Workers’ Compensation Claim Denied Preexisting Condition

Written by Adian Martin on . Posted in Posts: Workers' Compensation

     Your Oregon Workers' Compensation claim may be denied for different reasons. Often, SAIF and other insurance companies may say your work injury has combined with a preexisting condition. This is a common reason for claim denials.

     Let's look at an example:  A middle-aged construction worker in Portland, OR, had an on-the-job low back injury when he fell down a flight of stairs.  Aside for some soreness, he never had any real low back pain before.  After the low back injury, he had severe back pain which shot down the back of his right leg.  It felt like burning pins and needles. He could not work anymore and needed help.  

     He went to a Portland ER, and was referred to an occupational medicine specialist. An MRI was done and it showed a herniated disc.   A workers' compensation claim for       portlandspinemri

the herniated disc was filed.  After he filed his claim, SAIF sent him to a medical exam with one of their IME doctors.   Weeks later, SAIF sent a claim denial.   The worker called Ransom, Gilbertson, Martin and Ratliff and we requested a hearing about the claim denial.

     In such cases, SAIF and other insurers must prove to the workers' compensation judge that there was a preexisting condition.  There are two types of preexisting conditions:  1) a condition that has been medically treated before the work injury, or 2) arthritis.  If a preexisting condition is proven, SAIF or the insurer must next prove the preexisting condition was the major cause of the disability or need for medical treatment after the work injury.  

     Workers' compensation judges look closely at the medical opinions given by IME doctors, and it is very important that your own doctor write a report for the judge explaining why your work injury is the major cause of your disability or need for treatment.  Ransom, Gilbertson, Martin and Ratliff can help you prepare for your hearing with the judge on your denied claim.  

    We fought the construction worker's case all  the way to the Oregon Court of Appeals, and he finally won.   As the Oreogn Workers' Compensation Board decsion in that case shows, you need an experienced lawyer in this type of case.     http://www.cbs.state.or.us/external/wcb/2007/remand/dec/0306069a.pdf