How Pre-Existing Conditions Affect Your Nevada Workers’ Compensation Claim

Few workers go through their careers without some pre-existing injuries or health conditions. You might have an old back injury, a prior surgery, or a chronic illness when you suffer a new accident at work. Understandably, injured workers in Nevada often worry: Will a prior injury or condition ruin my workers’ comp claim? The good news is that Nevada’s workers’ compensation laws protect employees with pre-existing conditions in many cases. However, these situations can complicate your claim. In this article, we’ll explain what counts as a pre-existing condition, how Nevada law handles them, and what you can do to ensure you receive the benefits you deserve.

If you’re struggling with how pre-existing conditions are affecting your Nevada workers’ compensation claim, it’s time to take action. Shook & Stone can work to ensure you get what you deserve. Contact us for guidance on your case or call us at (702) 570-0000 to discuss your situation today. Let’s work together to secure your financial future.

What Is a Pre-Existing Condition in a Work Injury Claim?

In workers’ comp terms, a pre-existing condition is any injury, illness, or health issue you already had before your work accident. This could be a physical injury (like an old knee injury or a herniated disc from years ago), a chronic medical condition (such as arthritis or diabetes), or even a prior mental health condition.

Common examples of pre-existing conditions that might come up in Nevada work injury claims include:

• Chronic back, neck, or spinal injuries – e.g. an old back injury or degenerative spinal conditions
• Joint problems or past surgeries – for instance, a previous knee injury or shoulder surgery
• Repetitive strain injuries – such as pre-existing carpal tunnel syndrome or tendonitis
• Chronic illnesses – like arthritis, diabetes, or COPD
• Mental health conditions – e.g. anxiety or depression

Having a condition like those above does not automatically disqualify you from Nevada workers’ compensation benefits. But it’s important to understand how insurers and laws will treat your claim when such factors are in play.

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Nevada Law Protects Workers with Pre-Existing Conditions

Nevada has worker-friendly laws that address pre-existing conditions in workers’ comp claims. State statute NRS 616C.175 is particularly important because it provides that an injury may be compensable when a work accident aggravates, accelerates, or exacerbates a pre-existing condition, so long as the work accident is shown to be a substantial contributing cause. In simpler terms, if your job made your pre-existing condition worse, your claim should be covered – and it’s up to the insurance company (not you) to prove otherwise.

Additionally, under NRS 616C.177, insurers are allowed to ask you about prior injuries or medical conditions during the claim process, and you must disclose relevant pre-existing conditions if asked. However, Nevada law does not allow an insurer to deny your claim solely because you have an unrelated pre-existing condition. The focus is on what happened in the work accident and how it impacted your health, not simply what your health was like before.

Key Takeaway: Nevada’s workers’ compensation system is designed to compensate employees for work-related injuries even if a pre-existing issue is present. If your work accident significantly worsened a prior condition, you are generally entitled to benefits for that worsened condition.

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How Pre-Existing Conditions Can Impact Your Claim

While a pre-existing condition should not be grounds for outright denial of a claim in Nevada, it can certainly make the process more complicated. Workers’ comp insurers and employers often try to use pre-existing conditions as an excuse to minimize or deny claims.

Here are a few ways pre-existing conditions might affect your Nevada work injury claim:

• Claim Delays or Denials: The insurer might initially deny the claim arguing that your condition was “pre-existing” and not caused by work. Some insurers aggressively (and wrongly) deny claims whenever they see a pre-existing condition mentioned, hoping the worker will just give up.
• Closer Scrutiny of Causation: You and your doctors will need to clearly prove the work accident aggravated your condition. You’ll need medical evidence that the work accident substantially worsened your condition.
• Medical Treatment Challenges: Doctors who aren’t familiar with Nevada law might hesitate to link the injury to work if they see a pre-existing condition. This can lead to legitimate treatments being denied unless challenged.
• Benefit Reduction (Apportionment): In Nevada, a pre-existing condition can affect the amount of benefits, especially when determining any permanent disability compensation. This concept is called apportionment. It means your eventual disability rating or settlement can be reduced to account for the portion of disability that existed from before the work accident. For example, if you already had a 5% impairment in your knee before the accident, and the work injury leaves you with a total 15% impairment, you might receive compensation for the additional 10% caused by the work incident.

Despite these challenges, a pre-existing condition by itself is not a valid basis to deny a Nevada workers’ compensation claim when medical evidence shows the work accident aggravated the condition. The insurer must provide evidence if they want to claim your work injury wasn’t a major factor.

