Workers Comp and Pre-Existing Conditions in Georgia

Georgia follows what is known as the aggravation rule. The principle is straightforward: if a work-related incident aggravates, accelerates, or combines with a pre-existing condition to produce a disability, the full resulting disability is compensable under workers comp.

In plain terms, this means the insurer cannot deny your claim simply because you had a prior condition. What matters is whether your work made it worse.

For example, say you had mild arthritis in your knee before your work injury. You could still function and do your job without problems. Then you suffer a fall at work that tears a ligament in the same knee. The insurer cannot deny your claim by pointing to the arthritis. The fall made a manageable condition into a disabling one. That is covered.

The aggravation rule applies to prior injuries from any source: old sports injuries, previous surgeries, age-related degeneration, prior workers comp claims, and chronic conditions like diabetes or heart disease that complicate your recovery.

Nearly everyone over the age of 40 has some kind of pre-existing condition. The insurance companies know this, and they use it aggressively. Here are the conditions that come up most often.

Degenerative disc disease is extremely common. Almost everyone develops some degree of spinal degeneration with age. If a work injury causes a disc herniation or worsens an existing spinal condition, the work injury is still covered.

Prior back or knee surgeries raise red flags for insurers. They will argue your current problems are from the old surgery, not the new injury. But if you were functioning and working before the workplace incident and could not afterward, the aggravation rule applies.

Arthritis, old sports injuries, and prior fractures are all conditions that insurers try to use. The key question is always the same: were you able to do your job before the work incident, and are you unable to do it after?

Diabetes, cardiovascular conditions, and obesity can complicate recovery from a work injury. Insurers may argue these conditions are responsible for your slow healing or ongoing symptoms. An experienced attorney knows how to counter these arguments with proper medical documentation.

Insurers have a playbook for pre-existing condition cases. Knowing their tactics helps you prepare.

Denial at the outset. The insurer reviews your medical history, finds a prior condition involving the same body part, and issues a blanket denial claiming the injury is not work-related.

Independent Medical Examination (IME) strategy. The insurer sends you to a doctor of their choosing. That doctor is more likely to attribute your symptoms to the pre-existing condition rather than the work injury. This gives the insurer a medical opinion to support their denial.

Requesting extensive prior medical records. The insurer will dig through years of your medical history looking for anything they can use. Prior complaints about the same body part, prior imaging showing degeneration, prior treatment records -- all of it becomes ammunition.

Pressuring you to admit prior symptoms. During depositions or recorded statements, the adjuster or defense attorney may ask leading questions designed to get you to say the symptoms existed before the work injury. Be honest, but be careful about how you characterize things.

Seeking apportionment. Even if the insurer cannot deny the claim entirely, they may argue that only part of your disability is from the work injury. Under Georgia law (O.C.G.A. 34-9-243), a judge can reduce benefits proportionally if a non-work condition contributes to the disability. This is more common with occupational diseases than traumatic injuries.

Be completely honest with your doctor about your medical history. Do not hide prior injuries or conditions. Lying or omitting information will destroy your credibility if the case goes to a hearing. The insurer will find the records eventually.

Make sure your doctor documents the connection between the work incident and the worsening of your condition. The medical records should clearly state that the work injury aggravated, accelerated, or combined with the pre-existing condition to produce the current disability.

Keep records of your functional ability before the injury. If you were working full duty, exercising, or living normally before the workplace incident, that evidence supports the argument that the work injury caused the change.

Do not let the insurer bully you into accepting a denial. The aggravation rule exists precisely for situations like yours. Many workers give up because they assume the pre-existing condition disqualifies them. It usually does not.

Work with an attorney who has experience handling pre-existing condition cases. These cases require specific medical evidence and legal arguments. Attorney Ginsberg has dealt with hundreds of these situations over 30+ years.

In some cases, the law allows benefits to be reduced if a non-work condition contributes to the disability. This is called apportionment.

Under O.C.G.A. 34-9-243, apportionment applies primarily to occupational diseases. If a worker suffers from a condition that is partly caused by work and partly caused by non-work factors, an administrative law judge can reduce weekly income benefits or shorten the duration of benefits proportionally.

Apportionment is less common in traumatic injury cases (such as falls, being struck by objects, or machinery accidents). In most traumatic injury cases, the full extent of the resulting disability is covered if the work incident was a contributing cause.

The burden of proving apportionment falls on the insurance company. They must demonstrate with medical evidence that a specific, measurable portion of the disability is unrelated to work. This is a high bar, and strong legal representation often prevents or limits apportionment.

Having a prior medical condition does not mean you are out of options. The Georgia workers comp system recognizes that most workers -- especially those in physically demanding jobs -- have some wear and tear on their bodies. The law is designed to protect you when work makes it worse.

The insurance company will fight you on this. They will dig through your records, send you to their doctors, and try to convince you that your claim has no merit. Do not believe them without getting a legal opinion first.

Attorney Jodi Ginsberg has handled hundreds of pre-existing condition cases. She knows the medical evidence that matters, the legal arguments that win, and the insurance tactics to watch out for. Call (770) 351-0801 for a free consultation.