Workers Compensation Lawyer on Pre-Existing Conditions and Aggravation

When a worker with a bad back, a prior shoulder tear, or diabetes gets hurt on the job, the conversation shifts quickly. Insurers ask whether the injury really belongs to the workplace or to the worker’s past. Doctors chart “degenerative changes” and “pre-existing conditions” in nearly every middle-aged spine. And the worker, caught in the middle, wonders if the benefit checks will ever start. I have lived that cycle with hundreds of clients and in countless mediations. The law does not require a perfectly healthy employee. It does, however, demand clarity about what changed because of the job.

This is a practical guide to how pre-existing conditions interact with workers’ compensation, with a focus on strategies that work, mistakes that cost money, and the medical-legal proof that actually moves adjusters. The core principle is simple: employers take workers as they find them. If work aggravates, accelerates, or exacerbates a prior condition, the resulting harm can be a compensable injury under workers’ comp. The rest is detail and proof.

The legal backbone: aggravation versus recurrence

Every state recognizes some version of an aggravation rule, though the language varies. Aggravation means a work event or exposure caused a measurable, new worsening of an underlying condition. Recurrence means the old condition flared on its own without any new injurious event. The consequences are enormous. Aggravations are usually compensable. Recurrences frequently are not, or they fall under the older claim with a prior carrier.

What makes something an aggravation? Medical evidence that the work incident changed the baseline. That proof can be subtle. A worker with asymptomatic lumbar degeneration who lifts a motor and develops radiating leg pain, weakness, and a new MRI finding of a herniation has a classic aggravation. A worker with chronic knee arthritis who notices more pain by Friday, no specific event, no functional change, and no new objective findings is much harder to call an aggravation.

Insurers lean hard on the recurrence narrative. They point to old imaging or prior treatment, then argue that today’s complaint is the same song. The counter is functional change confirmed by credible medical opinion. Experienced workers compensation attorneys know to anchor that change in objective markers and before-and-after comparisons rather than adjectives like “worse” or “flare.”

What “compensable” looks like in real life

Compensable injury in workers’ comp turns on whether the injury arose out of and in the course of employment. With pre-existing conditions, two details carry weight.

First, symptoms versus diagnosis. Many people have abnormal imaging without pain. If a worker had cervical spondylosis for years but no limitations, then a ladder fall produces constant neck pain, numbness in two fingers, and a positive Spurling’s test, that functional shift is the sort of fresh harm the law covers.

Second, mechanism matters. Insurers are more skeptical when there is no identifiable incident. That does not mean a claim fails. Cumulative trauma claims are legitimate, especially in jobs with forceful, repetitive tasks or awkward postures. The proof package needs better ergonomics detail and a doctor willing to connect the dots. Warehouse pickers, meat processors, dental hygienists, and welders can all develop work-related aggravations over time, but the charting must be thorough.

The medical record tells the story you will live with

The first treating physician sets the tone. Adjusters read that initial chart note more closely than almost anything else. If the note says “patient reports chronic knee pain, worsened today, no trauma,” the opening move is denial. If it says “patient with prior knee arthritis had sudden pain stepping down with a popping sensation on a delivery route,” the claim breathes. Semantics matter because they guide the doctor’s diagnostic path, and they frame the insurer’s view on compensability.

When you speak to the doctor after a work incident, give a clear timeline. Describe the job task, the position of your body, the feel of the onset, and what changed after. If you had prior issues, say so candidly, along with whether you were asymptomatic recently and performing full duty. Doctors appreciate full disclosure, and hiding history almost always backfires. A good work injury lawyer helps clients prepare for that first visit so the chart captures the right details without embellishment.

A quick note on imaging. X-rays reveal chronic degenerative changes readily. MRIs pick up bulges, tears, and edema. Radiologists often include phrases like “degenerative changes,” which carriers then treat like a get-out-of-claim-free card. The radiology impression is not the end of the analysis. Comparing studies before and after the incident, or correlating a new finding with dermatomal symptoms, supplies the bridge from degeneration to aggravation. Savvy workers comp attorneys request prior records selectively, then highlight the distinctions that matter.

