Most workers who walk into my office are not blank slates medically. They have old sports injuries, a cranky lower back that flares after yard work, a shoulder that clicks from years on the job. When a new accident happens at work and that body part lights up, the first worry is predictable: am I barred because I wasn’t perfect to begin with?
You are not barred. Workers’ compensation law, across most states, recognizes the human body as it is, not as an idealized model. The friction, though, lies in proving what changed after the work event and how that change affects your ability to earn a living. That is where claims with pre-existing conditions win or fail.
This is a practical guide drawn from years of handling these cases as a workers compensation lawyer. Expect nuance. Some of it may feel counterintuitive. All of it is grounded in how insurers evaluate claims, how doctors document causation, and how judges weigh credibility.
The legal backbone: aggravation versus recurrence
Every workers comp attorney knows the fight usually centers on one question: was your work incident an aggravation of a pre-existing condition or merely a recurrence of symptoms you already had? That label carries real consequences.
An aggravation is a material worsening caused by work. Material does not mean catastrophic. It means the condition measurably changed. That change might be structural, such as a new disc herniation atop degenerative discs, or functional, such as baseline pain jumping from a 2 to a 7 with new neurological findings. Aggravations are generally compensable, which means medical treatment and wage benefits should flow, even if your spine or knee had some wear and tear before.
A recurrence, in insurer speak, means the condition flared without a new injurious event or worsening. Think of seasonal back tightness that returns after stressful work but with no new findings on exam or imaging, and no change in work capacity beyond what you had before. Recurrence cases are picked apart and often denied, or benefits are limited to medical treatment only.
The hard part is that the difference is rarely obvious in real time. Imaging may lag behind symptoms, and primary care notes often fail to draw clear before and after lines. If you have a pre-existing issue, the key evidence will be comparison points: objective findings, function, and work restrictions before versus after the incident.
How insurers actually evaluate pre-existing conditions
On paper, adjusters are trained to accept aggravation claims. In practice, they start with skepticism. The internal logic goes like this: if you had a vulnerable back, of course it hurts after lifting a box. Did anything really change? They look for reasons to chalk the problem up to degeneration. Here is the pattern I see in files across carriers:
- They comb your records for any mention of pain in the same area, even a single urgent care visit five years ago, to argue this is nothing new. They seize on imaging phrases like degenerative disc disease, osteophytes, tendinosis, and mild arthrosis. Those words are used to suggest an inevitable progression unrelated to work. They commission an independent medical exam, often with a treasured vendor, to secure a phrase like temporary exacerbation now returned to baseline.
Understanding this pattern helps you and your workplace injury lawyer get ahead of the narrative. The aim is not to pretend your body had no history. The aim is to prove with evidence that something materially changed when you got hurt at work.
What counts as a material change
Judges and hearing officers respond to concrete comparisons. In my experience, five classes of evidence move the needle:
- Specific functional losses with dates. Before the incident, you lifted 50 pounds and worked 10-hour shifts. Afterward, you could not carry a 20-pound box or stand longer than 20 minutes. Write this down early. Details fade. Objective findings that were not present before. New weakness on manual muscle testing, new reflex changes, new positive straight leg raises, or a new tear on ultrasound. Even small quantified changes matter. Escalation in medical care. A person who previously managed with home exercises and occasional ibuprofen now needs physical therapy, injections, or surgery. That escalation signals a meaningful shift. Formal work restrictions that did not exist before. If your occupational health provider limits lifting, overhead work, or repetitive bending for the first time, that is evidence of aggravation. Clear chronological linkage. Symptoms begin immediately or within a plausible window after a specific task or incident. Vague onset or delayed reporting muddies the picture, though it is not fatal if you can explain why.
Medical records that articulate these shifts in plain terms are far more persuasive than broad diagnoses. A workplace injury lawyer often collaborates with treating providers to capture this granularity.
Everyday examples that shape outcomes
Two quick case sketches illustrate how nuance drives decisions:
A maintenance tech with known lumbar degeneration tweaks his back lifting a water heater. He goes from intermittent soreness to radiating pain into his calf, plus new numbness in the big toe. MRI shows a new L5-S1 herniation superimposed on old DDD. His doctor imposes no-lifting-over-15-pounds restrictions and recommends epidural injections. The carrier argues degeneration. The claim wins because the nerve symptoms, imaging change, and restrictions did not exist before.
A retail worker with a 10-year history of knee pain reports increased pain after a long holiday shift. No slip, no twist, just more standing than usual. Exam shows familiar crepitus without effusion or instability. X-rays match prior studies. Physical therapy restores baseline within four weeks. The carrier initially denies, then pays medicals but not wage loss. Compensability is borderline. There is no clear aggravation beyond a transient flare, so wage benefits were unlikely.
Real cases sit between these poles, but the pattern holds: new structure, new function limits, new care intensity.
Disclosing prior injuries without tanking your claim
Many workers worry that mentioning old problems will give the insurer ammunition. It might, but hiding prior care is worse. If the adjuster discovers an undisclosed history, credibility craters. Judges do not like surprises, and defense medical experts will use omissions to portray you as unreliable.
