Joe is lifting a heavy box at work when he hears a pop in his back. He stands up and feels pain shooting down his leg. X-rays show that the pain is related to a herniated disc—the same injury that he suffered previously while weightlifting, before he started his current job. For years, the condition had been asymptomatic. Now, the condition prevents him from performing his usual job duties and he wants to make a workers’ compensation claim. But does he have a pre-existing condition that is ineligible for benefits?
A significant gray area exists with work injuries related to a pre-existing condition. In addition, recent changes to the law give more power to employers in cases involving aggravation of a pre-existing injury or chronic medical condition. If you’re unsure about whether your work injury qualifies for additional compensation related to a pre-existing condition, or if any part of your claim was denied, contact the workers’ compensation lawyers at Graham & Graham for a free case evaluation.
When Workers’ Comp May Cover a Pre-Existing Injury
Pre-existing conditions are typically not covered under the Ohio workers’ compensation system unless affected by a work injury. The Bureau of Workers’ Compensation (BWC) considers two issues when determining whether a worker’s pre-existing condition qualifies for benefits: relatedness (so-called “substantial aggravation”) and medical necessity (i.e. “co-morbidity” conditions). BWC notes that these issues must always be considered together.
Relatedness means that a work-related injury or disease aggravates a pre-existing condition. BWC uses the “but for” rule to decide whether the pre-existing condition would not have been aggravated “but for” an employment-related activity. Using the example above, it’s possible that, had Joe not been lifting heavy boxes, the herniated disc injury would not have occurred. He therefore may be able to make a workers’ comp claim and receive money for his back injury.
Co-morbidity refers to a pre-existing condition that, although not authorized for treatment by itself under workers’ compensation, may be authorized when it affects the treatment of an authorized injury. Let’s imagine a scenario where Jane, an office worker, slips and falls while on the job and breaks her ankle. Workers’ compensation covers Jane’s ankle surgery and recovery period, because the injury is work-related. However, Jane also suffers from diabetes—a pre-existing condition that is not work-related—which negatively affects her post-surgery healing time. In this scenario, BWC allows payment for treatment of Jane’s pre-existing diabetes for as long as she’s recovering from ankle surgery. By itself, the diabetes would not be covered by BWC, because it is not work-related. And as soon as Jane’s ankle is healed and she returns to work, she can’t make a claim related to her diabetes.
Proving “Substantial Aggravation” Can Be Difficult
Changes to Ohio workers’ compensation laws have made it more difficult for workers to prove that a pre-existing condition was substantially aggravated by a workplace injury or illness. The new law also places limits on compensation for pre-existing conditions.
Adding the word “substantial” increased the burden of proof for an injured worker. In the past, an increase in symptoms alone was often sufficient to prove aggravation of a preexisting condition. Now, the worker must have objective medical evidence, such as diagnostic findings or test results, showing that the pre-existing condition has measurably worsened. Not only that, but under the new law, employers do not have to provide compensation for a pre-existing condition once the condition has returned to a level that would have existed without the injury.
Helping Injured Ohio Workers Since 1923
Graham & Graham works hard to protect the rights of hard-working Ohioans injured while on the job. We understand that losing the ability to work and earn an income—even for a short period—can cause serious problems. We’re here to help you navigate the road to recovery, receive the benefits you need, and return to work.
Our attorneys have helped many injured workers with issues related to pre-existing conditions, substantial aggravation, and co-morbidity. To find out how we can help you with your claim, call 1-800-621-8585 or send us a message. We handle workers’ compensation cases on a contingency-fee basis, which means you pay nothing unless we recover money for you.