If you’ve lodged a workers compensation claim in NSW and the insurer responds by saying your condition is “pre-existing”, it can create immediate uncertainty. Many injured workers first encounter this issue in a section 78 notice, a work capacity decision, or a liability denial stating that their symptoms are not work-related but instead the result of an earlier injury or degenerative condition.
In practice, the dispute often centres on one key question: has work caused a new injury, or has it aggravated a pre-existing condition? The distinction matters, because it affects liability, medical treatment, weekly payments, and potentially permanent impairment compensation.
What Is a Pre-Existing Condition?
A pre-existing condition is a medical condition that existed before the workplace incident. This may include:
- Degenerative disc disease
- Prior back or shoulder injuries
- Previous psychological conditions
- Long-standing knee or joint problems
Having a pre-existing condition does not automatically prevent you from claiming workers compensation. The legal issue is whether employment contributed to the injury in a meaningful way.
In NSW, workers compensation claims are governed by the Workers Compensation Act 1987 and related legislation. The law recognises that work can aggravate, accelerate, exacerbate, or deteriorate an existing condition.
What Is an Aggravation of a Pre-Existing Condition?
An aggravation occurs when employment worsens an existing condition.
For example, a worker with previously asymptomatic degenerative disc disease may suffer a significant flare-up after heavy lifting at work. Even though the degeneration existed beforehand, the workplace incident may have aggravated it to the point where treatment and time off work are required.
To succeed in this type of claim, employment must be a substantial contributing factor to the aggravation. Medical evidence is critical. Doctors will usually be asked to address:
- Whether the condition existed before
- Whether work activities worsened it
- Whether the worsening is temporary or permanent
If accepted, compensation can cover medical treatment and, in some cases, weekly payments
What Is Considered a New Injury?
A new injury arises when the workplace incident causes a distinct pathological change, rather than simply worsening something already present.
For instance, if a worker suffers a previously undiagnosed disc herniation after a lifting incident, this may be characterised as a new injury, even if there were underlying degenerative changes.
The distinction is not always clear-cut. Insurers often argue that imaging findings reflect natural degeneration rather than work-related trauma. The question then becomes one of causation: What actually caused the symptoms and incapacity?
This is typically determined through medical reports and, if disputed, may proceed to the Personal Injury Commission for resolution.
Why Does the Distinction Matter?
Whether a condition is classified as an aggravation or a new injury can influence:
- Liability acceptance
- Duration of weekly payments
- Entitlement to lump sum compensation
- Assessment of whole person impairment
In some cases, insurers argue that a flare-up has resolved and that any ongoing symptoms relate solely to the underlying condition. Workers, on the other hand, may contend that work caused a lasting deterioration.
The outcome often depends on the quality and clarity of medical evidence.
How Are Disputes About Pre-Existing Conditions Resolved?
When an insurer disputes liability on the basis of a pre-existing condition, the matter may proceed through:
- Internal review processes
- Independent medical examinations
- Referral to a Medical Assessor
- Determination by the Personal Injury Commission
Medical causation is frequently the central issue. Independent specialists may be asked to provide opinions on whether employment was a substantial contributing factor to the condition or its aggravation.
Strict time limits apply to dispute applications, and procedural compliance is essential.
How Can Law Advice Assist?
Disputes involving pre-existing conditions are legally and medically complex. Insurers often rely heavily on medical terminology and imaging findings to argue that a condition is unrelated to employment.
The personal injury lawyers at Law Advice assist injured workers by:
- Reviewing liability notices and insurer reasoning
- Obtaining targeted medical evidence addressing causation
- Briefing appropriate specialists
- Preparing structured submissions for the Commission
- Representing clients in disputes before the Personal Injury Commission
Importantly, we understand how statutory tests such as “substantial contributing factor” are applied in practice, and how to frame medical evidence so that it directly addresses those legal thresholds.
Early legal advice can prevent procedural missteps and ensure that relevant medical evidence is obtained before critical deadlines expire.