We recently reported on a significant Court of Appeals case that interpreted the important statutory term “compensable injury” as applied to evaluating “combined conditions.” In a recent decision, the Workers’ Compensation Board applied the new case law, finding that an employer did not meet its burden of proof to show that claimant’s on-the-job injury was no longer the major reason for her combined condition.
A combined condition occurs when an otherwise compensable injury combines with a pre-existing condition. It is up to the employer to prove that “compensable injury,” which is the injury event combined with a “pre-existing condition.” If the employer meets this burden of proof, the combined condition is accepted only so long as the compensable injury remains the major cause of the need for treatment, or the disability.
Under the old statutory definition, an employer would accept a certain medical condition, like a strain or sprain, and then claim that it combined with the pre-existing condition, like arthritis, or degenerative disc disease. The employer would then send the injured worker to an “independent” medical examiner, who would find that the on-the-job injury condition, i.e. the strain or sprain, was no longer in issue, and that any ongoing issues were a result of the pre-existing condition.
That has changed. Now, the relevant question is whether not the actual injury event is the main cause of the need for treatment. In this case, the Board found that the insurance company did not show that the on-the-job injury event was no longer to may cause for the need for treatment.
This is an encouraging signed that the statute will be interpreted more fairly to allow injured workers to seek treatment for medical problems resulting from on-the-job injuries.
If you have an open claim, or even a denied claim, and it involves a combined condition, call our office at 503-325-8600. We have worked on several cases involving “combined conditions” and “pre-existing conditions” and can share our knowledge.