If you have a pre-existing condition, can you get workers’ comp benefits?
Yes, you can.
In the recent Illinois case of Sandra Johnson-Clemons v. Rush University Medical Center, this issue was raised. As in many cases, the specific evidence offered was key to the recovery of benefits.
Here are some facts from this case:
- Sandra originally worked in a customer service job at Rush that was “not at all physical,” until around April 2014, where she became a full time worker and had to do more work, such as clean offices, dust, vacuum, and take out garbage.
- July 24, 2014: She reported that she lifted a half full bag of recycle paper from a bin. She did not feel pain at the time of this action, but later experienced muscle spasms at 3:00 am.
- August 4, 2014: She saw a doctor at Rush, and reported problems with her left lower back, left quad, and left iliac crest (hip bone area.) She was prescribed physical therapy.
- September 15, 2014: She saw another doctor at University of Chicago, who noted that an MRI showed L4-L5 degenerative spondylolisthesis and spinal stenosis. It was noted that these problems were likely present before the work accident, “but the twisting motion ‘may’ have irritated the nerve roots,” which was causing her radiculopathy. He recommended an epidural injection.
- October 31, 2014: Workers’ comp insurance sent her to an IME, or independent medical exam. He noted that records indicated she had symptoms two weeks prior to the work accident, and claimed that, “at most, her condition was a temporary exacerbation of a pre-existing already symptomatic condition that was not aggravated or accelerated beyond its normal progression.” He noted that she only needed physical therapy, and was at MMI (maximum medical improvement), in his opinion, for any part of her condition that might be related to the work incident.
- November 5, 2014: She had an injection with her treating doctor.
- December 17, 2014: She followed up with her doctor, and reported great improvement in her low back and left leg. Records show that she reported 100 % relief of lower back and radicular pain. Later, when the case was at trial, she would claim that when she had told doctors she was 100 percent, she only meant her leg pains were 100 percent, and not her back, which she reported as still giving her problems.
In the end:
- First, the arbitrator ruled against the injured worker, and said that she lacked credibility, and that she failed to prove a work accident.
- The Commission later reversed the arbitrator’s findings, and awarded benefits to the injured worker. However, they ruled that this accident caused a “temporary aggravation of her pre-existing condition, and that she reached MMI as of December 17, 2014.” In other words, she was owed workers’ comp benefits roughly only for the period from the accident date through to December of 2014. Their examination of medical records brought them to the conclusion that her condition after that point was not related to the work accident.
- It appears that the point in the medical records where she reported she was 100 percent was what cost her from receiving more benefits for her case. It is absolutely crucial that an injured worker be 100 percent clear with his or her doctors, as in the end, what is in the medical records can be the turning point in the total value of any workers’ compensation case.
The main point: Even a temporary aggravation of a pre-existing condition can result in an award of workers’ comp benefits, as it did in this case.
Illinois Workers’ Compensation Commission, Independent Medical Exam (IME), Maximum Medical Improvement (MMI), Pre-Existing Condition
