Will Workers' Comp Cover My Pre-Existing Condition?


Doesn’t the Affordable Care Act (ACA) cover all pre-existing conditions?  In short, the answer is, no, not for workers’ compensation injuries. Workers' Comp

Personal healthcare and workers’ compensation are two different programs.  Personal healthcare is intended to address health issues which will include those illnesses that just happen, like getting a cold, diabetes, cancer, arthritis, or, pretty much anything health-related.  It also includes injuries when those injuries are not the fault of someone else, like your employer. 

Workers’ compensation is a program that addresses health issues that are caused by exposures at work, whether that is an accident, a repetitive motion, a chemical exposure, or some other effect of being on the job site.  A person has personal healthcare when one has an effective insurance policy and seeks medication treatment.  A person enters the workers’ compensation program when one files a claim and declares that a condition is the fault of their employment. 

The issue with pre-existing conditions and personal healthcare is that occasionally people change their personal healthcare insurance.  Maybe they found a cheaper insurance policy or they changed employer and lost their insurance coverage with the prior employer.  If a person had arthritis before they came to have new insurance, the personal healthcare insurance provider would assert that they did not provide coverage when this condition originated, before they had coverage of the person, so they should not have to cover the treatment.  The arthritis was “not on their watch” and not their problem.  The prior insurance would then simply assert there is no active coverage with them because the patient no longer has an effective policy. This leaves the person facing the high costs of medical treatment without assistance from any insurance. 

The ACA declared, in short, that the personal health insurance carrier could no longer make a pre-existing condition the basis to deny coverage for treatment.  The law made every, and any, insurance carrier responsible for any healthcare issues for anyone for whom they provided coverage.  In other words, if a person sought treatment “on their watch”, they were responsible for coverage.  After all, if you pay healthcare premiums, why would treatment of your health not be covered by your personal healthcare insurance?  

Workers’ compensation is separate from the ACA.  “Their watch” begins when you arrive at the workplace.  It ends when you leave.  The common cold is not covered, although one might know they got sick at work, but asthma from breathing chemicals might be a condition covered by workers’ comp. 

But, what if a person’s pre-existing asthma was worsened by breathing in harmful chemicals on the job?  That will be covered until the extent of the asthma returns to its severity prior to the exposure to the chemicals.  Repetitive motion claims, such as arthritis, are also gray-area issues where pre-existing condition conversations come into play.

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If you’re pre-existing condition becomes worsened throughout your employment, it’s important to document each interaction you have with your employer and healthcare provider leading up to your workers’ comp claim.

To ensure your claims are treated fairly in relation to your pre-existing condition, you may consider working with an attorney so that you have access to all medical benefits that you are entitled.


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