Sixty percent of Americans have one or more chronic health conditions. And many people who have chronic medical issues are employed. What happens when you have a comorbid condition and you’re hurt at work?
Horton & Mendez Injury Attorneys explains comorbid conditions in a workers’ compensation case.
What Are Comorbid Conditions in Workers’ Compensation Claims?
A comorbid condition in a workers’ compensation claim is a previously existing or co-occurring medical condition that did not arise from the workplace injury. By itself, a comorbid condition is not compensable. But having it doesn’t prevent a worker from claiming workers’ compensation, even if they are more susceptible to injury because of the condition.
Understanding Comorbid Conditions and Their Impact on Claims
Comorbid conditions exist along with a workplace injury. For example, a person who falls and injures their back may have diabetes. A person who suffers amputation of a limb may have obesity.
A comorbid condition in and of itself won’t stop you from receiving workers’ compensation. With 60% of Americans having one or more chronic medical issues, that would be unfair.
If you have a comorbid condition, you can still receive workers’ compensation. However, the condition may impact your claim.
Common Comorbid Conditions That Affect Workers’ Comp Cases
- Obesity
- Diabetes
- Hypertension
- COPD (chronic obstructive pulmonary disease)
- Back problems
- Heart disease
- Stroke
- Cancer
- Substance use, drugs, and alcohol abuse
- Chronic pain
- Smoking, tobacco use
- Skin conditions
- Mental health conditions including depression and anxiety
- Carpal tunnel, tendonitis, arthritis
- Organ failure
What is the law in North Carolina for workers’ compensation with comorbid conditions?
N.C.G.S. § 97-2(6) defines a workplace injury as injury by accident that arises out of and in the course of employment. An employer is liable for personal injury or death by accident as provided by North Carolina workers’ compensation law. There are no exceptions or exclusions when a person has comorbidity, even if the injury is an aggravated pre-existing condition.
How Comorbid Conditions Influence Medical Treatment
As compared to claims that do not include comorbidity, claims involving comorbid conditions generally:
- Take longer
- Result in lost work time more often
- Have higher medical costs
- Are more likely to require surgery
There are several reasons this might be the case, including delayed symptoms, slower recovery times, the potential for complications, and the possibility of infection.
One source says that workers’ compensation claims cost twice as much as claims without co-occurring health conditions.
Workers’ compensation claims with multiple comorbidities are 300% more costly than when there is no condition.
The Role of Pre-Existing Conditions in Workers’ Comp Settlements
A person who is injured at work or who suffers an occupational disease may receive workers’ compensation. Even if they are more medically fragile than the general population, they may receive compensation.
While the pre-existing condition can impact the settlement, only a new or aggravated injury can be compensated. The original condition is not compensated.
Medical care is provided to return the person, as best as possible, to the pre-injury condition. In the case of comorbidity, this may mean that the person will not be fully healed from an underlying or unrelated condition.
Why is medical compensation for workers’ compensation limited to the aggravation of a pre-existing condition?
N.C.G.S. § 97-2(19) says that medical compensation in workers’ compensation is limited to what will cure, give relief to, or lessen a period of disability for a workplace injury. To the extent the person has a pre-existing comorbidity, that extent of an injury or condition is not a workplace injury. Only the worsening of the injury is covered.
Legal Challenges in Proving Claims With Comorbid Conditions
- Proving that the injury was made worse because of a workplace injury and not from another event
- Responding to questions of whether the condition was concealed at the time of hiring
- Challenging overly invasive requests for medical information
- Disputing what specific medical care should be covered
- Showing that the person suffered a complete loss of wage-earning capacity when the loss is partially based on comorbidity
Because comorbidities significantly increase the cost of a typical claim, coverage may be more likely to be contested on all issues.
Evaluating suitable work
Comorbidities may impact whether there is suitable work available. A legal challenge in proving a claim with comorbid conditions may be responding to whether the person should be able to work. The ability to work is specific to the person and any medical conditions that they may have, regardless of whether or not those conditions are from the workplace injury (N.C.G.S. § 97-2(22)).
Willful misrepresentation of a pre-existing condition
Another question that may arise is willful misrepresentation during the job application. At the time of hiring, an employee must be truthful in representing their physical condition. If they willfully make a false representation to get hired, it may prevent them from receiving workers’ compensation.
The employer must have relied on the false representation. It must have been a substantial factor in hiring. There must be a causal connection between the false representation and the injury (N.C.G.S. § 97-12.1).
What if the injured person was more vulnerable because of their comorbidity? Can that be held against them?
No. There are previous North Carolina workers’ compensation cases that say an employer takes their employees as they find them (Mabe v. North Carolina Granite Corporation, 15 N.C. App. 253 (1972)). Even though the person may have been more vulnerable to injury than others, employer liability still extends to the full extent that the injury is the result of work.
Workers’ Comp Outcomes for Claimants with Comorbid Conditions
Building a strong case when a comorbid condition is involved can help a claimant achieve the desired outcome. A claim will likely rely on significant medical evidence. A person can have a lawyer represent them in the claims process, addressing medical information, other facts, legal arguments, and procedures that are important to the case.
Contact an Experienced Gastonia Workers’ Compensation Lawyer
Horton & Mendez Injury Attorneys handles workers’ compensation claims involving comorbid conditions. If you’ve been hurt at work, a lawyer may assist you. Contact an experienced Gastonia workers’ compensation lawyer today.
