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Three Pre-existing Conditions and Workplace Injuries

How to distinguish between pre-existing conditions and workplace injuries?
 Dr. Dave says, with an aging workforce, distinguishing between pre-existing injuries due to aging and a workplace injury is becoming more important. It is very important to get the worker’s medical records prior to the occurrence of the workplace injury, even if you have to get these records from more than one source. Earlier records are very helpful in establishing a baseline for comparison such as with an MRI.
Once an injury occurs, look to see if there has been a pain free interval, suggesting the current pain is the progression of underlying disease and not due to the specific workplace event. Is it also helpful to obtain functional capacity tests?
Degenerative Arthritis, a.k.a, Degenerative Disc Disease: The single most frequent consideration with back pain is what is often called degenerative arthritis or degenerative disc disease. The presences of signs these “diseases” does not necessarily mean there is disease. Frequently, degenerative disease is just a sign of aging -- like wrinkles and gray hair! A worker may have x-rays full of bony spurs and narrowing of the discs with no back pain whatsoever. Similarly, a back x-ray can be normal but the person suffers from accompanying pain. This is why x-rays of the back as a screening tool were abandoned many years ago. One of the most frequently overlooked considerations is spinal stenosis.
Spinal stenosis never occurs from an acute injury but develops over many years and is rarely affected by a new injury. Look in the injured employee’s medical history for a significant pain free interval after the injury, strongly suggesting the back injury has returned to baseline and the ongoing pain is the natural progression of the underlying disease.
Back and Knee Injuries:  When reviewing an injured person’s  medical records look for a lack of correlation between what the x-ray looks like and extent of disease. Misunderstandings about the significance of bulging discs, etc. are very important.
If your medical director is not looking for these pre-existing conditions at the time of a workplace injury, put a policy into place requiring him/her to do so.
Have a medical question? email  MD@WorkersCompKit.com.  We have four highly qualified medical doctors with whom we have had an independent contractor relationship for many years. They are available for consulting projects or review of a specific claim.
Workers Comp KIt® (www.ReduceYourWorkersComp.com) is a web-based online Assessment, Benchmarking and Cost Containment system for employers. It provides all the materials needed to reduce your costs significantly in 85% less time than if you designed a program from scratch.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment

 ©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.

About the Author

David Dubin, MD. is an emergency room physician who serves as a medical advisor for several companies. Formerly president of Aon Medical Consultants, he has been helping employers and insurance companies develop innovative cost containment programs and reduce workers comp costs for over 20 years. He can be reached at: MD@WorkersCompKit.com or 860-553-6604.

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