A health care worker with pre-existing back problems can’t collect workers’ compensation benefits after injuring her spine while moving patients, the West Virginia Supreme Court found.
The court said the medical history detailing her back problems proved there was no new work-related injury that qualified for workers’ compensation benefits.
Doctor: Injury was work-related, aggravated prior injury
Donna Carter was a health care worker for Davis Health System. On Dec. 12, 2019, she experienced pain in the right side of her lower back while moving patients.
Carter sought treatment at the Davis Health System Emergency Department on Dec. 13, 2019, and her doctor found that she injured her back due to a muscle strain from pulling and lifting. The doctor felt that the injury was work-related and noted that it also aggravated a prior injury.
Specialists note history of back pain
On the following Monday, Carter attempted to return to work, but a few days later she was unable to tolerate the pain and was taken off work. She saw two spine specialists in January 2020 who noted that she had undergone a:
- nerve block injection July 1, 2019, which provided months of relief from back pain prior to her work injury, and
- surgical intervention for back problems in 1997.
An MRI led to diagnoses of:
- lumbosacral radiculopathy
- radicular leg pain
- lumbar nerve root impingement
- lumbar disc herniation with radiculopathy
- stenosis of part of the spine, and
- a history of lumbar surgery.
Surgery was required along with stronger medication to address Carter’s severe back pain.
Symptoms in claim same as those prior to work injury
Carter filed a workers’ compensation claim and on Jan. 25, 2020, a claims administrator rejected the claim, stating that “the disability complained of is not due to an injury or disease received in the course of and resulting from employment.”
The claims administrator pointed out that medical records indicated Carter’s condition pre-existed her Dec. 12, 2019, injury and that the symptoms and diagnoses in her claim were the same as those prior to the work-related injury.
Carter protested the rejection of her claim while continuing to receive treatment for her severe back pain. However, she did admit she had previously suffered from back problems prior to the Dec 12, 2019, injury. She argued that she “sustained a discreet new injury which required surgical intervention in order for her to recover and return to work.”
On June 22, 2020, the West Virginia Office of Judges affirmed the rejection of the claim. The Office of Judges concluded that while Carter had an incident on Dec. 12, 2019, while moving patients, that incident didn’t result in a new injury. Further, the Office of Judges found that Carter failed to identify any new symptoms that weren’t reported prior to December 12, 2019.
Medical evidence supports denial of claim
Carter filed an appeal with the state’s Supreme Court, which upheld the denial of benefits.
The court said that “in determining whether an injury resulted from a claimant’s employment, a causal connection between the injury and employment must be shown to have existed.” There was also a rule in West Virginia that “a non-compensable preexisting injury may not be added as a compensable component of a claim for workers’ compensation medical benefits merely because it may have been aggravated by a compensable injury.”
The only way a worker’s disability would be presumed to have resulted from a compensable injury in this case is if:
- before the injury, the pre-existing disease or condition was asymptomatic, and
- following the injury, the symptoms of the disabling disease or condition appeared and continuously manifested themselves afterwards.
In this case, the court found that the medical evidence showed that Carter’s symptoms were not only diagnosed prior to December 12, 2019, but they were actively symptomatic and required treatment.
Because of this, the court said the Office of Judges’ decision to deny benefits must be upheld.
Dissenting judge: Decision ‘manifestly unfair’ to Carter
One Supreme Court judge dissented, finding that Carter’s case was “an opportunity to correct a structural fault in our workers’ compensation review procedures: an age-related bias against workers such as (Carter), who are far more likely to have degenerative musculoskeletal conditions after a lifetime of physical labor.”
The judge found that the result in Carter’s case was “manifestly unfair” to her and “evidences a discriminatory, age-related bias that has taken firm root in the workers’ compensation system.”