Will Workers' Compensation Cover an Aggravation of a Pre-Existing Injury?

Many times when people are involved in a work accident, they will aggravate an old injury. We oftentimes hear concerns from these individuals that the Workers’ Compensation (“WC”) insurance carrier MAY NOT cover medical treatment for these types of re-injuries.  So the question in South Carolina becomes, is a work accident that aggravates and/or makes worse a pre-existing injury covered by the employer’s WC insurance carrier?

The simple answer to this question is YES.  According to S.C. Code Ann. § 42-9-35 -  

(A) The employee shall establish by a preponderance of the evidence, including medical evidence, that:

(1) the subsequent injury aggravated the preexisting condition or permanent physical impairment; or

(2) the preexisting condition or the permanent physical impairment aggravates the subsequent injury. 

What does this mean to my WC injury and claim?  If your WC claim is denied because of an aggravation of a pre-existing injury, it is necessary that YOU obtain the opinion of your treating physician that “to a reasonable degree of medical certainty,” that it is more probable than not that the work accident aggravated the pre-existing condition. How can I obtain this medical opinion?
 
 If your claim is denied because of this particular situation, it is always best to discuss your claim with attorneys experienced in these matters.  As attorneys working with WC clients on a daily basis, Ernie Trammell and Roy Trammell have spent countless hours drafting doctor affidavits for clients whose claims are being temporarily denied because of this reason.   
 
What if my pre-existing condition is degenerative in nature?
 
If your work accident aggravates and/or makes worse a condition like arthritis, your employer’s carrier must cover the claim.  As noted above though, a treating physician does have to document that in his opinion based on a reasonable degree of medical certainty that it is more probable than not that the work accident aggravated the arthritis in the body part injured.  
 
Regardless of your Workers' Compensation question or issue, we are here to help. If you have been injured on the job, please give us a call for your free consultation. Call us at 1-864-231-7171, find us on Facebook, or Twitter. We are here to help. 

THIS ARTICLE WAS WRITTEN BY ROY TRAMMELL, a Workers' Compensation attorney. 

Are You Covered By Workers' Compensation If You Fall at Work?

         Don't fall victim to the "There Ain't Nothing Wrong With the Floor" defense. If you trip over an object on the floor at work and fall, you are almost certain to be covered by the workers’ compensation laws.  But what happens if you simply fall at work on a completely level floor or on a smooth rug and there is no obvious cause for your fall?  What if your employer responds that you can not get workers’ compensation benefits because “there ain’t nothing wrong with the floor” to have caused you to fall?  Is the employer right?

Let’s look at three different scenarios:
Situation 1
 
Assume that my paralegal, Ashley, is walking down the hallway at our office with a hand full of files and trips over a magazine that had been inadvertently dropped on the floor by a client.  Is she covered under our workers' compensation laws?
 
Yes, she is covered because she suffered an injury by accident at work during the course and scope of her employment.  Since the workers’ compensation system is a “no fault” system, it doesn’t matter whether Ashley could have avoided that accident because fault is irrelevant in a workers’ compensation claim. 
 
Situation 2
 
Let’s now assume that Ashley is walking down the hallway at our office with a hand full of files and loses her balance and falls for no apparent reason.  There was nothing specifically on the floor that had caused her to fall.  Is she covered under our workers’ compensation laws?
 
Yes, she needs only to prove a causal connection between the conditions under which the work is required to be performed and the resulting injury.  The fact that Ashley suffered an “unexplained fall” does not preclude her from being covered by workers’ compensation.  There does not have to be some work hazard on the floor causing the employee to fall in order for there to be workers’ compensation coverage.  Instead, she again only needs to prove that she was injured during the course and scope of her employment.  It is no defense for the employer to deny coverage because  “there ain’t nothing wrong with the floor” to have caused you to fall.
 
Situation 3
 
Let’s assume that Ashley has a bad knee which has bothered her for years.  As she is walking down the hall with a hand full of files, her bad knee simply gives away and she falls.  There was nothing on the floor that had cause her to fall.  As she was being helped up from the floor by her co-workers, Ashley responded that “my knee just gave away.”  Is she covered under our workers’ compensation laws?
 
No, in this case Ashley would be determined to have suffered an “idiopathic fall.”  That is a fall caused solely by an inherent medical condition (the bad knee) or weakness which is specific to Ashley.  An “idiopathic fall” is much different than the “unexplained fall” described above in Situation 2.  In an “idiopathic fall” the burden of proof is on the employer to establish that the fall was caused solely by Ashley’s inherent medical condition.  It will be easy for the employer to prove that Ashley’s fall was idiopathic because she admitted it when she told her co-workers that “my knee just gave away.”  A fall caused by fainting is also an example of an idiopathic fall.
 
The Moral of the Story
 
If you suffer a fall at work, you will be covered by workers’ compensation if a specific work hazard (like water on the floor or an object on the floor) causes you to fall or if your fall is simply unexplained.  The only way you lose is if the employer can prove that your “unexplained fall” was actually an “idiopathic fall” in that it was caused solely by your inherent medical condition, which had nothing at all to do with your work or work environment.  Therefore, if you do have the misfortune of falling at work, by all means tell the truth to your employer as to what happened but don’t carelessly make a statement in the midst of your natural embarrassment that you fell because your bad knee gave away (unless that is in fact what happened)!
 
If you fall at work and have questions regarding your claim, please do not hesitate to contact Ernie Trammell at Trammell & Mills Law Firm, LLC.   Ernie Trammell has been a practicing law for 32 years and has focused the last 15 years of his practice solely on representing injured workers in workers’ compensation claims in South Carolina and Georgia

 

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