Safety and OSHA News

Workplace injury or preexisting condition?

ShoulderPain

An employee says he was injured at work. But wait: He had previously suffered a similar injury and was being treated for it. Does the employee get workers’ comp benefits for the injury?

Charles Spencer was a cook at the Hyatt Regency Crystal City in Virginia.

One day at work, Spencer slipped on wet floor in the men’s restroom and fell backward, hitting his right shoulder against a sink. He immediately sought treatment.

He applied for workers’ comp benefits.

Hyatt sought to deny those benefits, noting that Spencer had received treatment for right shoulder pain before his fall.

The Workers’ Compensation Commission awarded benefits to Spencer. Hyatt appealed to a state court.

In its appeal, Hyatt argued that Spencer didn’t report his medical history, including preexisting shoulder pain, to two doctors and therefore the commission shouldn’t have relied on those doctors’ opinions to award comp.

The company also argued that the commission erred in finding that Spencer’s shoulder condition wasn’t related to his preexisting condition. Hyatt claimed that Spencer’s treatment for shoulder pain was essentially the same before and after the fall.

At the request of Hyatt, Spencer went to a third doctor for an independent examination and opinion. That doctor said his shoulder pain was related to his preexisting condition.

On top of that, at a hearing, Spencer testified that he didn’t recall any previous injuries or problems with his shoulder before his fall.

Hyatt also claims that Spencer hid his preexisting condition from the two doctors that treated him.

While it would seem that Hyatt had multiple reasons to deny comp coverage to Spencer, none of the company’s arguments stuck.

The appeals court said Hyatt couldn’t show that Spencer had hid his preexisting condition. It also said it would defer to the commission’s decision to give more weight to the opinion of the two doctors who said it was a work-related injury rather than to the one who said it wasn’t.

Finally, the court said there was enough difference in the treatment for Spencer’s shoulder pain before and after the fall to establish that the work incident had created a separate, compensable injury.

Decision: It was a separate injury. Spencer should receive workers’ comp benefits.

What do you think about the court’s decision? Let us know in the Comments Box below.

(Hyatt Regency Crystal City v. Spencer, Court of Appeals of VA, No. 1007-10-4, 1/25/11)

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  • http://lexmac.com Blackgold

    After having read the entire ruling, we conclude that the claimant (Mr. Spencer) is scamming the system.

    According to the court documents, it appears Mr. Spencer lied about ever having been treated for the previous condition – which condition apparently went back to 1975. The documents presented here are silent on whether the 2007 ‘fall’ was witnessed by anyone, although Mr. Spencer reported the injury to his employer.

    The Court of Appeals used the phrase: “Viewed in the light most favorable to claimant…”, which we suggest biases all appeals against any employer that has the misfortune to have its case heard before the Virginia Court of Appeals.

  • Chuckc

    Wow this is a real can of worms. I really wouldn’t have any problem with workers’ compensation covering the first aid for the injury that he had from the slip and fall injury IF he had fessed up that he had a pre-existing injury. But when he denied any previous injury, he out and out lied (while under oath at the hearing) and that, in my opinion, is illegal. This is not a violation but a fraudulent claim. And is considered criminal in most legal circles. Have you ever noticed how miserable the workers’ comp frauds become?

  • Jan

    Here in IL we get slammed with aggravation of a pre-existing condition so he would have won either way. It doesn’t matter how good the evidence is againist the employee the employer always loses. all these states are so employee orientated the employer doesn’t have a chance. While I was getting ready for work this morning I heard four commericals for WC Atty’s

  • TLV

    I have been involved with workers’ compensation cases in WA,OR, CA & TX and I believe most would find in favor of the worker and call it aggravation of a previous injury. I do not have a problem with this if the employee has advised the company up front about the previous injury. I do have a problem if the employee has hid this from his employer.

  • Gideon Pennyroyal

    How much would Hyatt have paid for a straightforward worker’s comp claim? How much did they spend to fight the claim? How much did they lose from lowered employee morale? This comes across as a primitive monkey dominance struggle.

  • Jan

    We recently decided we are taking a claim to trial. We don’t expect to win and it is low exposure but we are trying to make a point. Often when I have a settlement, suddenly I have multiple injuries and all are looking for a settlement. We are trying to send a message that we are not a money pool

  • Bill

    Blackgold, Jan, Chuckc,and TLV have all provided good answers. I have known employees who hid conditions to get a job, claimed injury on the job that was caused elsewhere, aggravated an existing known injury, been non-compliant following therapy, as well as not following safety procedures and causing an injury. All cases were found in the workers favor. The only situation that I recall resulting in a permanent partial disability was with the non-compliant worker who still got workman’s comp.

  • Toolbox

    This is sooo typical, the liberal courts have always ruled in favor of the poor employee. Why waste your time and money fighting it? Its the due cause of higher and higher WC premiums.

