Safety and OSHA News

Knee replacement needed because of work injury or preexisting condition?

A doctor said a worker had a “terrible-looking knee” five years ago but that a work injury exacerbated her condition. Now the employer doesn’t want workers’ comp to pay for her knee replacement. 

Fairhope Health & Rehab (FHR) in Alabama employed Lula Durgin as activities director at a nursing home. Her duties included taking residents on outings.

On Feb. 10, 2012, Durgin was getting ready to take a van of residents shopping. As she climbed into the driver’s seat of the van, she twisted her right knee and immediately felt pain.

Her doctor diagnosed a torn medial meniscus (torn cartilage) in her right knee. How bad was it? The doctor said Durgin’s meniscus was “shredded.”

However, she had preexisting degenerative damage before the work injury. The doctor looked at a 2007 MRI of Durgin’s right knee and said she had a “terrible-looking knee” then and a “terrible-looking knee in 2012.”

Her doctor said, “The condition of her knee was a combination of the preexisting degenerative change plus some acute exacerbation by the twisting injury.”

On May 25, 2012, the doctor operated on Durgin’s knee to remove the meniscal tear. Six weeks after the surgery he concluded she had reached maximum medical improvement from the twisting injury. The discomfort Durgin still felt in her knee, according to the doctor, was from the preexisting arthritis.

The doctor released Durgin to return to work.

When the doctor saw her again in September 2012, Durgin said she still had right knee pain and that the knee would “give out” sometimes, causing her to fall. Her doctor said this was due to her preexisting injury and referred her to an orthopedic surgeon who diagnosed “severe degenerative joint disease” and recommended right knee replacement.

Durgin had the knee replacement and applied to have the costs paid for by workers’ comp. FHR didn’t want comp to cover her initial surgery or the knee replacement.

A trial court ruled FHR should pay for the initial surgery and the knee replacement. FHR appealed.

Comp should cover some, but not all

FHR argued that because Durgin’s knee twisted before she climbed into the driver’s seat that no workplace accident occurred.

The appeals court soundly rejected that argument, stating, the “occurrence is the very definition of an accident arising out of and in the course of employment.”

However, the court said FHR had a better argument that workers’ comp shouldn’t pay for the knee replacement because that wasn’t related to the work injury.

The court noted that an employee who suffers from a preexisting condition isn’t precluded from collecting workers’ comp benefits if it exacerbates the condition. However,

“This court has held numerous times that if a work-related accident temporarily aggravates a preexisting condition, not contributing at all to the preexisting condition after a period, the employer is liable for compensation under the Act only for the temporary disabling effects caused by the accident.”

So in Durgin’s case, the court concluded that there wasn’t enough evidence to show that the work injury continued to contribute to her preexisting degenerative condition. The court said FHR’s workers’ comp insurance shouldn’t pay for Durgin’s knee replacement, but it did have to pay for the initial surgery and treatment because that was due to a work-related injury.

What do you think about the court’s decision? You can share your opinion in the comments section below.

(Lula Durgin v. Fairhope Health & Rehab LLC, Alabama Court of Civil Appeals, No. 2131074, 2/27/15)

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