is grounded in defensible reasoning. Vague numbers without a bridge to the records invite challenge. Concrete anchors, like comparison imaging and pre-injury function, carry weight.
Surveillance, social media, and the credibility trap
Pre-existing conditions open the door to surveillance. Insurers hire investigators who film yard work, grocery trips, or kids’ soccer games. Clips without context can look damaging. A worker asked to demonstrate a painful movement during an exam may later be shown on video lifting a case of water. Judges understand real life but frown on contradictions. Two practical rules help: stick to doctor-approved restrictions and do not stage performance for social media. A single post of weekend kayaking can undo months of careful record building, even if the paddle lasted ten minutes and ended in more pain.
The independent medical exam and how to prepare
An IME is not independent in any meaningful sense, but it is routine. Approach it as a high-stakes deposition with a stethoscope. Bring a concise timeline: prior condition history, the work event or exposures, and how your symptoms changed. Be accurate about baseline activities you could do before and those you cannot do now. If you had prior treatment, acknowledge it. The examiner’s report will fill with phrases like symptom magnification if answers are inconsistent or evasive. A work-related injury attorney often preps clients with a 15-minute rehearsal to avoid common traps like guessing dates or underreporting prior issues.
Surgery and the “degenerative” label
Orthopedic surgeons frequently confront mixed pictures: a worker with prior cuff tendinosis sustains a traumatic tear, or a person with degenerative meniscus fraying sustains a work twist resulting in a displaced flap. Insurers latch onto the word degenerative to deny. The counter lies in surgical findings. Operative reports can separate chronic fraying from acute tears by describing tissue quality, edge shape, and reactive changes. When the surgeon writes, “acute full-thickness tear superimposed on chronic tendinopathy,” that is gold. A workers comp attorney who coordinates with the surgeon early can ensure these distinctions make it into the chart, not just the surgeon’s memory.
Return to work and future risk
Workers with pre-existing conditions who suffer a new aggravation often worry about job security and the risk of re-injury. Safe return depends on meaningful restrictions, employer compliance, and a realistic path to full duty or a settled new normal. Graduated return schedules that step up hours and tasks over two to six weeks work better than flipping a switch. If permanent restrictions remain, vocational rehabilitation may come into play. A workers comp lawyer evaluates wage differential benefits or permanent partial disability awards to cover the financial gap when a worker cannot return to the old job at the old pay.
How prior settlements, MMI, and reopeners fit in
If you had a prior workers’ comp claim for the same body part, the landscape changes. Prior settlements might reduce the value of a new claim or require a showing of a new compensable injury rather than a mere continuation. In some states, once you reach maximum medical improvement and the file closes, you can petition to reopen for a “change of condition” within a time window, usually one to five years, if there is a demonstrable worsening tied to the original injury. In others, a new work event justifies a new claim regardless of the old file, as long as the facts and medical evidence support it. This is one of those edge cases where a workers comp attorney’s familiarity with local statutes and case law pays dividends.
Practical steps that move the needle
Here is a tight checklist I give clients who have pre-existing Work Injury Lawyer workerscompensationlawyersatlanta.com conditions and a new work injury:
- Report promptly with a specific description of how the injury occurred and what changed. Be candid about your medical history, and emphasize the new symptoms or increased severity. Ask your doctor to compare current findings to prior records, in writing, and to address causation using your state’s legal standard. Follow restrictions, accept suitable light duty, and document any mismatch between assigned tasks and medical limits. Keep a symptom and function journal for the first 60 to 90 days, noting activities you can or cannot do and any flare patterns.
Those five actions do not guarantee success, but they greatly improve the odds of a fair evaluation.
A short case study: the forklift operator and the quiet disc
A forklift operator in his mid‑50s had an MRI three years earlier after a fender bender. It showed multilevel lumbar degeneration without nerve impingement. He returned to full duty and forgot about it. One winter morning, he hopped down from his forklift to clear a pallet jam, twisted awkwardly while lifting a corner, and felt a bolt of pain into his left leg. He reported the incident within the hour and visited the occupational clinic. His exam showed decreased ankle reflex on the left, a positive straight‑leg raise, and weakness in dorsiflexion. A new MRI revealed a paracentral L4‑L5 herniation contacting the L5 root.
The insurer denied, citing the prior “bad back.” We requested the original MRI and obtained a side‑by‑side analysis from a radiologist. The older film had no focal herniation and no nerve contact. Treating notes documented the new neurological findings. The surgeon wrote that the lift‑twist event was a substantial contributing factor to the herniation and the need for a microdiscectomy. The claim converted from denied to accepted within a month. The worker returned to modified duty six weeks post‑op, then full duty with a 35‑pound lift limit. His permanent disability rating accounted for both the surgery level impairment and pre-existing degeneration, but the wage‑loss benefits covered the recovery window fully. The pivot point was not clever lawyering, it was the clean before‑and‑after record.
When to bring in a lawyer, and which kind
You do not need a lawyer for every claim, but pre-existing conditions add friction. Bring in a workers compensation lawyer early if you see any of the following: a denial mentioning degeneration, an IME scheduled within weeks, a light‑duty offer that ignores restrictions, or a doctor who won’t address causation in writing. Experienced counsel can front the right questions to your providers, obtain prior records strategically, and push back on overreaching IMEs.
Titles vary by region. Search terms like workers comp lawyer, workers compensation attorney, work injury attorney, job injury lawyer, workplace injury lawyer, or work-related injury attorney often lead to the same talent pool. Focus less on labels and more on experience with combined condition cases, success handling IME disputes, and trial readiness. Ask how frequently they take pre-existing condition claims to hearing and what their approach is to medical proof.
Cost, fees, and expectations
Workers’ compensation fee structures are usually contingency‑based and capped by statute, often a percentage of benefits obtained or a fixed fee schedule approved by a judge. Most workers comp attorneys offer free consultations and front costs for medical opinions, recovering them only if they win. Clarify who pays for record retrieval and expert reports. A fair expectation is clarity on timelines, the range of potential outcomes, and the points where settlement makes sense. If you need surgery and the insurer is stonewalling due to the degenerative label, a targeted hearing on medical necessity can break the impasse faster than a global settlement negotiation.
Key myths to set aside
Several misconceptions hurt legitimate claims. You do not have to be in perfect health before the injury. You do not need an audible pop or a dramatic fall. Missing a day of work is not required to have a compensable injury, though wage benefits hinge on disability. Telling your doctor about prior issues does not doom your case; hiding them probably will. Degenerative findings on imaging are common by middle age and do not decide causation alone. Work can be the spark that turns background wear into a disabling problem the law recognizes and covers.
Final thoughts from the trenches
The best outcomes follow a pattern: early and accurate reporting, thoughtful medical documentation that distinguishes old from new, steady adherence to restrictions, and measured legal pressure where insurers default to denial. Pre-existing conditions complicate but do not preclude. I have watched a welder with a repaired shoulder return to the trade after a new labral tear was properly tied to a stuck clamp incident. I have also seen a nurse’s case collapse because the initial clinic note read “gradual onset, unknown cause,” even though a grueling double shift with heavy lifts clearly preceded her flare. Small details at the start echo through the file.
If you are navigating this terrain, remember that you are proving change. Show how your function shifted, how the exam differs, what the imaging now reveals, and why work materially contributed. Engage a knowledgeable workers comp attorney if the insurer hides behind the word degenerative. With the right record and a steady hand, most legitimate aggravation claims land where they should: approved care, fair wage replacement, and a safe pathway back to work or to a sustainable next step.