What to Do If Your Workers’ Compensation Claim Is Denied Due to Pre-Existing Conditions

You’ve been injured on the job and filed a workers’ compensation claim, but now you’ve been denied—why? Because a little while back, you went to a doctor because of pain or injury to the same part of your body that you’ve now injured at work. That is called a pre-existing condition. 

One of the most common reasons for denial is the existence of a pre-existing condition. It’s frustrating, confusing, and can leave you wondering what your next steps are. If this has happened to you, you’re not alone. In Utah, workers are often denied benefits because an insurance company claims that their injury isn’t work-related but stems from a pre-existing condition. Let’s take a closer look at what this means and what you can do about it.

Why Are Pre-Existing Conditions an Issue?

Insurance companies are quick to deny work comp claims if there’s any indication that a pre-existing condition might be the cause of your injury. This is because they don’t want to be held responsible for medical costs that they believe are not directly related to your job. However, just because you have a pre-existing condition doesn’t mean you aren’t entitled to benefits.

Example: Let’s say you have a history of back problems, and while lifting heavy boxes at work, you severely aggravate your back, causing significant pain and mobility issues. The insurance company might argue that your current condition is due to your prior back issues and not from the specific incident at work.

What Does Utah Law Say About Pre-Existing Conditions?

Utah law provides protection for workers even if they have pre-existing conditions. The key is whether the work-related incident made your condition worse or caused a new injury. In fact, under Utah’s workers’ compensation system, if your job caused your condition to worsen, you may still be entitled to benefits.

However, proving this can be challenging, especially when insurance companies focus on minimizing their payouts. That’s why having proper documentation and possibly even medical experts who can clearly explain how your work contributed to your injury is critical.

What Should You Do If Your Claim Is Denied?

Here are some important steps to take if your work comp claim has been denied due to a pre-existing condition:

1. Review the Denial Letter

Your first step is to carefully review the denial letter. Insurance companies are required to provide a reason for the denial, and understanding their reasoning is the first step toward an appeal. Was it because of a pre-existing condition, or did they say your injury didn’t happen at work? This information will shape your next moves.

2. Gather Medical Evidence

If your injury has been made worse by your job, you need medical proof. Get medical records from your treating physician that clearly show how the work-related incident aggravated your pre-existing condition. If your doctor supports your claim, this evidence can be the backbone of your appeal.

3. Consult an Attorney

Navigating a workers’ compensation claim can be confusing, especially when you’re up against an insurance company. An experienced attorney can help you file for benefits with the Utah Labor Commission, guide you through the process, and present the strongest possible case. Many workers feel they have to handle the process on their own, but having a lawyer gives you a much better chance at a successful outcome.

Example: A previous client of ours had a history of knee problems but severely injured his knee after falling at work. The insurance company denied his claim, citing his pre-existing condition. By working together, we gathered the necessary medical documentation to prove the fall significantly worsened his condition, and we were able to overturn the denial and get him benefits.

4. Appeal the Decision

If your claim is denied, you have the right to appeal. Utah allows you to challenge the insurance company’s decision through a formal process, starting with filing an Application for Hearing with the Utah Labor Commission. The process can be complicated, but it’s an important step in fighting for the benefits you deserve.

5. Don’t Wait Too Long

Utah has strict deadlines for filing a workers’ comp case. If your claim is denied, don’t wait to seek help. If you miss these deadlines, you could lose your right to assert your claim altogether. Acting quickly ensures that you keep your options open.

Don’t Let a Pre-Existing Condition Denial Stop You

A pre-existing condition shouldn’t automatically disqualify you from receiving workers’ compensation benefits. If your injury was caused or worsened by your job, you have the right to fight for the compensation you need to recover and get back on your feet.

At Schriever Law Firm, we’ve helped many Utah workers successfully navigate denied claims and win the benefits they deserve. Don’t let the insurance company dictate your recovery—get the help you need to ensure your rights are protected.