Georgia specifics that often surprise people

Georgia law recognizes aggravation of pre-existing conditions as compensable if a work accident or exposure contributes to the disability. The statute also codifies a concept that becomes decisive later: after the aggravation resolves, only the underlying condition remains, and benefits can stop.

Here is how that plays out. A worker with a prior back condition suffers a lifting incident, receives conservative care, and improves to the point the doctor says the work-related aggravation has resolved. At that moment, in Georgia, entitlement to further workers compensation benefits may end even if the worker still has pain from the underlying degenerative disease. Timing and precise language matter. Doctors sometimes write that the worker is “at baseline.” If that baseline involves restrictions, the question becomes whether those restrictions existed before the work event. An experienced Georgia workers compensation lawyer will gently press treating physicians to differentiate what remains due to the work injury versus the old condition.

Another Georgia nuance is late notice. The law generally requires prompt notice to the employer. With pre-existing conditions, workers sometimes wait, expecting the pain to pass. If more than 30 days go by, the insurer may deny the claim based on lack of timely notice. A credible explanation and corroboration from coworkers can salvage it, but the delay raises the bar. I advise injured workers to notify supervisors as soon as they suspect the aggravation is work-related, even if they hope to improve quickly.

If you are in Atlanta or anywhere in the state, look for an atlanta workers compensation lawyer who routinely deals with aggravation claims. Local doctors and insurers have patterns, and pattern recognition wins cases.

Maximum Medical Improvement and what it does to your case

Maximum medical improvement, or MMI, is not a magic date, but it changes leverage. MMI means your condition is stable and further significant functional improvement is not expected with medical treatment. In workers’ comp, MMI can affect wage benefits, the possibility of a switch to permanent partial disability, and settlement timing. In pre-existing condition cases, MMI raises a harder question: has the work-related aggravation ended even if the underlying disease persists?

I have seen treating physicians declare MMI prematurely, often under pressure or based on a couple of missed PT sessions. A well-timed request for a second opinion, particularly from a specialist who understands the job’s physical demands, can reset the trajectory. Conversely, chasing indefinite treatment without measurable gains can erode credibility. Objective measures help. Grip strength changes, range-of-motion data, repeat nerve conduction studies, or validated pain and function questionnaires can document continued work-related impairment.

When a doctor places you at MMI, ask for clarity: MMI as to the work aggravation or MMI as to the whole condition? That distinction influences compensation and medical coverage. A workers comp dispute attorney skilled in medical cross-examination can extract that detail documented in the records.

The role of credibility and the 90-day arc

Most contested claims are won or lost in the first 90 days. Not in a courtroom, but in the way information lands on the adjuster’s desk. The employer incident report, the first medical note, the recorded statement, and any prior treatment records tell a story. If the story is consistent, specific, and proportionate, the path to acceptance opens. If it is vague, shifting, or inflated, the file heads toward denial.

Credibility is not about perfection. It is about congruence. If you say you could not lift your arm after the incident, then the urgent care note shows full range of motion and normal strength, you need an explanation rooted in how symptoms fluctuate. If old records show a back strain a month before the current event, disclose it and distinguish what changed. A seasoned workers compensation attorney will not hide bad facts. We reframe them accurately: two events, different body mechanics, different symptoms, different exam findings.

What insurers argue and how to answer them

The most common insurer arguments in pre-existing cases come in five flavors.

There is no new injury, just a flare of the old disease. The reported mechanism cannot cause the claimed harm. The worker had similar complaints before and failed to disclose them. The injury is idiopathic, meaning it arose from a personal condition unrelated to employment. The worker reached MMI and any ongoing issues are unrelated.

