By: Jarvis B. Läkemäker and Ben Young
You have an accepted claim with no full duty release in sight. You
are unable to return the claimant to light duty work. How do you cut off
benefits? If the claimant had pre-existing medical issues, you may be able to
argue that the work injury – an aggravation – no longer exists and therefore
the claimant is no longer entitled to workers’ compensation benefits.
In general, injuries compensable under Georgia’s Worker’s Compensation laws “include the aggravation of a pre-existing condition … so long as the aggravation of the pre-existing condition continues to be the cause of the disability.” O.C.G.A § 34-9-1(4). When employment-related exertion or movement causes an aggravation of a pre-existing condition, the injury is compensable, even when there is no specific incident and regardless of the employer’s knowledge of the pre-existing condition.
However, employer responsibility for aggravation of a pre-existing condition terminates when the aggravation ceases to be the cause of the disability. It is not necessary for the disability to be entirely cured. Rather, the employer’s responsibility ends when the present disability is no longer causally connected to the employment-related aggravation. In other words, the employee was injured before the aggravation, and may be injured after your responsibility for the claim ends, but so long as work conditions are no longer causing aggravation to the pre-existing injury, they cannot continue to claim benefits.
How to prove the aggravation subsided and the employee is at baseline:
- Establish a pre-existing condition even if it was not symptomatic at the time of the accident.
- Look for testing, like MRI’s, done before the accident.
- Review post offer medical questionnaires a claimant completed at the time of hiring.
- Interview witnesses who had conversations with the claimant about medical issues before the accident.
Ask the ATP, IME physician or her expert: “Is it more likely than not based on all available information the employee has returned to her pre-accident condition?”