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South Dakota Workers’ Compensation & Prior Injuries

A prior injury or chronic health condition does not automatically bar you from receiving workers’ compensation benefits. These claims can be more challenging when an insurer questions what caused your current symptoms. At Christensen Law Office, PC, we review your medical history, what changed after your workplace injury and how those changes affect your ability to work and need for treatment.

Table of Contents

The “Major Contributing Cause” Standard in South Dakota

South Dakota law treats pre-existing conditions differently based on whether they are work-related. A workplace injury can interact with a condition you had before the injury occurred. The work injury must remain a major cause of the resulting impairment, need for treatment or disability. If the condition came from a prior compensable work injury, the new injury only needs to contribute independently to the resulting condition.

You must also support the work injury with medical evidence. You do not have to be in perfect health to receive workers’ compensation benefits. For example, an old back injury may have caused occasional pain, but a workplace lifting accident could make it worse and limit your ability to work. A new workplace accident could also worsen symptoms from a prior neck injury.

Common Pre-Existing Conditions That Affect Workers’ Comp Claims

A pre-existing condition can affect how your body responds to the physical demands of your job. Common conditions that may affect a claim include:

  • Degenerative disc disease: Lifting, bending, twisting or standing for long periods may worsen back symptoms.
  • Arthritis: Repetitive work, falls or joint injuries may increase pain.
  • Prior back or neck injuries: A new accident may cause more pain, less movement or a need for more treatment.
  • Rotator cuff degeneration: Lifting, pulling or overhead work may worsen shoulder problems.
  • Carpal tunnel syndrome: Repeated gripping, typing, vibration or forceful hand use may increase nerve symptoms.
  • Diabetes: Diabetes may slow healing after another injury.
  • Obesity: Extra stress on the joints and spine may affect recovery.
  • Cardiovascular disease: Physical exertion or an injury may affect an existing heart or blood vessel condition.
  • Previous surgical repairs: A repaired knee, shoulder, back or other joint may be more prone to another injury.

For a pre-existing injury workers’ comp claim, the evidence should prove what changed after the workplace injury. It should also show whether the work injury caused or prolonged your disability, impairment or need for treatment.

How Insurance Companies Use Pre-Existing Conditions Against You

An insurer may say your symptoms come from an old condition, not your workplace injury. It may also send you for an independent medical examination (IME) and rely on a doctor’s opinion that downplays the work injury.

The insurer may also claim that your condition would have gotten worse on its own. It may point to certain medical records while ignoring records that show you were working normally before the accident.

An adjuster may ask you to sign a broad medical release. South Dakota law allows insurers to access medical information that relates to a workers’ compensation claim. If there is a dispute over whether a record is relevant, the law provides a process to address it. Review any medical release carefully so unrelated health records do not distract from your work injury.

Proving Your Work Injury Aggravated a Pre-Existing Condition

A strong claim establishes your health before and after the accident. Helpful evidence may include:

  • Medical records showing your symptoms and ability to work before the injury
  • Imaging that compares your condition before and after the accident
  • Medical opinions on whether the work injury made your condition worse
  • Opinions that explain the effects of your prior condition and new injury
  • Witness statements about changes in your work or daily activities
  • Records showing more pain, new limits, added treatment or missed work

You must generally prove the link between your work injury and your condition by a preponderance of the evidence. Medical evidence is required. If the work injury combines with a pre-existing nonwork condition, the work injury must be and remain a major contributing cause of the resulting need for treatment, impairment or disability. If a prior condition came from a compensable work injury, the new injury only needs to contribute independently to the resulting condition.

If you are receiving treatment, your physician may provide useful evidence because they may have records that show how your condition changed over time. South Dakota law does not require courts to favor a treating physician’s opinion. However, a court may give more weight to a well-reasoned opinion that is supported by the medical record, especially when compared with a one-time IME opinion.

Calculating Compensation When Pre-Existing Conditions Are Involved

A pre-existing condition does not automatically reduce your workers’ compensation benefits. Benefit apportionment applies when you were already disabled and receiving workers’ compensation benefits.

For permanent impairment, medical experts must separate impairment from a prior condition and the new injury. Temporary disability benefits follow a different analysis. A prior condition does not automatically prevent temporary benefits when a work injury keeps you from working during recovery.

Pre-Existing Conditions and Your Age

Older workers may have age-related changes such as arthritis or disc degeneration. An insurer may point to these changes and argue that aging, not the workplace injury, caused the worker’s current condition.

South Dakota courts recognize that age and degeneration can make a worker more likely to suffer an injury. These conditions do not automatically prevent workers’ compensation benefits. The key issue is whether the job or work injury meets the required causation standard. State law also bars employers from refusing to hire someone because of a pre-existing injury when that injury does not affect the person’s ability to perform the job.

When Pre-Existing Condition Claims Are Denied

An insurer may use your medical history to question whether your workplace injury caused your current condition. It may deny a claim by arguing that:

  • The condition is not related to work
  • The injury existed before the workplace accident and was not aggravated by work
  • The symptoms result from the natural progression of the underlying condition
  • You failed to disclose important medical history

A denial will not necessarily stop your claim. Ask for the denial and its reasoning in writing. Gather records showing your condition before the accident and what changed afterward. You may also need a medical opinion that directly addresses the insurer’s reason for denying the claim.

Questions About Pre-Existing Conditions and Workers’ Compensation

A prior injury or health condition can make a workers’ compensation claim more complicated. Below you’ll find questions and answers address common concerns about prior/ pre-existing conditions and workplace injuries.

Yes. A prior back problem will not prevent you from receiving benefits automatically. If a prior condition was not work-related, you must prove that your new workplace injury is, and remains, a major contributing cause of your current disability, impairment or need for treatment. Medical records should prove your condition before the accident and how your symptoms and ability to work changed afterward.

You can still pursue a claim. Testing after a workplace injury may reveal an underlying condition that you did not know about. That discovery does not automatically mean the condition caused your current symptoms. Medical evidence should prove what the workplace injury changed, including new symptoms, increased limitations or a greater need for treatment.

Age or normal degeneration alone does not establish that a claim lacks a work-related cause. An insurer may dispute causation, but the issue remains whether the employment or work injury meets South Dakota’s legal standard. Medical evidence can help distinguish age-related changes from changes that followed the workplace injury.

You should provide truthful information about your medical history when required during the workers’ compensation process. Do not hide a prior condition because you fear it will hurt your claim. Review medical releases carefully and understand what records you authorize an insurer to obtain.

A pre-existing condition existed before the workplace injury. A work-related aggravation occurs when work makes that condition worse or creates a greater disability, impairment or need for treatment. In a workers’ compensation aggravation of pre-existing condition claim, medical evidence should explain your condition before the incident and the changes that followed it.

Not automatically. Benefit apportionment may apply when a worker was previously disabled and receiving workers’ compensation benefits. For permanent impairment, medical experts may also need to distinguish pre-existing impairment from impairment caused by the new workplace injury.

A prior condition can make a claim more complicated, but it does not automatically end your claim. Clear records showing your condition before the injury and the changes that followed can help establish what the workplace injury caused.

Protect Your Rights After A Workplace Injury

A prior injury or chronic condition should not automatically end your workers’ compensation claim. At Christensen Law Office, PC, we investigate your medical history, examine what happened at work and develop evidence to address the insurer’s concerns. If you believe your job aggravated an existing condition, contact us at 605-206-5872 or send us an email. We can discuss your claim and help you pursue benefits under South Dakota law.