Answering these points takes more than indignation. It requires testimony that either neutralizes the premise or narrows it. When carriers say the mechanism is weak, bring ergonomics into play and, if necessary, a treating physician willing to opine on forces and tissue failure. If the worker hid prior care, credibility can still be rebuilt with a full timeline and a decent explanation. Idiopathic defenses succeed when the workplace contributes nothing. If the floor is slippery, the lighting poor, or the job requires a twist under load, the environment contributed.

On MMI, remember that stability and causation are different. A condition can be stable yet remain the responsibility of the employer because work caused the stable impairment. Conversely, a condition can still be changing but no longer work-related if the aggravation has fully resolved. Distinguish the two.

Practical medical strategy that pays off

I encourage clients to pick one physician group with the right specialty and to stay consistent unless the care stalls. Doctor shopping looks bad. That said, if progress stops and the insurer refuses a second opinion, a workers comp lawyer can push for a change in provider through the panel process or, in some jurisdictions, an independent medical examination.

Explain your job in granular detail each visit. Do not say “delivery driver.” Say you lift 60-pound packages, climb in and out of a truck 60 times a day, and walk three miles on concrete. Doctors write what they hear. Ask them to include baseline function. If you ran three miles twice a week before the incident and now cannot, that contrast matters.

Medication issues and comorbidities also show up in these cases. Diabetes slows healing. Obesity strains joints. Smoking impairs fusion rates. Insurers love to point to these factors. The smart approach is to acknowledge and manage them. If your doctor notes well-controlled A1C levels and a tailored rehab plan, the comorbidity becomes less of a cudgel.

Documenting work restrictions the right way

Light duty can help or hurt depending on execution. If your employer offers a suitable light-duty position and the doctor approves it, refusing can jeopardize wage benefits. If the offered job is a paper exercise that violates restrictions, document the mismatch. Ask the doctor to write restrictions in concrete terms: lift no more than 20 pounds Atlanta Work Injury Lawyer occasionally, avoid overhead reaching with the right arm, limit standing to 20 minutes at a time, no ladder climbing. Vague restrictions invite conflict.

A good workplace injury lawyer cross-checks the written job description against reality. We sometimes ask clients to keep a short daily log for a few weeks. Not a diary, just time on task, weights lifted, pain spikes with specific movements. That log helps doctors adjust restrictions and gives the adjuster a reason to authorize therapy or imaging.

Surveillance, social media, and the optics of pain

Pre-existing condition disputes often attract surveillance. Insurers hope to catch something that contradicts your claimed limitations. The footage does not need to show fraud. It only needs to raise doubt. Be consistent. If you say you cannot lift more than 15 pounds, do not carry a 40-pound dog into the groomer while your case is pending. Social media tells on people. A single photo of you smiling at a nephew’s soccer game becomes Exhibit A against claims that you never leave the couch. None of this means you cannot live your life. It means align your activities with your documented restrictions.

Settlement dynamics when an old condition meets a new injury

Settling an aggravation case takes a different calculation. You are not selling the underlying disease. You are resolving the portion of the condition for which the employer is responsible. That subtlety affects valuation. The key factors include whether the injury is accepted, your current work status, the likelihood of future surgery, and the credibility of the causation opinion.

Permanent partial disability ratings often become the only permanent benefits in contested aggravation cases. The rating follows from MMI and is expressed as a percentage of the body part or whole person. A workers compensation benefits lawyer helps ensure the rating uses the correct edition of the AMA Guides and accurately reflects range-of-motion loss, strength deficits, and sensory changes.

Future medical is the other lever. If your surgeon recommends an L4-5 fusion and you are 48 with ongoing radicular pain, the cost exposure is large. Carriers will pay more to close medical in that scenario, but they will push hard on the degenerative component. A detailed medical narrative that ties the levels and symptoms to the work event, and addresses the pre-existing degeneration head-on, can bump the settlement significantly.

