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Court upholds denial of benefits to workers with pre-existing conditions



A divided West Virginia Supreme Court on Thursday upheld a denial of benefits to a health care worker for her back condition, finding that they did not arise out of a workplace accident but instead aggravated a pre-existing condition.

Donna J. Carter was working for Davis Health System when she injured her back in December 2019 while moving patients. A “consistent” medical history of sciatica with an increased level of back pain dating back to 2017 was part of her records, according to Carter v. Davis Health System.

Her doctor stated that she injured her back due to a muscle tear from pulling and lifting and that her condition was a direct result of a work injury, noting that it aggravated a previous injury. Another doctor reported that Ms. Carter̵

7;s latest symptoms began after moving patients to the operating room while she was at work and she needed surgery.

A claims administrator for the health system’s insurance company denied Carter’s claim, stating that medical records pointed. to a pre-existing condition.

The judge’s office determined the rejection of Ms. Carter’s claim, and the review board upheld.

The West Virginia Supreme Court agreed with the lower rulings, stating that under state law, a non-compensable, pre-existing injury may not be added as a compensable component of a worker’s compensation medical benefits claim merely because it may have been aggravated by a compensable injury . damage.

A dissenting judge wrote that the case “gives us an opportunity to correct a structural flaw in our workers’ compensation review procedures: an age-related bias against workers like the petitioner, who are far more likely to develop degenerative musculoskeletal conditions after a lifetime of manual labor.”

WorkCompCentral is a sister magazine to Business Insurance. More stories here.


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