Tell your work injury attorney about every related complaint you can remember, even if it feels minor. Provide names of clinics and approximate dates so records can be gathered and framed properly. A frank narrative wins more cases than a polished one that cracks under cross-examination.
There is a clean way to present it: I had occasional back pain after yard work, but I never missed shifts or needed formal restrictions. After the pallet collapse on March 7, I had immediate pain, shooting into my right leg, and I have not been able to complete a full shift since. That is honest and draws the contrast that matters.
The medical conversation that changes the file
Doctors do not write for judges. They write for clinical care. That means they often omit the precise causation language the law requires. A workplace accident lawyer spends significant time nudging providers to address three specific issues:
- Diagnosis specificity. Instead of lumbar strain on top of degenerative disc disease, ask for clarity: acute L5-S1 disc protrusion superimposed on pre-existing DDD. Causation phrased to the legal standard. In most states, the standard is more likely than not or a substantial contributing cause. If your jurisdiction uses major contributing cause, that matters. Your workers compensation attorney should advise the doctor on the phrasing. Baseline comparison. A simple paragraph that contrasts pre-injury function with post-injury limitations is gold. It does not need legalese. It needs dates, tasks, and changes.
Doctors respond when they understand why the words matter. A respectful letter from your job injury attorney, enclosing a brief timeline and targeted questions, often yields a chart note or narrative report that turns a denial into an acceptance.
Degeneration is not a defense to all claims
Insurers love the word degenerative. Most imaging after age 40 shows degenerative change in joints and spine. That does not mean work cannot aggravate those structures. Courts routinely accept that normal degeneration can become disabling when a specific work event accelerates or destabilizes it.
Where lines are drawn depends on your state. Some jurisdictions require the work event to be the major cause of the need for treatment when a condition is pre-existing and degenerative. Others accept substantial contributory cause. The difference between 51 percent and 50 percent can be dispositive. Experienced workers comp lawyers tailor strategy to those standards. For some clients, that means emphasizing the acute nature of symptom onset. For others, it means stacking multiple workplace microtraumas over weeks to meet the standard.
The reporting trap: timing, detail, and your credibility
Late reporting torpedoes good claims more than any single factor. If you felt a pop or a sudden onset at work, tell a supervisor the same day, or as soon as you reasonably can. If you waited, explain why, and do it consistently. People delay for understandable reasons, like hoping it will pass or not wanting to miss overtime. Those reasons are believable when stated plainly.
Your first medical visit matters. If the triage nurse asks what happened, be specific. I was pulling a jammed reel off the line at 2 pm, felt a sharp pain in my shoulder, and could not lift my arm without pain afterward is far stronger than shoulder pain for two days. That first note will be read a dozen times by the adjuster, the IME doctor, and the judge.
What to do in the first 14 days after a work injury with a pre-existing condition
Early decisions shape the tone of the entire claim. Here is a concise plan that fits most situations:
- Report the incident in writing to your supervisor the same day or as soon as possible, naming the task, time, and body part. Seek medical care, ideally with an occupational health clinic or your primary care provider, and describe the mechanism with specifics. Mention your prior condition honestly and emphasize what changed. Photograph any visible signs, like swelling or bruising, and note dates when you could not perform usual tasks at work or home. Keep a simple daily log of symptoms, missed work, and medications taken. Two lines a day is enough. Call a workers compensation attorney for a free consult before recorded statements with the insurer. It costs nothing to understand your rights and avoid pitfalls.
Navigating modified duty, wage loss, and permanent impairment
When a doctor imposes restrictions, your employer may offer light duty. If the work is safe and within the restrictions, accept it. Declining legitimate modified work can undercut wage benefits. That said, if a proposed job is a sham, like punitive cleaning tasks or hours far beyond restrictions, document why it violates medical limits and get clarification from your doctor.
Temporary total disability benefits fill the gap when you cannot work at all under medical advice. Temporary partial benefits may apply when you work fewer hours or at lower pay. These benefits often lag because insurers dispute the link to your pre-existing condition. Persistence and proper documentation, not bluster, close the gap. Pay stubs, schedules, and written restrictions win arguments.
If your condition stabilizes with ongoing limitations, the system may evaluate permanent impairment. Pre-existing impairment complicates this step. Some states apportion, meaning they compare your impairment before and after the injury and only pay the difference. Others pay for the entire impairment if the work injury contributed meaningfully. Your work-related injury attorney should prepare for this early, collecting older records and, when appropriate, arranging an independent rating that addresses apportionment head-on.
The role of independent medical exams and how to handle them
Insurers use independent medical exams to probe causation and necessity of care. The name is aspirational. Many IME doctors perform hundreds of exams per year for carriers and develop predictable conclusions. That does not make them invincible on the stand. What hurts claimants is inconsistency, not adversity.