  • Molly

    I am dealing with this same issue and now I know we are going to lose AGAIN. It seems so simple that we all can figure this out, why cant Workers comp do the same???? I need a new JOB

  • Cheri

    I have been doing Worker’s Compensation for over 20 years and due to the Pro-Employee attitude of the Magistrates in Michigan you never win. I have seen cases go through that it was proven that they were scamming the system and they still won. Unfortunately if someone has a pre-existing condition the minute they go to work for you, you own that injury forever (all you have to do is aggravate it, even if getting out of bed aggravates it!!!! ) I firmly believe that if you are injured at work (legitimately) then you are entitled to Worker’s Compensation and to be treated with the best possible treatments available. On the other hand it aggravates me that so many people get away with scamming the system. In this economy it just puts more and more small businesses out of business. Sad but true!!!!

  • Hurley Henson

    And we’re wondering why many companies are packing up and moving to Mexico and elsewhere? Rogue judges are putting this country out of competion in the global economy.

  • Jan

    its nice to know there are others out there as frustrated as I am. I caught someone on video taking out trash, shoveling snow, etc. with a back injury and they still won. The judge said he must have had a good day. Gesh

  • TLV

    Cheri, you hit the nail on the head. The sad part of all this is that our good employees do not get the best treatment for the dollars we have to spend on insurance. Not only are some employees taking advantage of the system but some clinics encourage it.

  • Chuckc

    Being a syndical person, I have often considered that the WC people will justify their jobs by occasionally granting workers’ compensation to questionable claims. If they ruled properly, there would be fewer attempts at trying to get a free ride, and therefore there would be fewer people needed to staff the bureau.

    How scary would that be having a huge number of people without a personality looking for work?

  • Jan

    I pulled our business from the local clinic as everyone ended up in PT. I had someone who hurt her pinky finger, they put her in PT. That was the last straw, I found another clinic not to far away and they have been working with us. The first clinic is nationally known then I found out there sales are based on PT and medication.

  • Getreal

    OSHA considers an injury work-related if an event or exposure in the workplace caused or contributed to the condition or significantly aggravated a preexisting condition. I don’t know if comp law parallels OSHA, but the court in this case could have seen it the same way IF they acknowledged the preexisting condition. But preexisting condition or not, the injury occurred on the job and Spencer gets his benefits.

    Another thing to consider is doctors typically have no clue what goes on in the workplace. If the patient (employee) says it’s work related, the doctor usually goes along with it. Hence, the opinion of the 1st two docs is questionable.

    What stinks in this case is Spencer lying about the preexisting condition. I think most judges would toss the case based on the plaintiff’s dishonesty. Hyatt should have done a better job exploiting that lie.

  • Jim

    Sad results. We have aggravation of preexisting injuries like several mentioned in our State of Florida. Many years ago, we had the Carpenter defensive which basically allowed you to deny a claim if the worker lied on their application and it was the proximate result of the claim. Oh course, you can fire the individual for misrepresentation on the employee application but it does not resolve the claim. I have no issue with aggravation of preexisting conditions since it is percentage to the employer. Oh course, I always wonder would the injury be as severe or even at all.

    Until you get judge advocates out of the system, you will never change this process. No matter what State Workers’ Compensation Statutues that is created by the legislature to make it objective, judge advocates will ruin the process. Oh course, they have their own reason, it’s called employment.

  • Molly

    I also belive that the system should be used for injured workers and 90 % of my work force is intimidated by the thought of being a work comp case. I take them to the doctor and make sure they get the treatment they deserve. Its the cases that report after they are laid off and complain of a same injury that happened 4 years ago. We have the proof that the injury has not changed and all the medical shows no change from this previous injury. BUT the worker fained an incident and now the whole thing is MINE….
    We need to change some laws to even out the system.. I ask about the fraud investigators and they investigate companies that dont pay into the system… they need to do more investigating on the injured worker… When they can shovel snow????? its WRONG

  • MMMM

    OSHA has nothing t do with compensability nor does workers comp have anything to do with OSHA. There are a lot of things that can happen to a person that could cost a lot of money in workers comp and not be recordable on the OSHA log and you can also have an injury on the OSHA log that costs very little or nothing at all. The problem here is that he had a pre-existing condition then hid it, that should be enough to have it thrown out. Additionally he went to a third doctor un involved doctor at the rquest of the court then the court ignored the findings.

    Nope, this is a simple case (once again) of a liberal judge ignoring the facts and finding for the employee regardless of what is really the case. This is all to often the case.

  • Paleto

    What’s missing? Lot’s of questions and answers are missing here.

    “Spencer testified that he didn’t recall any previous injuries or problems with his shoulder before his fall.”
    But Hyatt said: “(Spencer) had received treatment for right shoulder pain before his fall.”
    So did Spencer forget he had been treated, before? or Where did Hyatt get the information about previous treatment?

    Here’s some more to chew over:
    Were there any witnesses to his fall in the bathroom?

    Was the bathroom floor actually wet?

    Or was this fall idiopathic?