When a workers’ comp carrier says your injury was “already there,” the conversation can get confusing fast. A lot of people hear that phrase and assume their claim is over. In many situations, that is not how workers’ compensation works.
Across many workers’ comp systems, the real issue is often not whether you had a prior condition, but whether work aggravated, accelerated, lit up, or worsened that condition in a way that led to disability, treatment, or lost time. Federal guidance under the U.S. Department of Labor’s workers’ compensation program recognizes aggravation of a preexisting condition as a recurring causation issue and looks for medical evidence separating the effects of the work event from the underlying condition. The same basic dispute shows up in state systems too, even though the exact legal test varies by state and sometimes by injury date (U.S. Department of Labor, California DIR, Washington L&I Medical Examiners’ Handbook).
In this post you’ll learn the nine questions workers ask most often when the insurer says the problem existed before the accident, what those questions often mean in practical terms, and where an attorney may be especially helpful in sorting out the medical and legal issues.
If you want a broader overview of how old injuries, aggravation claims, apportionment, and employer resistance fit together, it may help to start with this overview of preexisting-condition issues in workers’ comp.
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Usually, no.
A prior back problem, arthritis, degenerative disc disease, knee wear-and-tear, old surgery, or a congenital issue does not automatically bar a workers’ compensation claim. In many jurisdictions, workers can still recover benefits when job duties or a workplace accident made the condition materially worse. Washington’s medical examiner guidance expressly describes aggravation of a preexisting condition as a situation where an injury or occupational disease caused the condition to become a problem for the worker. Federal workers’ compensation guidance similarly addresses claims involving aggravation, acceleration, or precipitation of a preexisting condition rather than treating prior medical history as an automatic disqualifier (Washington L&I Medical Examiners’ Handbook, U.S. Department of Labor).
That said, insurers often focus on the words degenerative, chronic, preexisting, or age-related because those labels can shift attention away from the work event and toward medical history. Here’s what this often means in real life: the carrier may not be saying, “you were never hurt.” It may be saying, “we think work is not legally responsible for enough of the problem.”
That distinction matters.
Usually, the carrier is making a causation argument.
In plain English, they may be arguing one of several things:
Some state systems also divide cases between compensability and apportionment. Compensability asks whether the claim is covered at all. Apportionment asks whether some portion of permanent disability is attributable to other causes. California, for example, has statutory rules directing physicians and the system to address apportionment to causation in permanent disability cases (California Labor Code Section 4663/4664 summary from DIR, California Code of Regulations, Title 8, Section 10163).