Occupational Disease Claim Upheld

Posted on Jun 18, 2014

This claim involved an occupational disease claim for cervical condition. An occupational disease claim is a claim that exposure to some condition in the workplace, over time, caused a medical condition. To prove an occupational disease claim, a claimant must show that the employment conditions were the major cause of the medical condition. This means that the work factors must represent more than 50% of the cause of the condition when compared to all other causes combined.

As with most occupational disease claims, whether the work conditions are the major cause of the medical problem depends largely on a medical opinion.

This case involved a cervical strain sprain injury. The attending physician felt that increased work hours with frequent lifting of boxes weighing 40 to 50 pounds, often without assistance, was the cause of the cervical strain sprain injury. On appeal, the employer attempted to argue that the injured worker should have called other corroborating witnesses. However, the Workers’ Compensation Board dismissed this argument, explaining that in the other case decisions the employer cited, corroborating testimony was necessary, but not in this particular case.

In addressing the medical opinions, the Board dismissed an opinion from the insurance retained medical examiner that claimant could not have suffered this injury because the work activities did not cause head or neck trauma comparable to that of professional soccer players, divers, or African porters. Also, the Workers’ Compensation Board rejected the employer’s argument that its doctor, an orthopedic surgeon, was better equipped to render an opinion. The Board explained that its conclusion that the chiropractor’s opinion was more persuasive than that of the insurance company orthopedic surgeon is based on the substance of the opinions, not a comparison of the qualifications. The Board explained that medical expertise is certainly important, but does not qualify as a substitute for a well-reasoned opinion.

In the end, when the Board, or a Judge, decides which medical opinion should decide a case, it is looking for the opinion that makes the most sense.  If you have an occupational disease claim, and have questions about a denied claim, or even an accepted one, call us at 503-325-8600.  We have helped many workers' with these kinds of claims, and can answer your questions.