When you’re injured on the job, the Ohio Bureau of Workers’ Compensation (BWC) should cover your medical expenses. However, if pre-existing conditions are involved, the process may become complex.
“Pre-existing conditions” are medical conditions that a worker already had before they were injured on the job. This includes illnesses, chronic conditions and old injuries. Generally, “they are not addressed as part of a workers’ compensation claim until relatedness and medical necessity considerations are addressed.”
Medical Necessity
The BWC requires that treatment be “medically necessary” to be covered under workers’ compensation. The 1994 case State ex. rel. Miller v. Indus. Comm. affirmed that the BWC must consider medical necessity, as well as relatedness and cost, before approving treatment. In other words, any treatment must be related to the on-the-job injury and medically necessary: if you sprain your ankle, the BWC only covers what’s necessary to heal that injury.
Co-morbidity
Pre-existing conditions can affect how well your injury heals and what kind of medical treatment is deemed medically necessary. These are called “co-morbidity conditions,” and their treatment may be covered “for as long as the allowed conditions or medical care are affected; however, the conditions are not included in the workers’ compensation claim.”
That is, treatment for the co-morbidity condition is covered as long as it’s impacting your healing and recovery. It is not part of the workers’ compensation claim itself, because the pre-existing condition was not an on-the-job injury or illness.
Substantial Aggravation
Treatment of pre-existing conditions may also be covered when a work injury substantially aggravates the old injury. It is possible for a pre-existing condition to become an allowed condition in the claim but a substantial aggravation must be documented by objective diagnostic findings, objective clinical findings, or objective test results. Subjective complaints without objective findings are insufficient to substantiate a substantial aggravation.
For example, if your old back injury is aggravated by lifting heavy objects at work, the BWC may cover your claim. Although lifting the heavy objects did not cause the original injury, it aggravated the injury.
Recurrence
Note that there’s a difference between a pre-existing condition and a recurring injury. Recurring injuries are on-the-job injuries which have already healed, but are re-injured due to the employee’s job. A pre-existing condition, on the other hand, already existed before the worker was injured on the job. Each recurring injury may be treated as a separate workers’ compensation claim.
The attorneys at Dworken & Bernstein can help you navigate pre-existing conditions and the workers’ compensation process. Call us today for assistance.
