How Pre-Existing Conditions Affect Your Vermont Workers’ Comp Claim

If you’ve been injured at work or due to your work, you might be entitled to workers’ compensation. However, securing a fair claim might be challenging if you already have a pre-existing health issue. Sabbeth Law is here to support you during what may be a confusing and frustrating process.

Understanding exactly how pre-existing conditions and Vermont workers’ comp claims interact is essential. Insurance companies often use your medical history to complicate or deny your claim. Vermont law gives you the right to seek benefits, even if you’ve faced health problems in the past.

Vermont’s system is no-fault: you can generally claim benefits regardless of who caused your injury. However, insurers may try to argue that your current disability or need for treatment is due only to that prior issue, rather than your work activities. An experienced legal team can help prove that your job worsened your underlying condition, entitling you to compensation.

Reach out to us for a free consultation in Vermont.

Understanding Pre-Existing Conditions in the Context of Workers’ Comp

A pre-existing condition is a medical condition or health issue that a person already had before suffering a work-related injury.

The following often qualifies as a “pre-existing condition”:

  • Previous injuries to the same body part
  • Degenerative or chronic conditions like arthritis, disc disease, diabetes, or heart disease
  • Prior surgeries or medical treatments
  • Age-related deterioration
  • Congenital or previously asymptomatic health issues

State law recognizes that workers are not required to be in perfect health to qualify for workers’ compensation in Vermont. Under what is known as the “eggshell skull” doctrine, your employer accepts you as you are, including your vulnerabilities. They recognize that the worsening of a prior problem caused by or due to your work must be covered.

In determining whether or not workers’ comp covers your existing condition, there must be proof that your job:

  • Aggravated your pre-existing condition
  • Accelerated its progression
  • Combined with it to create additional disability
  • Triggered symptoms in a previously stable issue

According to the Vermont Workers’ Compensation Act (21 V.S.A. § 601-709), you are entitled to benefits if your work worsens an existing condition. When pre-existing and work-related factors both contribute to your disability, Vermont applies the “major contributing cause” standard. This means that you may be eligible for compensation as long as your job is a substantial factor in your condition.

To be entitled, records must show your baseline health before and after the work incident. Documents may pinpoint new or worsened symptoms and include expert opinions that differentiate work-aggravated problems from simple natural progression. Our team helps you collect and present this evidence so you can have a stronger claim.

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The Impact of Aggravation on Claims

When you have a medical condition or health issue before the work-related injury, you need to prove that your job causes an existing condition to worsen or be aggravated.

This aggravation may be temporary or permanent. This distinction determines or limits what you may be entitled to.

  • Temporary Aggravation

Work causes pain to flare up or symptoms to worsen temporarily, but your baseline health returns when the aggravation passes. Your benefits usually cover only the flare-up period.

  • Permanent Aggravation

Your employment leads to a lasting change or greater disability in your pre-existing condition. These cases may qualify for extended medical and wage replacement benefits. You may even get a permanent impairment award if your ability to work is permanently reduced.

In Vermont, the “last injurious exposure” rule makes the employer and insurer liable for the most recent work-related aggravation. That means you may still claim even if your original condition occurred somewhere else or long ago.

Our team works with local medical professionals who are experienced in linking workplace aggravation to clinical findings.

Evaluating Claims: Employers’ and Insurers’ Perspective

Knowing how employers and insurance companies approach pre-existing conditions and Vermont workers’ comp claims is important. Their main goal is to limit liability by showing your symptoms stem from an old injury or illness, not your job.

Some of the steps they take to scrutinize your claim include:

  1. Thorough medical history reviews: Insurers will search your medical records extensively for past complaints, diagnoses, or treatments, even if your prior symptoms were resolved long ago.
  2. Apportionment arguments: They may try to divide up responsibility for your disability. They may insist that some portion (or all) of your problems would have occurred regardless of your work.
  3. Independent medical examinations (IMEs): They would consult with doctors who focus on minimizing work-related injury.
  4. Surveillance and social media monitoring: They will look for discrepancies between your claimed disability level and what you do outside work.
  5. Delay and deny tactics: Slow responses can pressure you into low settlements or giving up your claim entirely.

