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Court Applies “Major Cause” To Worker’s Need For Treatment

A decision which will affect the nature of opinions sought from doctors in workers’ compensation cases was handed down by the Oregon Court Of Appeals in May1997. This is of special interest to our readers in light of our recent series of articles on “preexisting conditions.” Doctors treating injured workers with preexisting conditions will now be asked to state whether the injury was the major cause (51% was or more) of the need for treatment, rather than the major cause of the “combined condition.”

 

The case (SAIF v. Nehl) involved a low back injury to a probation officer after a series of encounters (both physically strenuous and intense) with a mental health patient. Prior to these work incidents, the worker had had two microdiscectomies for herniation at L3-4, followed by ongoing low back and left leg symptoms attributed to these and spondylolysis of L5, finally resulting in a fusion from L3 to the sacrum, with Steffe plates screwed to the spine.

The worker had returned to work after surgery and experienced continuous low back and left leg pain, for which physical therapy was prescribed and x-rays were taken just two days before the work injury. Following the encounters with the patient (which involved squatting, attempting to help the patient to her feet and tension) the worker experienced different and more intense pains in his low back. X-rays taken about a month later showed loss of bone around the screws in L-3.

The law1 says that when a work injury combines with a preexisting condition, the (resulting) “combined condition” is only compensable if the new work injury is “the major contributing cause of the disability of the combined condition or the major contributing cause of the need for treatment of the combined condition.”

Note that the loosened screws and loss of hone around L-3 concerned only a very limited part of the worker’s total ” combined condition.”

The Board stated that the focus of the statute was on the specific immediate need for treatment. If the major cause for this need for treatment was the work injury, the treatment should be compensable – even if the injury was not the major cause of the entire condition.

The Court of Appeals agreed with the Board and pointed out that words of the statute (emphasized above) provide that the on-the-job injury must be the major contributing cause of the need for treatment, not the major cause of the combined condition. (The underlined words were emphasized by the Court). The Court also noted that the claimed treatment is being directed at a very specific and limited part of the “combined, condition.” The Court concluded, “… regardless of the extent of claimant’s underlying condition, if claimant’s work injury, when weighed against his pre-existing condition, was the major cause of claimant’s need for treatment, the combined condition is compensable.” (SAIF v. Nehl, modified opinion, July 1997.)

As you will recall from our articles in Volumes 3 and 5, the Workers’ Compensation Act defines “preexisting condition” in a unique way which may differ from the use of this expression in medical parlance.

This decision corrects the confusion which formerly existed over whether the injury had to be the major cause of the combined condition or of the need for treatment of the combined condition. We believe this decision property applies what the statute says and enables injured workers to receive compensation where it is due. It also provides that medical services will he paid for by the Worker’s Compensation Carrier, when the need for treatment is caused by work.

This decision appropriately holds comp insurers responsible for the results of work incidents. At the same time, it recognizes they should not be responsible for treatment resulting from preexisting conditions which are unrelated to work.

1 The Workers’ Compensation Act, as revised in 1995.

This article was prepared by Robert F. Webber.

Posted in: Workers' Compensation Lawyer Articles