Often, injured workers in Pennsylvania have their claims denied by the workers’ comp insurance carrier because their disability is said to be related to a “degenerative” condition, rather than a traumatic one. In fact, almost inevitably, if the word “degenerative” appears in the medical records, the workers’ compensation claim will be denied by the workers’ comp insurance company, forcing the injured worker to litigate his or her claim.
Yet, these degenerative conditions are ones that allowed the injured worker to do his or her job, frequently even without difficulty, until the work injury. The fact that the work injury makes the degenerative changes disabling is what truly matters. In that situation, the injured worker is entitled to PA workers’ compensation benefits.
Recently, the Commonwealth Court of Pennsylvania confirmed this premise in Green v. Workers’ Compensation Appeal Board (US Airways). The case began when Ms. Green was injured at work in 1993. A Notice of Compensation Payable (NCP) was issued, accepting the injury as a meniscal tear in the right knee. The description of injury was later amended to include left tibial plateau cartilage damage and lateral femoral condyle defect. Workers’ compensation benefits were suspended in 2003.
In 2008, Ms. Green filed a Petition for Reinstatement, alleging that the work injury again caused her to be disabled. A deposition was taken of her medical expert, who essentially testified that the work injury triggered degenerative changes, which progressively made the condition worse. The workers’ compensation insurance carrier did not put on any medical evidence. This Petition was denied by the Workers’ Compensation Judge (WCJ), who found that Ms. Green failed to prove her case. Specifically, the WCJ found Ms. Green’s medical expert credible, but not persuasive. The only reason given by the WCJ for not accepting the testimony of her medical expert is that the doctor “characterized Claimant’s injuries as degenerative in nature.”
On appeal, the Workers’ Compensation Appeal Board (WCAB) affirmed this decision. The WCAB noted that the WCJ did not find the testimony of Ms. Green’s medical expert to be credible.
The Commonwealth Court of PA, however, vacated the decision and remanded to the WCJ for further findings. Initially, the Court observed that the WCAB made an error in saying the WCJ found the medical expert’s opinion not credible – the WCJ actually found the opinion credible, but not persuasive and there is a difference. Further, the WCJ erred in finding the opinion unpersuasive, since the opinion of the medical expert clearly was that the work injury started the chain of events, leading to the disability. Thus, any finding by the WCJ, based on the medical testimony, that the disability was related solely to degenerative changes, is not supported by the evidence. In analyzing the case, the Court made clear to observe that just because a condition is degenerative does not mean the cause of the disability is the same; in fact, often, as here, the work injury “aggravates” or “accelerates” the degenerative condition, making that condition disabling.
This case demonstrates that injured workers must not simply accept a denial from a workers’ comp insurance company, simply because degenerative changes have been mentioned. There still very well may be a valid PA workers’ compensation case, and the injured worker may still be entitled to workers’ comp benefits.