Can I Be Denied Workers’ Compensation Benefits Due to a Preexisting Condition?

In any personal injury case, it is essential to establish causation. In plain English, you need to prove your injury was the direct result of the defendant’s negligent act. If the defendant can prove that there was a preexisting condition or superseding cause of the plaintiff’s injury, it can escape liability regardless of its own fault.

Similarly, in workers’ compensation cases, an employee is only entitled to benefits if he or she can prove they were injured in the “course and scope” of their employment. Unlike other personal injury claims, the employee does not have to prove the employer was negligent–workers’ compensation is a no-fault system–but there must still be proof that the injury was job-related.

Court Finds Diabetes, Not Workplace Accident, Likely Cause of Foot Injuries

In some cases, even if an injury occurs on the job, it may not be covered by workers’ compensation because of a preexisting medical condition. Here is an example from a recent Tennessee workers’ compensation case. An employee of an electrical company broke his foot after slipping on a flight of stairs. The employee received treatment at a nearby emergency room. But a few days later, he returned to the hospital complaining of pain, fever, and nausea.

Doctors discovered the broken foot was “severely infected.” More specifically, the employee was diagnosed with a “charcot foot,” a loss of sensation in the foot or ankle. This condition is the byproduct of a number of ailments including diabetes. The employee in this case has type-2 diabetes.

The employee’s charcot foot required surgery and hospitalization for more than a week. Even after this, the employee continued to experience problems related to his foot. The employer ultimately denied the employee’s claim for workers’ compensation benefits, however, arguing his foot injuries were the result of his preexisting diabetes and not the fall on the stairs.

After a workers’ compensation judge ordered the employer to pay benefits, a physician approved by both parties examined the employee. The physician ultimately determined that the employee’s charcot foot was likely a result of a “pre-existing condition that was aggravated by the patient’s work injury.” The work injury alone could not explain the “whole problem.”

When the employee subsequently requested temporary disability benefits, the workers’ compensation panel said no. The court agreed with the employer this time, finding the employee could not prove that his “foot condition arose primarily in the course and scope of his employment.” The Special Workers’ Compensation Appeals Panel of the Tennessee Supreme Court agreed with this finding and rejected the employee’s appeal. The Panel noted the law requires an employee to prove his employment “contributed more than fifty percent in causing” his injury, and he failed to do so.

Get Help From a Knoxville Personal Injury Attorney

The inability to prove causation dooms many workers’ compensation and personal injury claims. This is why it is imperative to work with an experienced Tennessee personal injury lawyer who can help you investigate the underlying causes of your accident and make sure you head into court prepared. Contact the offices of Fox, Farley, Willis & Burnette, Attorneys at Law, in Knoxville or Clinton if you need to schedule a consultation with a lawyer right away.

Source:

scholar.google.com/scholar_case?case=3973716152482673019