Workers Compensation and Pre-Existing Conditions
Oregon’s workers’ compensation system allows people who are injured at work to receive compensation for their injuries without having to prove fault on the employer’s part. But what if your claim involves a pre-existing condition? Can you receive workers’ comp benefits for a pre-existing injury?
The answer depends on the specifics of your situation.
Pre-Existing Conditions Related to a Prior Workers’ Comp Claim
In general, a pre-existing condition includes any:
- Congenital issue
- Personality disorder
- Condition that requires medical care
If you’ve been treated for a condition before your on-the-job injury, and that condition requires medical care or qualifies you for disability benefits, then you might not be eligible for workers’ compensation unless the accident made the condition worse.
Let’s examine this through a sample situation:
Jane works as a package handler in a large distribution center. Approximately five years ago, she hurt her lower back lifting a large package. She was diagnosed with a sprain of her lumbar spine. After filing a workers’ comp claim, Jane was treated by a chiropractor for three months after her accident, missing only two days of work. She still experiences occasional pain in her lower back due to this accident, but her pain is easily relieved with over-the-counter medication.
Jane recently sustained serious injuries to her lower back in a slip and fall accident at work. MRI testing showed that she has a herniated disc in her back. The slipped disc touches the nerves of her spinal column, resulting in excruciating pain in her back. She needs surgery to repair the herniated disc. There is no other option for relief, and she is not currently able to work.
To recover workers’ compensation benefits in this instance, Jane must prove that she has what is known as a compensable injury – an injury sustained in the course of her work duties – caused by her slip and fall accident. A compensable injury must be established by medical evidence and supported by objective findings.
Oregon follows the “major contributing cause” standard. Jane must prove that her slip and fall accident caused a new injury to her back. That is:
- Jane must show by objective medical evidence that the slip and fall accident was the primary cause of her herniated disc.
- Since Jane had a prior injury to her lower back, she must prove that her pre-existing medical condition, for which she filed a workers’ comp claim, did not contribute to her new injury.
The workers’ compensation insurance company is likely to contend that Jane’s injury is the result of a pre-existing condition in her lower back, caused by her prior work-related accident. The workers’ compensation carrier, however, may still cover Jane’s medical treatment and provide Jane with temporary disability payments.
Separating New Injuries from Pre-Existing Conditions
Let’s now assume that after her slip and fall accident, Jane’s MRI testing showed only some slight bulging of the discs in her lower back. Her lower back pain has increased in frequency and intensity, and over-the-counter medications no longer help ease her pain. Jane is now working light duty.
Remember, Jane had a similar injury to her lower back five years ago. She had treatment related to her prior lower back injury, with ongoing symptoms. Her slip and fall accident, therefore, caused an aggravation of her pre-existing injury.
Jane will have the burden of showing that:
- Her slip and fall accident was the major contributing cause to the bulges in her lumbar spine and her need to return to treatment.
- Jane’s employer must prove that her pre-existing injury, combined with the injury she sustained in the slip and fall accident, caused her current condition. These proofs will come from doctors who examine the injured worker and issue opinions on causation.
If Jane prevails, her award will reflect the fact that the slip and fall accident caused only an aggravation of her prior workers’ comp injury and pre-existing medical condition.
Pre-Existing Conditions Not Related to Prior Workers’ Comp Claim
What if Jane had a pre-existing condition that was not related to a prior workers’ compensation claim?
In this instance, assume that instead of the sprain of her lumbar spine caused by lifting a large package at work, Jane had fractured a vertebra in a childhood automobile accident. Her fracture healed, but permanently altered the shape and the strength of her spine. Jane had no problems with her lower back until the day she slipped and fell at work.
- The pre-existing condition of Jane’s back is clearly not related to work, or a prior workers’ comp claim. However, her childhood accident and the resulting damage to her spine may have contributed to the herniated disc she sustained at work in the slip and fall accident.
- Because the slip and fall accident caused a new injury to Jane’s spine, she is still eligible for worker’s compensation benefits for the herniated disc. However, Jane will receive workers’ compensation benefits only for the worsening of the condition to her spine caused by her fall.
Common Reasons Claims Involving Pre-Existing Conditions May Be Denied
The workers’ comp insurer will look to deny claims for pre-existing medical conditions. That is, they do not want to pay twice for the same injury. They also do not want to pay for medical conditions that are not caused by a work-related accident.
Some reasons workers’ compensation claims involving pre-existing conditions could be denied are:
- Degeneration. Nearly all of the adult population experiences some disc degeneration by age 40. Workers’ compensation injuries will be denied if there are only medical findings of pre-existing degeneration.
- Identical Injuries. If subsequent work-related accidents show the same findings upon examination by a medical professional, and if the worker has the same complaints, a claim may be denied as a pre-existing continuation of a prior injury.
- Back-to-Back Accidents. If there are a series of accidents that occur close in time to each other, and the medical findings are also similar, the claim may be denied as pre-existing.
How the Law Offices of Jodie Anne Phillips Polich, P.C. Can Help You
Pre-existing conditions make workers’ compensation claims more complex. Insurance carriers may use this complexity to justify denying a valid claim or paying out less than it’s worth.
If you were injured at work and your injury involves a pre-existing condition, you should speak to a workers’ comp attorney as soon as possible. You have rights and may be entitled to compensation, even if you had a pre-existing medical condition and a prior workers’ comp claim.
Jodie Anne Phillips Polich, Esq. understands these issues, and can guide you toward a successful resolution of your workers’ comp claim, even if you have pre-existing medical conditions. She can help you pursue what you are entitled to under the law, whether it is a new injury or an aggravation of a pre-existing injury.