Workers compensation laws in California are clear: every workplace injury that is directly caused by an on-the-job incident should entitle the affected employee to workers' compensation benefits. Regardless of whether the employer followed safety rules or exhibited any negligence, a worker should get coverage for medical costs and other benefits as long as a direct link between the injury and the job can be proved.
In some cases, however, employees already have an injury but their work makes that injury worse. When this happens, the exacerbation of a pre-existing condition can often be covered by workers' comp. However, the employee may face an uphill battle in getting benefits and may find it is complicated to prove their injury was made significantly worse by work tasks.
Complex Cases Call for the Help of an Attorney
Recently, a report from Safety News Alert highlighted an example of the complex questions which may arise in situations where an employee is working with an existing injury or ailment. In this particular case, an employee had a degenerative joint condition that had resulted in necrosis of the hip. He had been advised by his doctor to undergo a hip replacement. However, his condition was largely asymptomatic. He walked with a small limp, but was able to effectively do his job loading and unloading trucks.
One day, however, he slipped in the back of the truck and he injured the same hip he had already been told to have replaced. He subsequently made a claim for workers' comp benefits, which would pay for his surgery and which would provide him with temporary total disability benefits during the recovery process.
The employer's insurer denied his benefits claim. They had him examined by a physician, who indicated the fall at work had not actually caused any lasting impairment. The insurer also claimed his need for the surgery was pre-existing from before the fall, and thus no workers' comp benefits should be available.
The employee appealed the denial of benefits. His treating physician and an orthopedic surgeon both indicated his fall at work had made his hip condition much worse. Because of damage sustained in the fall, he was no longer able to stand on his leg at all without significant pain. While he could have kept working before the workplace accident, he was no longer able to do so as a direct result of the on-the-job injury.
The employee was awarded benefits on his appeal, because the fall had sufficiently exacerbated his pre-existing hip problems. The insurer pursued multiple levels of appeal, but ultimately was not successful in getting even the state court to reverse the decision. The insurer would have to pay the benefits the employee deserved.
When a pre-existing condition exacerbates an injury, documenting the extent of the damage and getting qualified medical advice is key to being able to prove the injury was actually caused by a job. With the right medical and legal help, injured workers should be able to get the benefits they deserve.
If you have questions about your workplace accident, contact McLaughlin & Sanchez in San Diego for a free case review. An accident involving a pre-existing condition can lead to a difficult workers' comp claim. You will need superb representation. Call 866-324-9558.