Claim problem

Preexisting Condition Denial

Use this scenario page to organize the paperwork and questions connected to aggravation, baseline records, and doctor causation opinions.

Start with the issue actually in dispute

Preexisting condition used to deny claim is mainly a problem of baseline history versus work-related change. Build the file around the written notice, dated record, or event that created the problem.

Documents to gather

Prior medical records, new incident/exposure record, current diagnosis, treating opinion, and denial notice.

Questions to answer before acting

  • What changed, on what date, and who made the decision?
  • Is there a written notice or only a phone conversation?
  • Which medical, wage, employment, or incident record directly addresses the dispute?
  • What state or federal agency procedure controls the next step?
  • Is there a separate employment, third-party, leave, or discrimination issue that should not be mixed into the workers’ compensation question?

Important caution

Separate prior symptoms from any work-related aggravation or new condition recognized by state law.