An injured employee has the right to seek workers’ compensation benefits for a permanent disability. To obtain workers’ compensation benefits for permanent disability, a claimant must prove that he or she was hurt within the course and scope of employment. However, this is not always an “either/or” proposition. A pre-existing injury/condition could be a factor.
Recently, the California Workers’ Compensation Appeals Board (WCAB) issued an instructive decision that provides additional guidance for employers and insurers navigating a permanent disability claim involving a possible pre-existing condition. Here, our Sacramento workers’ compensation defense lawyer analyzes the WCAB opinion on the case involving a worker’s pre-existing condition.
Case Review: Cristina Jackson, Applicant v. FedEx Ground Package Systems, Inc.,
Background and Facts
The case of Cristina Jackson, Applicant v. FedEx Ground Package Systems, Inc., PSI, administered by Sedgwick Claims Management Services, Inc., involves an employee who was hurt on the job in 2015. There is no dispute that the employee (Ms. Jackson) sustained injuries to both her left knee and her right knee as a consequence of the industrial accident.
Further, there is no dispute that the worker (a package handler) had a significant disabling impairment that prevented her from returning to her position. However, there was a major dispute over the cause of permanent disability. The employee argued that it was work-related. The employer/insurer countered that only a small share was work-related.
The Legal Issue
Based on a review of the medical evidence provided by the parties, the Workers’ Compensation Judge (WCJ) ruled that the employee had a 21 percent permanent impairment due to her 2015 industrial accident. An additional 60 percent impairment was assigned to non-job-related factors (a pre-existing condition). The ruling was made primarily based on a medical assessment Qualified Medical Evaluator (QME). The worker appealed on the grounds that the QME’s assessment was not substantial evidence.
On appeal, the WCAB upheld the decision of the Workers’ Compensation Judge. It determined that the report provided by the QME met the statutory requirements of “substantial evidence” for the purposes of determining the cause of a permanent disability in a workers’ compensation claim. The WCAB affirmed that only 21 percent of the claimant’s permanent disability was work-related. The decision from the WCAB reaffirms the importance of a QME report. When there is a dispute over a purely medical issue—such as whether or not an employee’s pre-existing impairment contributed to their current disability—California courts will put a strong emphasis on these types of independent medical assessment.
Call Our Sacramento, CA Workers’ Comp Defense Lawyers for Immediate Help
At Yrulegui & Roberts, our Sacramento workers’ compensation defense attorneys are diligent and experienced advocates for employers, claim administrators, and insurers. If you have any specific questions about a claim involving pre-existing conditions, we can help. Contact our workers’ compensation defense team now to set up a fully private initial case review. Our firm provides workers’ compensation defense services in Sacramento, Fresno, Bakersfield, and communities throughout the area.