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What is a Combination Injury and How Does it Affect Eligibility for Benefits?

An employee can be injured on the job, and the injury may aggravate a pre-existing physical condition. This is called a combination injury.

The combination of physical problems may make it difficult or impossible for an employee to work. However, even when there may be no question that the new work injury made the old problem worse, the employee can still only receive benefits for the new injury that is directly related to work. x-ray-199078-m[1]

This is mandated by the Workers’ Compensation laws at Mass. G.L. ch 152 section 7 (A). This portion of the law provides that if an injury or disease that is eligible for compensation combines with a non-work-related injury or disease, even if the combination makes the work-related problem worse, the employee may only be compensated to the extent that the new problem is the major cause of the employee’s inability to work.

There are two important considerations that decide eligibility for benefits:

  1. Whether the pre-existing condition is also work-related. The pre-existing condition doesn’t have to result from the same work injury to be compensable, but if it isn’t work-related at all, even if the work injury aggravates it, it isn’t compensable.
  2. Whether the new injury is the major cause of the employee’s inability to work. If the old non-work-related illness or injury becomes so bad that the employee is incapable of working, even if this aggravation was caused by the new work injury, the employee is still only eligible for benefits if the new injury is the major cause of the employee’s inability to work.

For example, an employee who did maintenance for a car dealership argued that pain from a neck injury that occurred at work caused him to compensate by altering his body mechanics in such a way that his symptoms from an old back problem became much worse and also prevented him from working.

The employee worked as a salesperson and manager for a Chevrolet dealership. He maintained the grounds around the business, doing everything from planting flowers to snowplowing. His work as a sales manager involved frequent driving, bending, and overhead reaching.

In early January 2009 the employee was maneuvering a front-end loader to remove snow from the dealership’s lot. While climbing down from the machine, he slipped backwards and landed on the concrete surface of the lot. He sought treatment at a local emergency room and then returned to work.

However, his neck became so painful that within a few months he could not continue working. He applied for workers’ compensation benefits.

The examining physicians found him to be totally incapacitated, and the ALJ agreed, finding the employee’s testimony about his pain to be credible.

However, the ALJ couldn’t award the employee benefits for his back problem because it was not directly work-related. Even accepting that the employee’s neck injury ultimately caused his back problem to become worse, the ALJ under the law still could only award benefits for the neck injury.

The insurer appealed, arguing that the neck injury only merited an award of benefits for a partial incapacity to work, and the employee also appealed, contending that his back problem was also a compensable condition because it had become so much worse following his neck injury.

The Reviewing Board, in a decision issued in April 2014, disagreed with the insurer, finding that the medical opinions and the employee’s own testimony regarding his pain sufficiently supported the employee’s claim for total incapacity due to his neck injury. At the same time, the Board agreed with the ALJ that, although the symptoms from the back problem may have been aggravated by the work-related neck injury, the employee’s back problem was not caused by the employee’s work, and therefore his back problem was not compensable. The Reviewing Board affirmed the ALJ’s decision awarding total incapacity benefits.

So in this instance, despite the existence of a non-work-related pre-existing condition, the employee was still able to receive benefits for his work-related injury.

For more information about the workers’ compensation process, contact a Boston workers’ compensation attorney from Pulgini & Norton to schedule a free consultation to find out more about what our lawyers can accomplish for you. Contact us with a brief description of your situation or reach us by phone at our Downtown Boston, Hyde Park, or Braintree, Massachusetts office locations.

More Posts:

Pain Management and Workers’ Compensation, Massachusetts Workers’ Compensation Lawyer Blog, April 23, 2014

The Top Five Most Expensive Workers’ Compensation Claims, Massachusetts Workers’ Compensation Lawyer Blog, March 26, 2014

 

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