Court of Appeals Addresses "Combined Condition" Denial

Posted on Aug 07, 2017

In this Court of Appeals decision, the injured worker appealed what is commonly known as a "ceases" denial. These kinds of denials occur when the insurance company determines that an on-the-job injury combines with a "pre-existing condition." When this happens, the accepted claim is known as a "combined condition."

Insurance companies do this because as soon as the pre-existing condition takes over as the main cause of the need for treatment or disability, the insurance company can deny the claim.  To make this denial, the insurance company must have evidence if some change in the injured worker's condition that shows the pre-existing conditon is taking over as the main cause of the medical condition. To do this, insurance companies employ "independent medical examiners" to provide evidence.

This case involved a knee injury that apparently combined with some pre-existing knee arthritis. The Court found that there Was enough evidence to support the Workers' Compensation Board decision finding that the employer prove that it was entitled to deny the claim.

Read here to learn more about "combined conditions."  The case law is changing all the time, so if you have a denial, and want questions answered, order our free book, use our search function to find more information, or give us a call.