Vermont law puts the burden on employers and their carriers to prove when a condition is not work-related. Still, the practical challenge is on you to produce authoritative documents.

We support you through collecting records, preparing for IMEs, and building a compelling case. Our job is to challenge attempts to misclassify your issue and ensure your story is heard.

Legal Protections and Worker Rights in Vermont

Vermont offers strong worker protections when dealing with pre-existing conditions and Vermont workers’ comp claims. If your employer or insurer tries to use your medical history against you, the law provides several critical safeguards:

  • The “whole person” rule: Employers must take you as they find you. Pre-existing conditions should not disqualify otherwise valid claims.
  • Anti-discrimination provisions: Vermont law makes it illegal to fire or penalize someone for filing a legitimate claim, whether or not they have existing health issues.
  • Right to unbiased medical evidence: Your treating doctor’s opinions must be given considerable weight in the claims process.
  • Legal appeals process: If denied, you can appeal through the Department of Labor and, if necessary, to Vermont’s courts.
  • Statute of limitations: You must report a workplace injury within six months and formally file a claim within three years.
  • Independent medical exams: You may seek an independent examination if the insurer’s assessment seems biased.

For injuries that gradually worsen, the clock usually starts when you first realize your work worsens your underlying condition. Missing these timeframes can cost you your right to any recovery. It’s therefore ideal to secure legal support early.

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How Sabbeth Law Can Help in Workers’ Comp Cases

Our firm understands what’s at stake when pre-existing conditions threaten to undermine your workers’ comp claim in Vermont. Insurers often exploit the complexity of these cases, but our proactive, strategic approach can give you the best possible chance for success.

Our formula for success includes:

  • Comprehensive medical documentation: We collaborate with trusted medical professionals to conclusively show how your work aggravated or accelerated a pre-existing issue.
  • Detailed case building: Our firm gathers and analyzes employment records, witness statements, job demands, and timelines to demonstrate the actual link between your compensation claim and your work duties.
  • Countering insurer tactics: Insurers frequently argue that your symptoms are the inevitable result of aging or underlying illness. We confront these strategies head-on. We’re experienced in identifying fraudulent tactics, allowing us to counter every attempt to diminish your claim.
  • Thorough case management: We organize medical and job-related evidence and prepare you for any insurer-ordered medical exam. If required, we represent you through administrative hearings and appeals.

Insurers may attempt to twist medical records or downplay real aggravations. We respond by leveraging strong evidence, authoritative expert opinions, and direct advocacy. With us, you’ll get a partner who fights for your health, your work, and your future.

Book Your Consultation to Start Securing Your Rights

Handling a workers’ compensation claim in Vermont is never simple, especially with pre-existing conditions involved. The line between a denied and an accepted claim often comes down to how promptly and strategically you act.

We urge you not to delay. Gather medical records, expert opinions, and workplace documentation while the facts are still fresh.

As we’ve discussed, you are entitled to workers’ compensation if you were injured at or due to work. Even if you have pre-existing conditions, they do not automatically disqualify you from Vermont workers’ compensation. Moreover, your work injury may still be fully covered if your job aggravated, accelerated, or triggered your health issue.

At Sabbeth Law, we:

  • Meticulously review all your medical documentation to separate old conditions from work-aggravated injuries.
  • Coordinate with leading medical experts to provide clear and compelling testimony about your degree of disability and causation.
  • Support you directly through every step of your claim, from initial filing to hearings, appeals, and settlement negotiations.
  • Keeps you informed and empowered throughout your recovery.

An insurance company may use your health history to deny what Vermont law provides. We work with you and do not let that happen. We’ll help you fight back using our legal skills and personal dedication.

If you’re ready to secure your benefits, including timely wage replacement, medical care, and the respect you deserve, contact Sabbeth Law today. The sooner we start, the stronger your claim could be.

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