- Workers' Compensation
Preexisting Condition and Your Workers’ Compensation Claim in 2025
We represent injured workers in Atlanta with clarity and purpose. We know Georgia workers’ compensation law inside and out. Our team at Workers’ Compensation Lawyers Atlanta helps clients file claims, handle insurers, and collect benefits to which they are entitled. We focus on your medical needs and wage loss. When a preexisting condition complicates your claim, we gather evidence, secure medical opinions, and present your case with precision. We do not charge unless we win your case.
Many Georgia workers worry that a preexisting condition will cause their workers’ compensation claim to be denied. In most cases, the outcome depends on whether the job made the condition worse or caused new injury. Insurance companies often look for ways to argue that the medical problem is unrelated to work. Knowing how Georgia law treats preexisting medical conditions and how insurers evaluate these claims can help injured workers protect their rights and secure the benefits they need.
In this blog, you will learn how Georgia workers’ compensation law handles claims involving a preexisting condition, the common reasons insurers deny these claims, and the steps you can take to protect your benefits by working with an experienced Atlanta workers’ compensation lawyer.
Georgia Workers’ Compensation Law and Preexisting Conditions
Workers in Georgia often ask if a preexisting condition will stop them from receiving benefits after a work injury. The answer depends on how the injury happened, how it relates to the preexisting condition, and how well it is documented.
Georgia’s Definition of a Work Injury
Under O.C.G.A. § 34-9-1, a work injury must arise out of and occur during the course of employment. This means the injury must be connected to the worker’s job duties and happen while performing those duties. If work tasks make a preexisting medical condition worse, the injury may qualify for benefits under Georgia workers’ compensation law.
The Aggravation Rule
O.C.G.A. § 34-9-23 states that if job duties aggravate, accelerate, or combine with a preexisting medical condition to produce a new injury, the worker can receive benefits. This includes situations where lifting, repetitive motion, or workplace exposure triggers a flare-up or permanent worsening of an existing injury or illness. Once aggravated by work, the condition is treated as a new injury for workers’ compensation purposes.
Covered and Uncovered Conditions
A preexisting condition that is worsened by work is generally covered. For example, a warehouse worker with a prior back injury who strains their back while lifting at work may be eligible for benefits. On the other hand, a purely personal medical condition that develops naturally without a work-related trigger is not covered. The deciding factor is whether work directly contributed to the injury.
The Role of Medical Evidence
Insurance companies often examine medical records closely in cases involving preexisting conditions. They compare past medical history with current injury details to decide if work caused the problem or if it is simply a continuation of an old issue. Strong medical documentation from a treating doctor is critical to prove that work aggravated the condition. Without it, an insurance company may deny the claim.
How Insurance Companies Evaluate Claims with a Preexisting Condition
Insurance companies often review claims involving a preexisting condition closely before deciding whether to approve or deny benefits. Their goal is to determine if work duties actually worsened the condition or if the injury is unrelated to the job.
Reviewing Medical History
Insurance company adjusters often start by examining the worker’s past medical records. They look for prior treatment related to the same body part or medical condition. Any documented history of injury, illness, or treatment may be used to argue that the current problem existed before the reported work injury.
Comparing Past and Current Conditions
The insurer will compare the worker’s previous medical condition with the current diagnosis. If the records show the condition has remained stable over time, they may argue there was no work-related aggravation. If there is evidence of a significant change following the work incident, this may support the claim.
Independent Medical Examinations
Insurance companies sometimes request an independent medical examination. This allows a doctor selected by the insurer to evaluate the worker. The purpose is to determine if the current injury is new or simply the natural progression of a preexisting condition. These evaluations can heavily influence whether a workers’ compensation claim is approved or denied.
Use of Workplace Incident Reports
Insurers also review workplace incident reports and statements from supervisors or co-workers. They look for details that confirm or contradict the worker’s account of the injury. Any inconsistencies between the report and the medical records may lead to a denial.
Focus on Work Connection
The key question for the insurance company is whether the job caused or worsened the medical condition. Without strong evidence linking the injury to work duties, a claim involving a preexisting condition is more likely to be denied. Workers should be aware of this and gather clear documentation from the start.
Common Reasons for Claim Denials in Preexisting Condition Cases
Workers’ compensation claims involving a preexisting condition face closer scrutiny, and insurance companies often use specific reasons to deny coverage. Understanding these reasons can help injured workers prepare stronger claims.
Lack of Medical Evidence
Insurance companies often deny a claim if there is no clear medical proof that work duties aggravated the preexisting condition. Without diagnostic tests, treatment records, and a doctor’s opinion linking the injury to work, the insurer may argue the condition is unrelated to the job.
Late Injury Reporting
Under O.C.G.A. § 34-9-80, an injured worker must report a work injury to the employer within 30 days. Failing to report promptly can lead to a denial. The insurance company may claim the delay means the injury did not happen at work or is unrelated to job duties.
Incorrect or Incomplete Filing
In Georgia, injured workers must file a Form WC-14 with the State Board of Workers’ Compensation to start a claim. If the form is incomplete, incorrect, or not filed within the required time, the claim may be denied.
Conflicting Accounts of the Incident
If the worker’s account of the injury differs from the employer’s report or from what is stated in medical records, the insurer may deny the claim. Consistency between the incident report, witness statements, and medical notes is critical.
Claim Seen as Unrelated to Work
Insurance companies often argue that a claimed injury is the natural progression of a preexisting condition rather than the result of a workplace incident. If they believe job duties played no role, they may refuse to provide benefits.
Steps to Strengthen a Workers’ Compensation Claim When You Have a Preexisting Condition
A worker with a preexisting condition must take specific steps to improve the chances of having a workers’ compensation claim approved. These steps help show the link between the job and the injury.
Report the Injury Immediately
Tell your employer about the injury as soon as it happens. You must give notice within 30 days. Include details about how the incident occurred and how it affected your preexisting condition.
Seek Prompt Medical Treatment
See a doctor approved by your employer or the workers’ compensation program right away. Explain both your preexisting medical condition and how the job incident made it worse. This creates a clear medical record of the aggravation.
Gather Strong Documentation
Keep copies of all medical records, diagnostic tests, and doctor’s notes. Written statements from your physician explaining how work aggravated the condition can be critical. Keep incident reports, witness statements, and any related emails or forms.
File the Correct Forms
Submit a Form WC-14 to the State Board of Workers’ Compensation. Make sure the form is accurate and complete. Filing on time prevents delays and avoids giving the insurance company an easy reason to deny the claim.
Follow Treatment Plans Closely
Attend all scheduled medical appointments and follow the treatment plan. Missed appointments or gaps in care can lead the insurance company to argue that your condition is not serious or work-related.
Contact a Workers’ Compensation Lawyer
A workers’ compensation lawyer can gather the right evidence, communicate with the insurance company, and represent you at hearings. This is especially important when the claim involves a preexisting condition that insurers may challenge.
Get Help with Your Preexisting Condition Workers’ Compensation Claim!
If you have a preexisting condition and your work injury claim is at risk, our team at Workers’ Compensation Lawyers Atlanta can help. We know how Georgia law applies to these cases and how to challenge insurance company denials.
Contact us at 470-518-5026 for a free case consultation today!
