Aggravations of Pre-Existing Conditions
Louisiana workers compensation generally covers aggravations of pre-existing conditions. Louisiana law also covers whenever the employee's work accelerates the injury.
Specifically, Louisiana workers compensation courts have ruled that "an otherwise healthy employee with a pre-existing condition is entitled to benefits if she can prove that her work contributed to, aggravated, or accelerated her injury."
But going even further, Louisiana courts have found that workers compensation will cover any work-related injury "which is more than a gradual deterioration or progressive degeneration."
So, the general rule is that an employee's pre-existing disease or condition does not disqualify a claim, if the work-related injury aggravated, accelerated, or combined with the disease or condition to produce the disability for which compensation is claimed. In essence, the employer takes his employees as he finds them, and cannot deny a workers compensation claim based on pre-existing conditions.
Were There Symptoms Before the Accident?
Therefore, in a Louisiana workers compensation pre-existing condition aggravation case, the critical factors to look for are:
- Whether the condition was asymptomatic prior to the alleged incident;
- The sudden onset of symptoms; and
- The ability to identify some instigating incident at or during work.
And also, in workers compensation cases, a disability is presumed to be the result of a work-related accident if, before the accident, the injured person was in good health, but beginning with the accident the symptoms of the disability appear and continue.
But there should be medical evidence to show a reasonable possibility of a causal connection between the accident and the disability, or that the nature of the accident, when combined with other facts of the situation, appears to show a causal connection.
The phrase 'causal connection' means simply that one thing caused another thing.
So the bottom line of all this is: if an employee had preexisting back problems but no symptoms prior to his or her work-related accident, then that employee's back injuries should be covered under Louisiana workers compensation.
The Abnormally Susceptible Employee
Louisiana workers compensation courts have firmly ruled that "the employer must take the worker as he finds him." This simply means the worker who is abnormally susceptible - or predisposed - to disability is nevertheless entitled to full workers compensation benefits, even though the same accident would have caused little or no harm to a healthy worker.
It does not matter that a pre-existing disease or weakened condition might alone have eventually produced an employee's disability or death. Simply put, Louisiana workers compensation courts will not take into consideration the health deficiencies of an employee.
There are three main ways in which an employee may be abnormally susceptible or predisposed to disability. Specifically, the employee may have:
- Pre-existing conditions that produce accidents;
- Pre-existing conditions that produce disabling consequences; or
- Pre-existing conditions that delay or prevent an employee's normal recovery.
Pre-existing Conditions that Produce Accidents
First, a pre-existing condition may help cause the actual injury by an accident to an employee, when such an accident would not have happened if the worker did not have the preexisting condition.
A typical example of this kind of case is the worker with some form of heart disease which renders the employee susceptible to a heart attack. This employee may be so vulnerable that a very slight strain or exertion could cause a heart attack.
Nevertheless, this employee is fully protected and covered under Louisiana workers compensation for such a heart attack.
Such a heart attack will be treated as the “accident” which disables the employee, even though another employee without such a pre-existing disease would not have suffered a heart attack.
Other typical cases in which a preexisting deficiency has made an employee peculiarly susceptible to an accident are those cases that involve hernias.
Pre-existing Conditions that Produce Disabling Consequences
Second, a pre-existing condition can make the consequences of an accident disabling, even when this pre-existing condition does not make the employee susceptible to an accident or help cause the accident.
The typical example is an employee whose injury by accident aggravates a pre-existing arthritic or diabetic condition, and the consequences of that disease—now aggravated—cause the employee to be disabled.
Often these cases involve relatively minor accidents that produce disabling consequences in the injured employee because of a pre-existing disease or condition, when those same consequences would not be produced in a healthy worker.
In such cases, it will normally be held that an employee disabled by accident is not to be denied workers compensation merely because the employee was had a pre-existing condition that might have brought about the disability.
By far, the two most frequent pre-existing conditions (that make the consequences of an accident disabling) are arthritic conditions and various back ailments. And often these two pre-existing conditions are presented together.
Many of these back ailments involve the specific conditions of spondylosis or spondylolisthesis. Sometimes the treatment of and operation on the affected area in the back or neck can activate the disease in another disc or back area. But, of course, it must be shown that a congenital back ailment was in fact aggravated by an accident, or recovery will be denied.
Louisiana workers compensation courts have also approved workers compensation awards in situations in which the preexisting deficiency was arteriosclerosis, cancer, diabetes, hypertension, osteoporosis, various kidney ailments, syphilis, multiple sclerosis, tuberculosis, prostatitis, obesity, severe asthma, arthritis, uterine prolapse, epilepsy, pyorrhea, and others. Many of these cases involved rather serious trauma, but some of them involve relatively minor injuries with disastrous consequences for the employee with pre-existing conditions.
Also, often the pre-existing condition is not even a disease but a condition resulting from a previous injury. For example, employees have been granted workers compensation benefits for a disability produced by an employment-related accidental injury which combined with an old war injury to a leg, or an old back injury, or a prior knee injury, or a lingering traumatic neurosis from a previous accident.
The Disability Presumption and the Malingering (or Faking) Defense
Louisiana workers compensation courts have noted that it can be difficult to distinguish between the hard-working employee who was never previously bothered by his preexisting condition, but who now finds himself unable to return to work because of it; and the malingering - or faking or exaggerating - employee who, now aware of a preexisting condition previously unknown to him, has no great interest in returning to his employment.
Fortunately, the benefit of the doubt is usually given to the employee in such cases.
Louisiana workers compensation courts have maintained the following presumption in such matters which is of substantial assistance to the employee:
"An employee's disability is presumed to have resulted from an accident, if before the accident the injured employee was in good health, but starting with the accident the symptoms of the disability appear and continue afterward, so long as the medical evidence shows that there is a reasonable possibility that the accident caused the disability."
In other words, if the employee had no symptoms before the accident, but had symptoms after the accident, then it is presumed that the accident caused the injury. Despite this presumption, each case must be decided on its own facts, and the employer retains the right to overcome this presumption and prove, if he can, that the accident was not the cause of the employee's disability.
Pre-existing Conditions that Delay or Prevent Recovery
Third, a pre-existing condition may delay or slow down an employee's recovery, and thus prolong the employee's period of disability. The recovery of an employee without such a pre-existing condition would be much quicker, and this of course would have an effect on the amount of benefits actually paid to such employees.
Arthritis very frequently has this effect of prolonging the employee's disability. Other degenerative diseases and obesity may also prolong recovery.
But under Louisiana law, such pre-existing conditions do not matter, and the employee may recover up to the maximum allowed for the disability.