How Pre-Existing Injuries Are Considered in Back Injury Claims
Back or spinal injuries are among the most common workplace injuries, often leading to workers’ compensation claims in Queensland. However, if you have a pre-existing back condition, you might wonder how it will impact your claim. This article explores how doctors evaluate pre-existing injuries, what role they play in compensation claims, and the key legal principles involved.
Understanding Pre-Existing Conditions
A pre-existing condition refers to any medical issue you had before the workplace injury occurred. Common examples include:
- Degenerative disc disease
- Chronic back pain
- Previous spinal injuries such as disc bulges
How Doctors Assess Pre-Existing Back Injuries
1) Baseline Assessment
Doctors will evaluate the state of your back prior to the workplace incident. This involves reviewing:
- Medical history
- Imaging studies (e.g., X-rays, MRIs)
- Previous treatments or surgeries
2) Determining Aggravation
The critical issue for determination of a statutory claim is whether the workplace injury aggravated your pre-existing condition. Under the Workers’ Compensation and Rehabilitation Act 2003, aggravation is defined as a material worsening of the condition due to work-related factors. Doctors assess:
- Changes in symptoms (e.g., increased pain or reduced mobility)
- Objective evidence of worsening (e.g., new imaging findings)
- The timeline of symptom onset following the workplace incident
- The circumstances of the accident causing any alleged aggravation
3) Applying GEPI Guidelines
Doctors use the Guides to the Evaluation of Permanent Impairment (GEPI) to assess the degree of impairment caused by the injury, considering both the pre-existing condition and the workplace incident. The guidelines help quantify the percentage of impairment attributable to work.
Legal Considerations for Pre-Existing Conditions
1) Apportionment of Damages
In cases where a workplace injury aggravates a pre-existing condition, damages are only payable to the extent they are suffered because of the aggravation. This means that only the damages suffered because of the new injury will be compensable. For example:
- If a worker had pre-existing degeneration in their lumbar spine, and they suffered an aggravation. If a Court found the pre-existing degeneration was not going to impact their ability to work, then there should be little if any discount for future economic loss.
- If a worker had a pre-existing injury, and in the absence of the aggravation, the worker would have only continued to work for 10 years, then only the first 10 years would be compensable.
How Apportionment Works in Practice
Apportionment relies heavily on medical evidence to determine the contribution of the workplace incident versus the pre-existing condition. Doctors and independent medical examiners assess factors such as:
- The severity of the pre-existing condition before the injury.
- Changes in function or symptoms directly following the workplace incident.
- Objective findings from imaging or diagnostic tests.
Courts consider the following when deciding on apportionment:
- Whether the injury caused a distinct and material aggravation.
- The percentage of impairment attributable to the workplace injury versus the pre-existing condition.
- Whether the aggravation can be separated from the natural progression of the pre-existing condition.
Key Case Law
Watts v Rake (1960)
This High Court case established that defendants (or insurers) bear the burden of proving the extent to which a pre-existing condition contributes to the overall impairment. The decision reinforced that any doubt should be resolved in favour of the injured worker.
Kooragang Cement Pty Ltd v Bates (1994)
The court held that employers are liable for the aggravation of pre-existing conditions, even if the worker had a prior vulnerability. This case emphasised that the workplace injury does not need to be the sole cause of impairment, only a contributing factor.
Mitchell v WorkCover Qld (2015)
This case highlighted the importance of medical evidence in determining whether the workplace injury materially worsened a pre-existing condition. The court found in favour of the worker, ruling that the employer could not sufficiently prove that the symptoms were unrelated to the work incident.
Bailey v State of NSW (1986)
The court established that where an injury aggravates a pre-existing condition, the employer remains liable for the full extent of the injury unless the aggravation can be clearly separated and quantified. This case is often cited in disputes over apportionment.
2) Section 571 of the Workers’ Compensation and Rehabilitation Act 2003
Section 571 outlines the requirements for aggravation claims involving pre-existing conditions. It establishes that:
- Compensation is payable only for the portion of the injury related to the aggravation caused by work.
- Medical evidence must clearly identify the extent of the aggravation versus the underlying condition.
- Workers must disclose pre-existing injuries or medical conditions to their employer in certain circumstances, such as when applying for employment.
- Failure to do so can limit or exclude their ability to claim workers’ compensation for an injury or condition related to that undisclosed pre-existing condition.
3) Section 572 of the Workers’ Compensation and Rehabilitation Act 2003
Section 572 further reinforces this by outlining the employer’s ability to request a worker to disclose pre-existing conditions that could reasonably be aggravated by the nature of the proposed employment. If a worker fails to disclose such information after a valid request, they may lose their right to claim compensation for any resulting aggravation of the undisclosed condition.
4) “Eggshell Skull” Rule
Under this legal doctrine, an employer must take a worker as they find them. This means that even if a worker’s pre-existing condition made them more susceptible to injury, the employer is still liable for the full extent of the work-related aggravation.
Challenges in Claims Involving Pre-Existing Conditions
1) Proving Aggravation
The onus is on the worker to demonstrate that their employment materially contributed to the worsening of their condition. Medical evidence, such as reports from independent medical examinations (IMEs), plays a critical role.
2) Insurer Disputes
Insurers may argue that symptoms are solely due to the pre-existing condition rather than the workplace injury. Having a workers’ compensation lawyer can help counter such claims.
How Warming Compensation Lawyers Can Help
At Warming Compensation Lawyers, we understand the complexities of claims involving pre-existing back injuries. Here’s how we can assist:
- Gathering Medical Evidence: We work with leading medical experts to establish a clear connection between your workplace injury and the aggravation of your condition.
- Advocating for Fair Compensation: Our team ensures insurers don’t unfairly attribute your symptoms to pre-existing conditions.
- Navigating Legal Complexities: From lodging your claim to representing you in disputes, we provide expert guidance every step of the way.
If you’ve suffered a back injury at work and have a pre-existing condition, don’t let insurers minimise your claim. Contact Warming Compensation Lawyers for a free consultation. Let us help you secure the compensation you deserve.
