Workers' Compensation Claim Denied Due to Arthritis in Baldwin County, Alabama

Injuries on the job are inevitable. The Workers’ Compensation Act was created to help rehabilitate and compensate workers injured on the job. However, that is not always the case; workers’ compensation isn’t always executed in a timely manner. The Workers’ Compensation Act has proven to be a very difficult and convoluted process that contains many barriers for workers to overcome in order to receive benefits.

Under Alabama law, the employer must prove that the injury was caused by a work-related accident which is much easier said than done. In some instances, you may already have a current injury; these injuries are referred to as “preexisting problems.” For example, you have suffered from back problems your whole life and while at the job you slip and fall and hurt your back while working on the job.

After said accident, your injury worsened and became severely aggravated. Despite the pain you may be in, some workers’ compensation insurance carriers would see this an opportunity to dismiss the claim or refuse to pay for additional treatment. Typically, these types of issues arise in claims that involve arthritis issues.

The above scenario is illustrated in a workers’ compensation case that arose out of Baldwin County, Alabama in the case of Smith v. Brett/Robinson Construction Company, Inc. Here, the employee, hereinafter referred to as “Smith,” slipped and fell at work and injured her left knee in 2013. This injury required Smith to have arthroscopic surgery six weeks after her accident. Following the surgery, Smith complained that her pain worsened, and she requested a new treating physician.

The new doctor, hereinafter referred to as “Dr. McGowin,” examined Smith and noted that her main symptoms seem to be from arthritis that preexisted the fall. Specifically, Dr. McGowin noted that he did not believe the arthritis was caused by the injury and stated that the injury may have aggravated it.

By January 2014, Dr. McGowin determined that Smith was at maximum medical improvement and released her to return to work. Still complaining of the pain, Smith returned to Dr. McGowin again in March 2015. Dr. McGowin informed Smith that there was limited benefit to considering surgery and didn’t recommend pursuing such. Following the doctor’s visit, the workers’ compensation insurer for Smith’s employer refused to pay for additional treatment and Smith filed suit.

The Court of Civil Appeals affirmed the trial court’s decision and stated that the trial court had sufficient evidence to support their ruling. The appellate court rejected Smith’s reliance on Dr. McGowin’s note that stated Smith’s symptoms may have been the result of an injury and caused aggravation of the pre-existing arthritis. Specifically, the appellate court held that the evidence presented by a workers’ compensation claimant must be more evidence than mere possibilities. Hammons v. Roses Stores, Inc., 547 So. 2d 883 (Ala. Civ. App. 1989). Here, the appellate court determined that Doctor McGowin was of the opinion that Smith’s current problems were caused by preexisting arthritis.

Even though the above mention case did not end favorably for the employee, it is important to remember that just because you receive a letter denying your workers’ compensation claim that it is not the end of the road for you. If you have had prior health conditions, you may still be entitled to benefits.

If you have been hurt on the job or have been denied a workers’ compensation claim, please contact experienced workers’ compensationattorney Joseph A. Ingram at Ingram Law LLC at (205) 236-3997.

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