Often, people are not perfectly healthy when they suffer injuries at work. For example, a person who injures his back lifting at work may aggravate a preexisting condition. That person may have had some prior back pain or even prior medical treatment.
Our attorneys often get questions about whether workers’ compensation covers injuries where an individual already had a preexisting condition. This article will answer that question and some other questions associated with those types of injuries.
How do preexisting conditions affect a Georgia workers’ compensation claim?
The Georgia Workers’ Compensation Act does cover aggravation injuries. They are commonly known as aggravations of preexisting conditions.
For the most part, these injuries are covered just like normal injuries at work. This means that you potentially can recover benefits for being out of work, medical benefits, and permanent partial disability benefits.
How do aggravation cases differ from regular workers’ compensation injuries?
There is one significant difference between aggravations and other work related injuries. The insurance company no longer has to pay benefits for an aggravation if they prove that the aggravation is no longer the cause of the disability.
This is sometimes referred to as resolution of aggravation or “return to baseline”. If the insurance company proves this, your workers’ compensation claim will be over and you will draw no more benefits.
A good example of resolution of aggravation of a preexisting condition is the 2015 Georgia Court of Appeals case of Emory University v. Duval. This case shows how different medical opinions are used to reach decisions using this part of the law.
The facts behind the Court of Appeal’s decision
Ms. Duval injured her right shoulder at work in 2010. She got some medical treatment. She then had surgery on her left shoulder. When she later tried to get more medical treatment for her right shoulder, the insurance company refused to pay for it.
After a court hearing, the administrative law judge determined that Ms. Duval could get more medical treatment on her right shoulder based on the opinion of her treating physician. When the insurance company appealed, the Appellate Division of the State Board of Workers’ Compensation reversed the administrative law judge.
The Appellate Division believed the doctor to whom the insurance company sent Ms. Duval. That doctor (who just happened to also work for Ms. Duval’s employer) said that the aggravation injury to Ms. Duval’s right shoulder had resolved and that her problems were from a preexisting condition.
On further appeal, the superior court reversed this decision. The insurnace company then appealed to the Georgia Court of Appeals.
What did the Court of Appeals decide?
The Court of Appeals reversed the superior court’s decision based on a part of the law called the “any evidence” rule. This part of the law means that certain appeals courts do not really analyze the facts much. Instead, they focus on analyzing the law and how lower courts applied it. So, Ms. Duval lost the case.
This case demonstrates a common fight in workers’ compensation cases. Insurance companies often try to say that something else caused your medical problems. They often try to blame it on a preexisting condition, a previous injury or old age. In this case, they were successful because the Appellate Division judges believed the doctor that Emory used.
How can I prove that my problems are still caused by my aggravation injury at work?
How can I prove that my problems are still caused by my aggravation injury at work?The insurance company has to prove resolution of aggravation. It is not enough for the insurance company to just file some paperwork. They usually need to request a hearing and go to court.
If the insurance company claims that your aggravation injury has resolved, you can take action to prove that it has not. You can get an opinion from your treating doctor. If your current doctor is not supportive of your injury, you can probably change to another doctor or get an independent medical evaluation.
Workers’ compensation cases involving preexisting conditions are complicated. The insurance company tries to get off the hook by blaming your problems on some injury that happened years ago. However, if they can find a doctor who will support this argument, a judge may believe that doctor.
You should certainly talk to an attorney if the insurance company claims your aggravation injury has resolved. The stakes are high since your benefits will stop completely if the insurance company succeeds.