Prepare for the IME with your on the job injury lawyer. Review your timeline. Keep answers precise. Do not argue, speculate, or minimize. If a test causes pain, say so. If a movement is impossible, do not force it. The doctor is watching for overstatement and symptom magnification, but also for underreporting that makes your condition look trivial.
After the exam, write down what happened while it is fresh. Note the length of the visit, tests performed, and any concerning interactions. This contemporaneous note can undermine an IME report that claims a thorough exam when the appointment lasted six minutes.
Settlements: when they make sense and when they do not
Settlements come in flavors. Some close only wage benefits and leave medical open. Others, often called compromises, close everything for a lump sum. Pre-existing conditions influence both the value and the risk.
If your condition is stable, restrictions are established, and care is predictable, a full settlement may make sense if it accounts for future treatment. If your diagnosis is evolving, or surgery remains on the table, closing medical can be a mistake. Health insurance rarely covers work-related care after a workers comp settlement, and paying out of pocket for a surgery can dwarf the settlement premium you received.
Value is not math alone. It reflects credibility, jurisdictional standards, the quality of your doctor’s causation opinion, the IME strength, and the employer’s appetite for return-to-work. A seasoned workplace accident lawyer will not sell you certainty. They will walk you through scenarios, including tax implications and potential offsets with disability benefits, and weigh the downside risk of hearing.
Common misconceptions that derail claims
Several myths persist around pre-existing conditions in comp claims. Clearing them helps you make better decisions.
- If you had prior pain, you cannot win. Not true. You win by proving a meaningful change after a work event. Many claimants with old injuries prevail when they document the new baseline. You should avoid mentioning old problems. Silence invites credibility attacks. Honest disclosure, paired with concrete contrasts, is stronger than omission. MRI findings decide the case. Imaging helps, but function and credible timelines often carry more weight than pictures. Plenty of strong claims involve soft tissue injuries where the strongest evidence is restrictions and clinical exams. Light duty means your claim is weak. Light duty can be a bridge to recovery and a sign that the employer is engaged. It does not undercut compensability. It does affect wage benefits, which is why precise restrictions matter. You only need a lawyer if you go to court. Early guidance can prevent mistakes that lead to court. Most workers comp lawyer fees are contingency-based and regulated, and the initial call is free. Waiting until after a denial can limit options.
Industry-specific wrinkles
Job tasks shape both causation and the types of pre-existing conditions that flare. A few patterns I see:
Warehouse and logistics. Repetitive lifting and twisting accelerate disc and shoulder issues. Incident reports that specify weight, box dimensions, and shelf height carry extra credibility. Forklift jolts often trigger lumbar aggravations; documenting the surface condition and speed helps.
Healthcare. Nurses and aides with known lumbar or knee degeneration face frequent aggravations during patient transfers. Body mechanics training notes and staffing ratios can contextualize an incident and explain why a safe technique failed in a real-world moment.
Construction. Overhead trades like electricians and painters commonly aggravate rotator cuff tendinosis into tears after a forceful pull or slip while bracing. Weather, ladder placement, and tool weight details matter. For knees, crouching and uneven surfaces often convert asymptomatic degeneration into meniscal tears.
Office work. Carpal tunnel and cervical issues draw skepticism, but a rapid increase in keyboard hours during a crunch, coupled with ergonomics assessments, can tie aggravations to the job. Pre-existing mild numbness that becomes constant with measurable grip weakness is frequently compensable.
When to bring in a lawyer and what to expect
If any of these flags appear, it is time to speak with a work injury attorney:
- You receive a denial that cites degeneration or prior injury. The doctor hints at light duty, but your employer offers tasks outside restrictions or pressures you to return full duty. The insurer schedules an IME quickly, especially before you have seen a specialist. Your symptoms differ meaningfully from before, but your medical notes do not capture those differences.
The first meeting with a job injury attorney should feel like triage and strategy, not sales. Expect a review of your timeline, prior medical records, and the employer’s policies. The lawyer should explain your state’s causation standard in plain language, identify gaps in documentation, and propose immediate steps, like a clarifying letter to your doctor or a request for formal restrictions. Fees are typically a percentage of the recovery or regulated by statute, with no upfront cost. Choose someone who can speak fluently about your job tasks and has appeared before your local comp judges. Style matters. So does local knowledge.
Your voice is the through line
Pre-existing conditions do not doom claims. They require clearer storytelling backed by objective anchors. The best cases I have tried shared a few traits: the worker reported promptly, described the exact task that triggered the change, acknowledged old aches without defensiveness, and kept the focus on what changed and how that change limited real work. The medical records echoed that story because the provider understood why the details mattered. The insurer still contested, often with boilerplate references to age-related degeneration, but the file contained enough specific counterpoints that the judge had little trouble seeing the difference between a human body with history and a body altered by work.
If you are standing at the intersection of old pain and new injury, do not self-select out. Atlanta Worker Injury Lawyer Talk to a workplace injury lawyer who will map the path between the technical rules and your lived reality. The system is imperfect, but with the right evidence and a steady narrative, it does what it was designed to do: pay for the harms and limits that work introduced or meaningfully worsened.