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Pre-Existing Injury? What to do

Published on 27 June 2019
It is a common misconception that an injured worker with a pre-existing injury or disease cannot claim entitlements under the WorkCover scheme. Pre-existing conditions may exist in many forms. Like many people, you may have a degenerative disease of your spine, a dodgy knee that has given you trouble from your days on the football field, or you may have underlying depression and anxiety completely unrelated to your employment.

The simple presence of these pre-existing conditions will not prevent you from lodging a WorkCover claim or accessing various entitlements including weekly payments, medical and like expenses and potentially, two lump sum claims.

It may also be comforting to learn that it is not necessary to prove that the underlying pre-existing condition was caused by your employment. Conversely, in order to access WorkCover benefits, you must only prove that you have suffered a recurrence, aggravation, acceleration, exacerbation or deterioration of your pre-existing condition and that this worsening of your injury is contributed to by your employment.

Whilst the existence of a pre-existing condition does not prevent you from accessing the WorkCover scheme, it is likely to make your claim a little more complicated and fought with more strength by Victorian WorkCover Authority and its claims agents.  Here are a few helpful tips to minimise the impact of a pre-existing condition and navigate the insurance process:

1.    Be up front
If you are considering lodging a WorkCover claim in respect of your pre-existing condition, it is pivotal that you make a full and frank disclosure of the nature and extent of your pre-existing condition. Should you fail to adequately disclose details of your pre-existing condition your access to the WorkCover scheme may be hindered or potentially restricted entirely.

2.    Attend your treating doctors and explain how and why your condition has worsened
Any claim lodged that involves a pre-existing condition is likely to be forensically scrutinised by the claim’s agent. It is likely that in particular, your treating health practitioners’ records will be examined. The prospects of having your claim accepted are likely to increase if those records include references that detail what aspects of your employment are contributing to the worsening of your condition. This may be as simple as lifting a heavy box at work, a modification to your duties resulting in additional activity on your feet or increased stress due to the demands of management.

3.    Seek legal advice
Due to the complexity arising out of a pre-existing condition, it is important that you seek professional legal advice. Lawyers generally regularly assist injured workers with pre-existing conditions and likely can assist you in having your claim accepted, or alternatively, fight for you to dispute adverse decisions such as a rejection of your claim or a premature termination of your entitlements.

Written by
James Blair
James Blair
Specialities: WorkCover