Your Rights Under Nevada Workers’ Comp Law

Nevada law is clear that injured workers should be compensated even if they weren’t in perfect health before the accident. To recap your rights and protections:

• Aggravation = Compensable: If your work injury aggravates, precipitates, or accelerates a pre-existing condition, the claim should be accepted under NRS 616C.175.
• Burden of Proof Is on the Insurer: You do not have to prove your pre-existing condition wasn’t the cause; rather, the insurer must prove the work accident was not a substantial cause of your current condition if they want to deny coverage.
• Disclosure, Not Disqualification: You should disclose past injuries/conditions when asked, but having a pre-existing condition does not disqualify you from benefits.
• Coverage of Medical Costs: Employers are generally responsible for covering medical treatment that is reasonably necessary to address the work-related aggravation of a pre-existing condition, even if the same body part was injured before.

Insurance Company Tactics for Pre-Existing Conditions

Despite the legal protections, insurance companies try various tactics to minimize your claim when a pre-existing condition is involved:

• Claiming “Your Condition Isn’t Work-Related”: The insurer might flat-out deny the claim by arguing that your current injury is due to your pre-existing condition and not the work accident. Overcoming this tactic usually requires a strong medical opinion from your doctor that connects the dots and shows the work incident worsened your condition.
• Demanding Extensive Medical Records: Expect the insurance adjuster to request your past medical records. Be honest – hiding a prior injury can harm your credibility more than the injury itself.
• Pointing to Gaps or Inconsistencies: The insurer may scour your health history for any gaps in treatment or inconsistencies. A clear narrative helps prevent the insurer from twisting the story.
• Reducing Benefits Citing Pre-Existing Condition: The insurer might acknowledge your injury happened but argue that part of your disability or need for treatment is due to your prior condition, not the work. If you feel your benefits are unfairly low due to this, that’s something you can dispute.

These tactics can be frustrating and confusing. Remember, you have the right to push back. You can appeal a denied workers’ comp claim and present evidence that your work accident aggravated your condition.

Proving an “Aggravation” of a Pre-Existing Injury

One of the most important steps in these cases is demonstrating that your work injury aggravated your pre-existing condition. Here are some tips:

• Tell Your Doctor Everything: Make sure your treating physician knows about your pre-existing condition and the new accident. Describe how your symptoms changed after the work incident.
• Get a Detailed Medical Opinion: Ask your doctor to document in your medical records that the work accident aggravated or “substantially contributed” to your condition.
• Show Your Pre-Injury Baseline: Provide evidence of your baseline health before the work accident. If you rarely needed treatment or had no work restrictions for your pre-existing condition until the new injury, that’s strong proof the work incident worsened things.
• Expert Testimony if Needed: In complex cases, a medical expert can bolster your case by testifying that your previous injury was stable or resolved, and the work accident caused new damage.
• Follow Nevada’s Reporting Rules: Always report your work injury and file a claim promptly. Timely filing protects your rights.

Effects on Benefits and Disability Compensation

Pre-existing conditions can affect the amount of benefits you receive, even when your claim is accepted:

• Medical Benefits: Workers’ comp will pay for all reasonably necessary medical treatment related to your work injury. But if after the work accident you need surgery or additional therapy, those new medical needs should be covered.
• Temporary Disability (Lost Wages): If you have to miss work due to the injury, you’ll receive temporary disability payments regardless of a pre-existing condition.
• Permanent Disability (PPD) Rating: This is where apportionment often comes in. Nevada allows the rating doctor to apportion a percentage of your impairment to a pre-existing condition. Your Permanent Partial Disability award could then be reduced based on the pre-existing portion.

It’s worth noting that even with apportionment, a pre-existing condition doesn’t leave you with nothing. You still get benefits for the new level of impairment or the work-caused portion of the injury.

How an Experienced Las Vegas Workers’ Compensation Attorney Can Help

Navigating a Nevada workers’ comp claim is hard enough – it gets even tougher when a pre-existing condition is involved. A seasoned workers’ compensation attorney in Las Vegas can level the playing field by:

• Evaluating Your Case: Understanding the nuances of Nevada workers’ comp law and telling you frankly if the insurer is wrongfully denying your claim.
• Gathering Strong Evidence: Helping gather medical reports, expert opinions, and witness statements to prove the before-and-after impact of the injury.
• Handling the Insurer: Insurance companies have teams of adjusters and lawyers, but a workers’ comp lawyer will handle all communications on your behalf.
• Ensuring Full Benefits: Fighting to make sure you receive all benefits you’re entitled to, without improper reductions.
• Appealing Denials: Formally appealing denied decisions through Nevada’s workers’ comp appeals process.

When choosing a lawyer, experience matters – especially with pre-existing conditions issues. Consultations for workers’ comp cases are often free, so you can get professional advice without risk. Having an attorney can significantly improve your chances of getting the full benefits you deserve.

If you’re struggling with how pre-existing conditions are affecting your Nevada workers’ compensation claim, it’s time to take action. Shook & Stone can work to ensure you get what you deserve. Contact us for guidance on your case or call us at (702) 570-0000 to discuss your situation today. Let’s work together to secure your financial future.