In the case of comorbid conditions, it is necessary to demonstrate that these conditions are the result of your work, or at least were aggravated by the injuries or illness sustained at work.
Comorbidity refers to the cases when a worker suffers from multiple medical or psychiatric conditions that present at the same time, and as the same injury. A common example of a comorbid condition is arthritis and heart disease – according to the CDC, 49% of patients with arthritis also have some form of heart disease.
These comorbid conditions could potentially have a negative impact on your workers compensation claims, particularly because they tend to greatly influence the time frame the worker needs for treatment. And since workers compensation also must cover your lost wages, the insurance company will, therefore, have to pay a higher amount of benefits for your claim.
In addition, it may be more difficult to prove that all of your conditions/injuries are related to your occupation illness or injury. Insurance companies will look for any reasons to deny your claim.
The Issue with Comorbid Conditions
The problem with comorbid conditions is that it’s difficult to predict whether the claim will get approved or not because of it. Workers compensation applies for injuries or illnesses workers have as a direct result of their work activities or the work environment.
But in the case of comorbid conditions, it is necessary to demonstrate that these conditions are also a result of your work, or at least were aggravated by the injuries or illness sustained at work. Separate conditions with no link to each other are not considered comorbid conditions.
And since these conditions often mean higher benefit payments, and longer treatment periods (meaning time missed off work), it’s not entirely impossible for insurance companies to deny these claims or refuse to pay for the treatment of one of the condition.
What Can You Do If the Claim Is Denied?
By law, workers compensation benefits have to cover to costs of your medical treatment. Even if you already suffer from a certain condition, if it is aggravated by an injury or illness created by your employment, then the benefits must cover the costs of all your treatment.
If your claim has been denied, you can first appeal the decision directly with the insurance company. Reach out to a St. Louis workers comp lawyer to help you build a more compelling case, with enough medical evidence to attest your condition got worse because of your work, therefore making your employer liable.
Work Injury Attorneys in St. Louis
Do not let your employer or the insurance company deny you your rightful benefits. Call the Law Office of James M. Hoffmann at (314) 361-4300 or fill out our online contact form to request a free consultation concerning your workers compensation claim.
James M. Hoffmann has over 20 years experience as a Workers Compensation Lawyer. We can provide you with the necessary information to make the right choices so that you can receive the best medical care, benefits and income.