The employer’s perspective and how to make it work for both sides

Supervisors and HR professionals wrestle with these claims when they involve solid employees who have been reliable for years. They fear setting precedent for every sore back. They also need people back at work. Early, candid communication helps. Outline the restrictions, ask for a temporary modified role that produces real value, and set a review point in four weeks. That structure keeps the claim from drifting. It also reassures the employer that this is not a permanent assignment unless necessary.

From the employer side, prompt reporting and a supportive, non-accusatory tone pays dividends. Workers feel safer reporting early, which improves outcomes. Fight the urge to label every older worker’s complaint as “just arthritis.” People can have degeneration and a compensable injury. Both can be true.

When to call a lawyer and what to expect

If you see any of the following signs, involve a workers comp claim lawyer quickly: the adjuster focuses on old records and refuses to authorize recommended imaging, the employer offers a light-duty job that does not match your restrictions, the treating doctor hints at MMI early without functional restoration, or surveillance concerns emerge. Early guidance avoids mistakes that are hard to unwind.

Working with a workers compensation attorney should feel like gaining a project manager for your recovery and claim. Expect help coordinating medical care within the panel or network, sharpening the causation narrative, preparing you for recorded statements and independent medical exams, and pushing for timely benefits. A good work injury attorney also knows when to settle and when to keep treating. If you search for a workers comp attorney near me, interview a few. Ask about their experience with pre-existing condition claims, not just traumatic injuries.

A brief step-by-step if you think work aggravated an old condition

Report the event or onset to your employer promptly, ideally the same day. Be specific about the task and the change in symptoms. Seek medical care within the authorized network, and tell the doctor your full history and the precise mechanism at work. Keep duties within restrictions. If a task violates them, stop and document what happened. Follow the treatment plan, and track objective progress or setbacks. Share that data with your doctor. Consult a workers comp lawyer if benefits are delayed, treatment is denied, or the insurer disputes causation.

Hard cases and honest expectations

Not all claims with pre-existing conditions will be accepted, and not all denials are malicious. Sometimes the change from baseline is minimal or not medically traceable. In those cases, the right outcome may be a modest settlement or none at all. The job of a job injury attorney is to separate fixable proof gaps from insurmountable medical limits. We push where the medicine supports us. We counsel realism where it does not.

I handled a case for a 56-year-old HVAC tech with long-standing shoulder degeneration who felt a ripping pain pulling a rooftop unit panel. MRI showed progression of a partial-thickness tear to a full-thickness tear. The carrier argued the tendon was on borrowed time. True enough. But the job supplied the final insult, and his function cratered that day. With a clear surgical recommendation and a direct causation letter from the orthopedist that compared pre- and post-incident imaging, we secured acceptance and later settled for a figure that covered surgery, rehab, and several months of wage loss. Not a lottery. A bridge back to work and a fair tradeoff of risk.

By contrast, a warehouse worker with multi-year, weekly chiropractic notes for low back pain, no specific event, and a bare assertion that “standing makes it worse” struggled. We tightened the ergonomics story, but the absence of a change in exam findings limited the outcome. We obtained a short course of PT and a small rating-based settlement. Not what he hoped for, but aligned with the proof.

Bringing it together

Pre-existing conditions do not disqualify workers’ compensation claims. They focus them. The questions become concrete. What changed because of the job? How do we prove that change with medical facts, not adjectives? When does the work-related aggravation end, and how do MMI and restrictions interact with that endpoint? A workplace accident lawyer with a calm approach and strong relationships with treating physicians can answer those questions in a way that persuades adjusters and, if necessary, judges.

If you believe work aggravated an old injury, act quickly, speak precisely, and build a record that shows function before and function after. The law expects honest effort and clear proof. Give it both, and the system, imperfect as it is, will usually do its job. If you need help navigating the steps, a work-related injury attorney or an injured at work lawyer can steady the process, protect your benefits, and keep the focus on healing while the paperwork and arguments run their course.