Are Pre-Existing Conditions Covered in Work-Related Injuries for Workers' Compensation?

An injury or illness is considered to be work-related if an event or exposure in the work environment contributed to the resulting condition. It may also have significantly aggravated a pre-existing injury or illness.

An injury or illness is a pre-existing condition if it existed prior to the work-related event or exposure. Most times, pre-existing conditions are asymptomatic, meaning that the individual does not have any ongoing symptoms that prevent them from working or living a normal life. A pre-existing injury may be “significantly aggravated” in the following ways:

  • Death, provided that the pre-existing illness or injury would likely not have caused death but for the occupational event or exposure.
  • Loss of consciousness, provided that the pre-existing injury would not have caused the loss of consciousness but for the occupational exposure or traumatic injury.
  • Seven or more days away from work, days of restricted work, or days of transfer to a different department or work area that otherwise would not have occurred but for the occupational event.
  • Medical treatment in cases where no medical services were needed for the injury before the workplace event.

However, there are also situations where an injury occurs in the work environment and is not considered work-related. An injury occurring in the work environment and falling under one of these exceptions may be considered by a Pennsylvania Workers’ Compensation Judge to be not work-related:

  • At the time of the illness or injury, the employee was present at the work environment as a member of the general public rather than as an employee.
  • The injury involves signs and symptoms that surface at work but result solely from a non-work-related event or exposure that occurs outside the work environment.
  • The illness results from voluntary participation in a wellness program such as blood donation, a flu shot, a physical examination, or an exercise class, including sporting activities such as racquetball or baseball.
  • The injury is solely the result of an employee eating, drinking, or preparing food or drink for personal consumption. However, if the employee is made ill by ingesting food contaminated by workplace contaminants — such as lead — or by food poisoning from food supplied by the employer, the matter would be considered work-related.
  • The injury is the result of an employee performing personal tasks at the establishment outside the employer’s stipulated working hours and not within the course and scope of their employment.
  • The injury is intentionally self-inflicted.
  • The illness or injury is caused by a vehicle accident that occurs on the company’s parking lot or access road while the employee is commuting from work.
  • The illness is the common cold or flu. However, contagious diseases such as TB are considered work-related if the employee is infected at work.
  • The illness is a mental, as opposed to a physical, injury.

Every situation is fact-specific, and arguments are made on behalf of the employee and the employer. There is relevant law used to support both sides, and if an agreement cannot be reached as to whether the matter will be accepted as work-related, it will be up to a Workers’ Compensation Judge to determine the outcome.

5 Most Common Work-Related Injuries

  • Musculoskeletal injuries
  • Slips, trips, and falls
  • Repetitive motion injuries
  • Machinery and equipment accidents
  • Motor vehicle accidents

Causes of Work-Related Injuries

  • Overexertion, fatigue, and prolonged static posture — along with repetitive stretching and over-lifting — contribute to musculoskeletal injuries.
  • Wet, slippery floors and objects on the floor cause slips and falls.
  • Inadequate lighting and loose carpeting can cause trips.
  • Fixed-position activities such as keyboard use cause repetitive motion injuries.
  • Loose clothing, shoes, and unbound hair are potential machinery and equipment hazards.

Prevention Measures for Work-Related Injuries

  • Change positions frequently and set up a properly arranged workstation.
  • Keep the work space clean and use signage to indicate slippery conditions.
  • Train employees to reduce the frequency of repetitive activity and encourage them to take breaks.
  • Employees should know the safety precautions of the workplace.
  • Wear protective equipment and store materials in a safe and secure manner.