Causation determines who gets workers compensation benefits. In Wisconsin workers compensation benefits are paid in when an employee suffers an injury arising out of employment. Wis. Stats. Sec 102.01. The injury can be physical or mental, and can be caused by single traumatic accident or from job duties or occupational exposure over time. To qualify as a traumatic injury, a doctor must give an opinion that the work accident directly caused the injury. Many employees have pre-existing conditions which can be work-related. A traumatic accident can be the source of workers compensation benefits if the pre-existing condition was precipitated, aggravated and accelerated beyond normal progression by the incident. For an occupational condition or disease to be subject to workers compensation benefits, the employment job duties or environment must be either the sole cause of the condition, or at least a material contributory causative factor in the condition’s onset or progression?
With neck and back disc injuries, particularly where employees already have a pre-existing form of stenosis or degenerative disc disease, the insurance company denies that claim based on the pre-existing condition defense. A Wisconsin court case, Lewellyn v. Industrial Commission, 38 Wis. 2d 43 (1968) explains it this way:
1) If after the new work accident there is definite “breakage” such as a new bulge or herniation on an MRI, then workers comp should be paid regardless of whether or not there is a pre-existing condition or symptoms.
2) If after the new work accident there is no definite “breakage” but only a manifestation of a pre-existing condition then benefits should be denied.
3) If after the new work accident there is no definite “breakage” benefits should be paid if the accident precipitates, aggravates and accelerates the pre-existing condition beyond normal progression.
Many cases turn on the third category, and this is the question addressed in question 12 on the workers comp form WKC-16-B. This question of aggravation of a pre-existing condition only applies to traumatic accidents, not job duties over time.
Job duties over time resulting in a work-related condition are addressed differently. In question 13 on the 16B form, the issue is whether the job duties are the sole cause of the condition, or at least a material contributory causative factor in the condition’s onset or progression?
Its important to know that this causation can only be established by a medical, osteopathic or chiropractic doctor, or in the case of a mental injury, a psychologist or psychiatrist.
McCormick Law Office attorneys and paralegals review client’s records to see whether the case is a traumatic accident or job duties over time type of case. Then we ask the appropriate doctor because causation determines who gets workers compensation benefits.