A recent ruling by the Pennsylvania Workers’ Compensation Appeal Board highlights one of the complicated issues that may arise in a workers’ compensation claim – aggravating a pre-existing condition. The appeal board reversed a lower court’s finding that a worker’s work-related injuries included left knee pain caused by overcompensating for her right knee injury.
The case is Grimes v. Faulkner Mitsubishi, 28 PAWCLR 88 (Pa. W.C.A.B. 2013),
Scope of Employment
A worker who is injured on the job or becomes ill as a result of the job may be entitled to workers’ compensation benefits. To qualify, the injury or illness must have occurred in the “scope of employment.” Often, it is clear that an injury occurred in the scope of employment; however, that is not always the case.
When a construction worker falls off a roof while making repairs, it is fairly clear that any ensuing injuries occurred in the scope of employment. Other scenarios, such as the facts in Grimes, are not as simple to analyze. Grimes, like many cases, involved a pre-existing condition.
When a claimant has a pre-existing condition, the condition must be taken into account when evaluating the claim. A claimant cannot receive benefits for an injury that existed prior to his or her employment. However, if the worker’s employment aggravated a pre-existing condition, the worker may have a valid workers’ compensation claim.
The issue in Grimes was whether the worker’s employment aggravated her pre-existing right knee condition. Both sides in the case acknowledge that she had arthritis in her right knee prior to her employment. The claimant argued that her employment aggravated her pre-existing condition, causing new pain in her left knee. But the insurer argued that the worker’s awkward gait (resulting from the arthritis in her right knee) was the cause of her new injuries.
The appeals court concluded that the claimant failed to meet her burden of proving that her left knee pain was the result of an employment-related aggravation of her pre-existing right knee condition. Therefore, her workers’ compensation claim was denied.
If your workers’ compensation claim involves a pre-existing condition, you may find it more difficult to prove your claim without the help of a workers compensation lawyer. You may indeed be entitled to benefits through the Worker’s Compensation, but getting your claim approved may require the help of an experienced workplace injury attorney.