Workers' Comp Case Report: Pre-existing Condition

Posted on Jan 30, 2015

In this case, the Workers' Compensation Board reviewed a decision involving both an injury claim and an aggravation claim.

The worker, a mechanic, suffered an injuryworking for one employer, and that claim was accepted as an on-the-job injury claim.  Several months later, the injured worker went to work for another employer, and suffered a similar injury. The injured worker filed both an "injury" claim against his new employer, and an "aggravation" claim against his prior employer.

And "aggravation" claim is a claim that an accepted medical condition has "actually worsened" within a five-year period after a claim has been closed. In order for an injured worker to prove an aggravation claim, he or she must show that there has been an actual worsening of the accepted medical condition. Only a physician can file an aggravation claim. The term "actual worsening" means there must be some objective medical evidence that the original medical injury has worsened. To be "objective," the worsening must be verified either on a clinical exam, or some imaging study, like an MRI or an x-ray.

In this case, both employers sent the injured worker to independent medical examiners. Based on the opinions of the independent medical examiners, the hearings Judge found that the injury had combined with a pre-existing condition, and that the pre-existing condition was the main cause for ongoing need for treatment and disability. The injured worker disagreed, and appealed the case.

The Board acknowledge that when an injured worker proves that the injury was the material cause of either disability or a need for care, it is up to the employer to determine whether or not the injury event combined with a pre-existing condition. The Board sided with the employer, finding that there was enough evidence that the work related injury did in fact combined with pre-existing arthritis in the spine. The Board also found that the better medical opinion evidence established that the injury event was never the major cause of the need for treatment.

This case involved several medical opinions and two employers. It illustrates how complicated a workers' compensation claim can be. If you have a serious on-the-job injury claim, and wonder about making a new claim, or appealing a recently denied claim, call us at 503-325-8600. We can review your claims file,  and spell out all of your options.

Joe Di Bartolomeo
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Top-rated Personal Injury Lawyer Helping Oregon and Washington Families