Work Comp - Pre-existing condition

DW

Work Comp - As always, a messy situation!

I have an employee who works in production. Two days ago she swung her arm backward to hit a co-worker, missed, but as a result, dislocated her shoulder. Setting aside the question of violence in the workplace (both parties claim it was not, just playing around) we have now come to find out that this employee dislocates her shoulder frequently.

We sent her to our clinic immediately after the incident occured. She is now on work restriction and instructed to wear an immobilizer on her arm. The treating physician at our local clinic referred her to a specialist, which our employee went to see yesterday afternoon. The specialist wants to continue the restrictions, and has also ordered an MRI for next week, which awaits approval from my company. The specialist is of the opinion that the seriousness of her condition could not be the direct result of the work-injury, that due to the rotation of her arm, etc. her arm must have dislocated many times in the past.

My question: Is the Company responsible for all treatment going forward for this employee through Work Comp?

Whatever

Company's only responsibility is to file any and all possible wc claims with the wc carrier.

SMace

Whatever is right. It's up to your WC carrier and if it is disputed it will be up to the Industrial Commission. It is my understanding that in IL it does not matter if the condition was pre-existing. If it is worsened at work, it's yours.

The IC is IL is VERY pro-employee and I doubt you would win. Good luck.

Don D

Regardless of the ultimate outcome of whether or not it's determined to be comp, here's an opinion: All service providers make calls to either a company or its carrier to get approval prior to treating or running tests (certainly like an MRI). If the company or the comp carrier is authorizing the tests and treatment, then an obligation to pay has been established. That's the reason these people put the 'comp' patient on hold and start dialing for dollars.

At some point in the process, either the company or its carrier will have to start denying treatment as comp. if the objective is to have it classified as non-comp.

In this state, regardless of a person's prior condition, he is hired 'as is'. Anything that occurs at work that exacerbates a condition is comp.

pork1

I concurr with Don! I have on three occasions over the last 3 years had the opportunity to record an accident with injury as: an aggravation of a previously exsisting condition. One would want to do this in order to let the treating physician know that he/she could be able to sort through what was an old injury and what was a previous condition. It also lets the physician get a more complete history, to protect his work from denial of treatment later on. One of the employees, who is no longer working for us saw a physician for Corpal Tunnel of the right wrist came to me and wanted assistance in filling out a claim form for our medical plan; I stopped her and assisted her with putting a worker's Comp claim. At that time she let me also know that the situation had become worse since starting to work and told me that her left wrist was also worse than the right wrist, but that she did not use her left wrist in her work. After surgery on the right we put her back to work doing light duty with a physician approved job task list. Guess what the ee then attempted to hollar left wrist damage due to three weeks of light duty. Our carrier and we denied the claim and won. We paid out her disability claim for the right wrist and medicallly disqualified her for the work based on the left Carpol Tunnel she had previously reported. Her attorney wanted $75,000.00, he was very disappointed with the settlement for the exact amount ordered by the "scheduled member" disability and not a penny more. She has now gone on to find another "sucker employer" to get her left wrist and disability taken care of.

May we all have a Blessed afternoon and a better tomorrow!

PORK

hrwoman

Just out of curiosity - did you write these employees up for horseplay when they should've been working?

Parabeaglex2

That's just what I was going to ask. Also, check with your carrier. It's possible that an injury resulting from horseplay may not be compensable - I have seen our carrier deny such claims in the past.

Don D

In this state, even if the carrier denied it, when the employee filed a petition to controvert, the Commission would uphold the claim. Horseplay can get someone terminated; but, in our case, cannot allow the employer to escape liability.

TN HR

Unfortunately, had this happened in TN it would absolutely be compensable. The flip side of that is that in our environment, the behavior would constitute a safety violation and we would term the ee immediately.

Gene

Lori B

You do take your ee as you find them. However, if a prior employer's environment helped contribute to the condition, your carrier should attempt to subrogate against that prior employer to help share expense.

SMace

Have you been successful doing that?

Lori B

We're currently pursuing this in CA with an ergonomic type injury. Too early to tell if we will have success or not.

Don D

Best of luck in that pursuit.

njjel

In NJ a on the job injury to a preexisting condition is covered under w.c.

Don D

What she's suggesting is that the prior company's insurance company might be convinced to share the cost with the present company's carrier.