Workers' Comp Board Rules on Consequential Injury Claim

Posted on Nov 21, 2015

In a recent case, the Oregon Workers' Compensation Board ruled that the injured worker proved that she suffered sacroiliac dysfunction as a consequence of a hamstring injury.  This decision addressed several different medical opinions, but in the end, the injured worker was able to prove her claim.

A "consequential" condition claim is a claim that one medical condition from an on-the-job injury has led to a separate medical condition that requires treatment. The facts in this case illustrate the point. The injured worker suffered a hamstring injury. As result of the hamstring injury, the injured worker walked with a limp, or medical terms, a modified gait.  As result of the impaired gait, the injured worker developed sacroiliac and low back problems.

Several new medical conditions were made, and several physicians weighed in on the relationship between the accepted hamstring injury and the sacroiliac dysfunction. The Board adopted the treating physician's opinion that there was a sufficient relationship between the hamstring injury and the sacroiliac problems.

There are a few factors that put a treating physician in a better position to give an opinion on a workers' compensation claim. First, the treating physician almost always as more face-to-face experience with the injured worker,  and as a result, has a better understanding of the injured worker's medical problems. The treating physician is usually going to have a lot more information to support his or her opinion. For example, in this case, the Board emphasized that there were findings on examination that were consistent with the treating physician's opinion. The insurance medical examiners discounted the claimed sacroiliac problem, but failed to explain positive examination findings, which made their opinions less persuasive.

The Workers' Compensation Board applies many rules to weigh the strength of one medical opinion against the other. However, it boils down to whether medical evidence supports the opinion, and whether the opinion itself simply make sense.

This article talks about new medical condition claims, which are commonplace in today's Oregon Workers' Compensation system.

Joe Di Bartolomeo
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