This recent Oregon Workers' Compensation Board case dealt with a shoulder injury. The worker injured his shoulder at work. However, the worker had injured the shoulder before, which required a rotator cuff repair surgery. The insurance company try to prove that the pre-existing rotator cuff injury was contributing to the injured worker's current shoulder condition, and that it was the main reason the injured worker required medical care. If an insurance company can prove that an injury event combined with a pre-existing problem, and the pre-existing problem is the main reason an injured worker need to medical care, it can deny the claim. The insurance company in this case did just that.
However, the Board ruled against the insurance company, finding that the medical evidence showed the prior shoulder injury only rendered the injured worker more susceptible to injury. The Board explained that in order for the old rotator cuff injury to actually combined with the new injury event, the insurance company had to prove that the old rotator cuff injury was actually contributing to the need for treatment. The Board found that the old rotator cuff injury probably made the shoulder more susceptible to a new injury, that was not contributing to the actual need for treatment.
Whether an old injury or medical condition is actually contributing to the need for treatment, or only makes an injury event more likely can be a difficult issue to sort out. Many times, this depends upon how the injury occurred, with the old injury or condition was treated, and of course, medical opinions.
Check out this article to find out more about how treating physicians drive the workers' compensation system.
