Workers’ Compensation Win! Getting Osteoarthritis Accepted on the Claim.
Our client is a hard-working massage therapist who took a nasty tumble at work. L&I opened her claim for a strained knee, the initial diagnosis from the urgent care doctor. When things did not improve, it became clear that there were other issues. Her doctor referred her to a surgeon; she was diagnosed with a torn meniscus and traumatic knee osteoarthritis with the recommendation that a total knee replacement was necessary.
L&I tried to dodge paying for such a high-dollar treatment and sent our client to two so-called independent medical exams (IME). Both IME doctors said her osteoarthritis was pre-existing and unrelated to her fall. That’s when she came to us for help.
After reviewing her medical records, it was clear our client must have had osteoarthritis prior to the fall because it appeared on her first MRI, which was only weeks after her injury. It could not have developed that rapidly; it must have been present at the time of the fall. It was also clear from her medical records that she had no pain or symptoms in her knee prior to her fall. She was working hard and was very physically active helping friends cut down trees and remodel homes. She was able to lift sheet rock unassisted, climb ladders, haul material, etc.
We appealed the denial order to the Board of Industrial Insurance Appeals.
The law outlining when L&I must accept responsibility for pre-existing conditions is very clear. People can have pre-existing conditions such as osteoarthritis and not be aware because it doesn’t bother them or they don’t experience pain. Oftentimes something like a fall at work can worsen the condition and cause it to become painful. When that occurs, L&I has must accept responsibility for the full scope of the condition and pay for all related treatment.
While we agreed with the IME doctors that the osteoarthritis was pre-existing, we argued that L&I had to accept full responsibility because she had no pain before the work fall, but it had worsened afterwards and required surgery.
The Board of Industrial Insurance Appeals Board judge agreed with us and our doctor and found the IME doctor less credible. He ordered L&I to accept full responsibility for her knee osteoarthritis.
We forced L&I to add knee osteoarthritis as an accepted condition on our client’s claim, allowing her to get a much-needed knee replacement. Now, she can get the surgery she needs to get her back to working full time again and enjoying life!