How Pre-Existing Conditions Affect Workers’ Compensation Claims in Texas

You had a bad back before the work accident happened. An old knee injury from years ago. A shoulder that never quite healed right. Now you’ve been hurt on the job, and you’re worried the insurance company will use your medical history against you. This fear stops many injured workers from pursuing the benefits they deserve. But here’s what insurance companies don’t want you to know: pre-existing conditions don’t automatically disqualify you from workers’ compensation in Texas. The law recognizes that real workers have real medical histories—and when work aggravates those conditions, you’re entitled to benefits.
Understanding the Aggravation Rule

Texas workers’ compensation law follows a principle that protects workers with pre-existing conditions. If your job duties or a work accident aggravates, accelerates, or combines with a pre-existing condition to produce disability or need for medical treatment, that resulting condition is compensable. You don’t need a perfect medical history to receive benefits after a work injury.

Consider a warehouse worker with degenerative disc disease who lifts a heavy box and herniates a disc. The degeneration existed before the work accident, but the lifting incident caused the herniation. Under Texas law, this worker is entitled to workers’ compensation benefits for the herniated disc, even though the underlying spinal condition pre-dated the injury.

The same principle applies to conditions that worsen gradually through work activities. A worker whose arthritis progressively worsens due to repetitive job duties may have a compensable claim, even though arthritis existed before employment began. The key question is whether work contributed to the current condition—not whether the worker had perfect health beforehand.

How Insurance Companies Challenge Pre-Existing Condition Claims

Despite clear legal protections, insurance companies regularly use pre-existing conditions to deny or minimize claims. Understanding their tactics helps you prepare to counter them.

Claiming the Condition Isn’t Work-Related

The most common tactic involves arguing that your current symptoms stem entirely from your pre-existing condition rather than your work injury. Insurance adjusters review your medical records looking for any prior treatment related to the affected body part. They then argue that your current problems are simply a continuation of that previous condition, not a new injury caused by work.

This argument ignores the aggravation rule. Even if you received treatment for back pain five years ago, a work accident that causes new symptoms or worsens your condition remains compensable. The insurance company’s attempt to reframe your claim as a pre-existing problem doesn’t change the legal reality.

Disputing the Extent of Your Disability

Insurance companies also use pre-existing conditions to minimize the benefits they pay. They argue that your disability results partly from your prior condition and partly from the work injury, then attempt to reduce compensation accordingly.

Texas law doesn’t permit this approach for most benefits. When work aggravates a pre-existing condition, the resulting disability is compensable—you don’t receive reduced benefits because you weren’t in perfect health before the accident. The insurance company takes you as they find you.

Requesting Extensive Medical Records

Expect requests for your complete medical history when you have a pre-existing condition. Insurance companies cast wide nets, seeking records from years or decades before your work accident. They’re looking for anything they can use to attribute your current condition to prior problems rather than workplace causes.

While you generally must provide relevant medical records, you don’t have to hand over your entire lifetime medical history without question. Records unrelated to your claimed injury may not be legitimately discoverable. A workers’ compensation attorney can help you understand what records you’re required to provide and push back against overly broad requests.

Building a Strong Claim Despite Pre-Existing Conditions

Successfully navigating a workers’ compensation claim with a pre-existing condition requires strategic preparation and thorough documentation.

Honest Communication with Your Doctor

Your treating physician plays a crucial role in claims involving pre-existing conditions. Be completely honest about your medical history—concealing prior problems only creates opportunities for the insurance company to challenge your credibility later.

Explain clearly how your current symptoms differ from any previous issues. Describe what changed after the work accident. Help your doctor understand the connection between your job duties and your current condition. This information allows your physician to document the relationship between work and your need for treatment accurately.

Ask your doctor to provide opinions specifically addressing how your work injury affected your pre-existing condition. Medical statements that directly address causation carry significant weight in disputed claims. A doctor who clearly states that your work accident aggravated your prior condition provides powerful evidence supporting your claim.

Documenting the Change in Your Condition

Evidence showing how your condition changed after the work injury strengthens your claim substantially. This documentation might include comparisons of your functional abilities before and after the accident, records showing increased treatment needs following the work injury, testimony from coworkers or family members about observable changes, and your own detailed notes about symptoms and limitations.

The goal is to demonstrate that something meaningfully changed because of work. Even if you had some symptoms before, showing that those symptoms worsened, that you needed treatment you didn’t previously require, or that you lost capabilities you previously had all support your claim.

Preserving Your Pre-Injury Medical Records

Ironically, the same medical records insurance companies use against you can also support your claim. Records from before your work accident establish a baseline—they show what your condition was like before work made it worse.

If your prior records show that your pre-existing condition was stable, well-managed, or not limiting your activities, they actually help demonstrate the impact of your work injury. The contrast between your pre-injury function and your post-injury limitations tells a compelling story about what your work accident did to you.

The Legal Framework Protecting You

Texas courts have repeatedly affirmed that employers take workers as they find them. This “eggshell skull” doctrine means that if a worker is more susceptible to injury due to a pre-existing condition, the employer remains fully responsible for the resulting harm. You don’t receive reduced benefits because your body was vulnerable.

The insurance company cannot escape liability by pointing to your medical history. Their obligation is to compensate you for the disability and treatment needs that result when work combines with your pre-existing condition—whatever that combination produces.

Getting the Help You Need

Claims involving pre-existing conditions face higher rates of denial and dispute than straightforward injury cases. Insurance companies know these claims are more complex and that many workers will give up when challenged on their medical history.

Don’t let complexity discourage you from pursuing benefits you’re entitled to receive. A workers’ compensation attorney experienced with pre-existing condition cases understands how to counter insurance company tactics and present your claim effectively.

Your prior medical history doesn’t define your rights after a work injury. Texas law protects workers whose jobs aggravate existing conditions, and those protections apply to you. With proper documentation, honest communication with your healthcare providers, and a willingness to fight for your benefits, you can secure the compensation you deserve—regardless of what your medical records showed before the work accident occurred.