The last 3 cases I worked had pre-existing injuries 1-2 years prior to the current claims, identical complaints and medical findings. Clearly pre-existing? This led me to do some research in an attempt to help determine what is compensable. OSHA Section 1904.5 Determination of work-relatedness, paragraph (b) (4) (reference below), the final rule requires that the amount of aggravation of the injury or illness that work event contributes must be “significant,” i.e., non-minor, before work-relatedness is established. While the agency believes preexisting injury or illness cases that have been aggravated by work events should be recorded, they also show concern that there are some cases where work-related aggravation affects the preexisting case only in a minor way, i.e., in a way that does not appreciably worsen the preexisting condition, alter its nature, change the extent of the medical treatment, trigger lost time, or require job transfer. Accordingly, the final rule requires that workplace events or exposures must “significantly” aggravate a pre-existing injury or illness case before the case is presumed to be work-related.
Definitions noted of aggravation as significant (let’s be clear, solely because of the aggravation of the pre-existing) : (i) Death (ii) Loss of consciousness (iii) A day or days away from work or of restricted work, or a job transfer that otherwise would not have occurred (iv) Medical treatment where no medical treatment was needed for the injury or illness before the workplace event or exposure, or a change in the course of medical treatment that was being provided before the workplace event. So proving ongoing treatment (medications or HEP) was ongoing is one of the keys to establish pre-existing. I noticed that no time limit is mentioned. Another key is a change in course of treatment. Using these guidelines can significantly clear the picture of pre-existing conditions and compensability. As a case manager, I can see myself asking the doctor if the claimed aggravation is significant or minor, if off work status is due to the work injury or the aggravated pre-existing injury. This could certainly change the course of the claim.
References: excerpts from the preamble to the Occupational Injury and Illness Recording and Reporting Requirements, the Recordkeeping rule (66 FR 5916, 29 CFR Parts 1904 and 1952). These excerpts represent some of the key discussions related to the final rule (66 FR 6122, 29 CFR Parts 1904 and 1952).