Workers’ compensation in Kentucky is designed to protect employees injured on the job, but things get more complicated when a worker has a pre-existing medical condition. Insurance carriers often scrutinize these claims closely, looking for ways to link symptoms to past injuries or illnesses rather than workplace incidents. Understanding how Kentucky law treats pre-existing conditions can help you protect your right to benefits.

How Kentucky Workers’ Comp Handles Pre-Existing Conditions

Kentucky workers’ compensation law does not automatically disqualify you from benefits if you have a pre-existing condition. However, the law distinguishes between “active” pre-existing conditions and “dormant” pre-existing conditions at the time of the injury.

• Active pre-existing condition: If your condition was symptomatic and required treatment before the workplace injury, the employer’s insurer may not be responsible for that portion of your disability. Benefits typically only cover the additional impairment caused by the new injury.
• Dormant pre-existing condition: If the condition was symptom-free and did not impair your ability to work before the accident, it may be considered “aroused” by the work injury. In this case, the aggravation could be fully compensable under Kentucky law.

The Kentucky Supreme Court has repeatedly emphasized that aggravation of a dormant condition by a workplace accident can qualify for benefits, but the burden of proof falls on the injured worker.

The “Arising Out of Employment” Requirement

A key issue in these cases is proving that the injury—or the aggravation of a condition—arose out of and in the course of employment. This means:

1. Causation must be work-related – You must show that your job duties or a specific workplace incident triggered or worsened your condition.
2. Medical evidence is critical – Kentucky workers’ comp claims require credible medical documentation linking your injury to your work. Without a doctor’s clear opinion, the insurance carrier may argue the symptoms are solely due to the pre-existing condition.

Examples of How Pre-Existing Conditions Impact Claims

Example 1:

A warehouse worker with a history of mild, symptom-free back degeneration slips and falls at work. After the fall, they develop chronic back pain requiring surgery. Since the degeneration was dormant before the incident, the injury may be fully compensable.

Example 2:

A construction worker already receiving treatment for knee pain injures the same knee while lifting heavy materials. The insurer may argue only the additional impairment caused by the incident is covered, not the entire knee injury.

Common Pre-Existing Conditions in Kentucky Claims

While any medical condition could be at issue, certain pre-existing conditions frequently appear in Kentucky workers’ comp cases:

• Degenerative disc disease
• Arthritis in knees, hips, or shoulders
• Prior back or neck injuries
• Repetitive strain injuries (e.g., carpal tunnel syndrome)
• Chronic joint pain from past sports or work injuries

Why Medical Documentation Matters

In Kentucky, your claim’s outcome often hinges on medical records and expert opinions. Important steps include:

• Disclose your medical history – Failure to mention a prior condition can harm your credibility and may be grounds for denial.
• Get a detailed medical evaluation – Your doctor should document how the work injury aggravated or accelerated the pre-existing condition.
• Consider an independent medical exam (IME) – If the insurer disputes your treating physician’s opinion, an IME can provide additional support.

The Role of the “Apportionment” Rule

Kentucky’s apportionment rule allows insurers to limit benefits to the portion of the disability caused by the work-related injury. If the injury is found to be 50% due to a pre-existing active condition and 50% due to the workplace incident, you may only receive benefits for half the total impairment.

This is why legal and medical precision is so important—if you can establish that your condition was dormant before the incident, apportionment may not apply, and you could be entitled to full benefits.

Time Limits for Filing a Kentucky Workers’ Comp Claim

Kentucky law requires most workers’ comp claims to be filed within two years of the date of injury or the last voluntary payment of income benefits, whichever is later. When pre-existing conditions are involved, timely filing becomes even more important because medical timelines and histories will be closely examined.

Strategies to Strengthen Your Claim

If you have a pre-existing condition, you can improve your chances of a successful claim by:

• Reporting your injury immediately – Delays give insurers an opening to argue your condition worsened outside of work.
• Keeping thorough medical records – Maintain a complete file of past and present treatment.
• Following all treatment plans – Skipping appointments or therapy can weaken your case.
• Seeking legal advice early – An attorney familiar with Kentucky’s workers’ comp system can help you gather the right evidence and counter insurance arguments.

Insurance Company Tactics to Watch Out For

Insurers often use certain strategies to reduce payouts in pre-existing condition cases, such as:

• Claiming the symptoms are entirely due to your pre-existing condition
• Using surveillance to suggest your injury is less severe
• Disputing medical reports by requesting their own IME
• Offering low settlements in hopes you’ll avoid a legal fight

Being aware of these tactics can help you and your attorney prepare strong counterarguments.

Conclusion

Having a pre-existing condition does not automatically prevent you from receiving Kentucky workers’ compensation benefits, but it can make the claims process more challenging. The distinction between an “active” and “dormant” condition, the strength of your medical evidence, and how clearly your injury can be tied to your job will all affect the outcome. By acting quickly, keeping thorough records, and working with experienced professionals, you can protect your right to fair compensation even when a past injury or illness is part of the equation.

Need Legal Help? Brandon J. Broderick, Attorney at Law is One Phone Call Away

Navigating Kentucky Workers Comp Claims can be challenging. Fortunately, you don't need to do it alone. The experienced lawyers at Brandon J. Broderick, Attorney at Law, are available 24/7 to help you understand your legal options, gather necessary evidence, and build a strong case to secure the settlement you deserve.

Contact us now for a free legal review.