How Can Pre-Existing Conditions Affect Your WorkCover Claim?

Last updated on September 5th, 2024 at 12:13 pm

Anxiety, depression, back problems, arthritis, asthma, or diabetes — if you’re coping with one of these chronic conditions, you’re not alone. The Australian Institute of Health and Welfare reports that nearly half of the population has at least one pre-existing medical condition, and about a quarter manage two or more.

You might think having a pre-existing condition disqualifies you from making insurance or worker’s compensation (WorkCover) claims, but this isn’t true. In fact, if your work worsens your condition, you’re entitled to compensation.

Let’s dive into how your pre-existing conditions can affect your WorkCover claim.

Defining Pre-Existing Conditions

What is a Pre-Existing Condition?

Any medical issue you had before starting your health insurance policy, including chronic illnesses and physical injuries, is a pre-existing condition. This is based on observable signs or symptoms, not just a formal diagnosis. Even unrecognised conditions, if symptomatic, can be considered valid. 

What is the Waiting Period for Pre-Existing Conditions?

Typically, health insurers impose a 12-month waiting period for hospital treatment benefits relating to pre-existing conditions. However, there are shorter waiting periods for certain conditions. These include psychiatric care, rehabilitation, and palliative care.

Waiting periods prevent individuals from selectively obtaining or upgrading their hospital coverage only when they anticipate needing treatment. In a way, they also protect regular fee-paying members. Without this policy, they will have to shoulder the costs of those who accumulate medical bills only to leave the fund.

Common Pre-Existing Condition Examples

• Musculoskeletal Disorders: Conditions like chronic back pain and arthritis are common, especially in physically demanding jobs.
• Mental Health Conditions: Workplace stress can exacerbate conditions such as anxiety, depression, and PTSD.
• Cardiovascular Diseases: Heart conditions and hypertension can be influenced by workplace stress.
• Respiratory Conditions: Asthma and COPD are often found in industries with exposure to irritants.
• Diabetes: This condition can impact work routines and medication management.
• Previous Injuries and Skin Conditions: Injuries and conditions like eczema can affect your ability to work. 
• Hearing and Vision Impairment: Long-term issues may require special accommodations and can sometimes be classified as workplace injuries if they are worsened by the work environment.

Pre-Existing Conditions and WorkCover Insurance Eligibility

Even with pre-existing conditions, you can file a worker’s compensation claim. The crucial part is proving that your work environment has negatively impacted your health. 

Tips to Ensure Successful WorkCover Claim

1. Keep Your Medical Records Up-to-Date

You need to get detailed records from your doctors about your health condition. These records should show how your job has affected your health. Has it made it worse? Has it caused new problems? 

The records must include what treatments you’ve had, any medicine you take, and any changes made for your health. Have notes from your doctors saying how they think your job has made your condition worse. This information is very important if you need to make a claim or take legal action.

2. Update Your WorkCover Medical Certificates

Always have current WorkCover medical certificates, which are typically valid for 28 days. These certificates, issued by your treating doctor, should detail the following:

• Any necessary medical treatment.
• Your ability to perform specific activities and to what extent.
• Referrals to workplace rehabilitation providers.
• Any delays in your recovery process.

3. Be Honest in Your Disclosures

When you apply for or update your insurance, you must tell them about your conditions. If you don’t, you might face issues with your claim. Be clear and understand your policy’s rules. Sometimes, your pre-existing conditions might be covered, especially if they are well-controlled and not likely to get worse or come back. But, some policies may not cover certain conditions or might make you wait before they cover you.

4. Seek Legal Advice

Are you having trouble with your WorkCover claim, especially with pre-existing conditions? Talk to Seymour Furlong Lawyers. We can help you choose the best policy for your needs. Our lawyers will look into your claim and tell you what might happen. Our expertise extends to Total and Permanent Disability (TPD) Claims and other factors that can affect your workers’ compensation. This can really change how your claim turns out.

Seeking professional legal help can make a significant difference in the outcome of your claim. Don’t navigate these waters alone.

Need Legal Support for Your WorkCover Claim?

Seymour Furlong Lawyers have a lot of experience with workers’ compensation claims. We are dedicated to helping you get the compensation you deserve. We also offer a free first meeting and work on a no-win, no-fee basis. This means you don’t have to worry about extra costs.

Learn more about WorkCover claims like what you need to include and how to file one. If you need personal advice about WorkCover claims or insurance with pre-existing conditions, talk to the experts at Seymour Furlong Lawyers.

Frequently Asked Questions

Can you claim WorkCover for a pre-existing injury?

Yes, you can. If your job makes your injury worse, you can claim WorkCover. It’s important to show that your job played a big part in making the injury worse.

What are considered pre-existing conditions?

Pre-existing conditions are any health problems you had before your insurance or job started. This could be things like diabetes or heart disease, injuries, or mental health issues. The main thing is whether you knew or should have known about these conditions before getting insurance or starting your job.

Which pre-existing conditions are not covered?

The coverage of pre-existing conditions varies between insurance providers and policies. Usually, high-risk conditions or ones that need a lot of medical care might not be covered. Always read your insurance policy to know what’s not covered.

How do pre-existing conditions affect health insurance premiums?

If you have a history of pre-existing conditions, your health insurance might cost more. This is because insurance companies think you might need more medical care.

What to do if your WorkCover claim is denied?

If your claim is denied, get legal help. Sometimes claims are denied because things are not clear or there’s not enough information. A lawyer who knows about workers’ compensation can look at your case, find any problems, and help you appeal if needed.

Can I get travel insurance with a pre-existing condition?

Yes, but travel insurance policies are all different. Make sure to check the policy about your conditions before you travel. This is really important for conditions that travel or environment changes might make worse. Some policies cover these conditions, but others might not or only offer limited coverage.