What Is Medical Causation and Why Does It Matter in an Alabama Workers Compensation Claim?

What Is Medical Causation and Why Does It Matter in an Alabama Workers Compensation Claim?

Many injured workers believe that if they are hurt at work, they automatically qualify for workers’ compensation benefits.  Unfortunately, workers’ compensation claims are often more complicated than that.

One of the most important issues in almost every disputed workers’ compensation case is something known as medical causation. Simply put, medical causation is the legal and medical question of whether the workplace accident actually caused, contributed to, or worsened the condition for which benefits are being sought.  Understanding medical causation can help injured workers better understand why some claims are approved while others are denied.

What Is Medical Causation?

Medical causation refers to the connection between a workplace accident and the injury or medical condition being claimed. In many cases, causation is obvious; for example: a worker falls from a ladder and breaks a leg, a machine crushes a worker’s hand, or a worker is struck by a falling object and suffers a shoulder injury.  In these situations, there is usually little dispute that the accident caused the injury; however, many workers’ compensation cases are not so straightforward.

One of the most common reasons a claim is denied is because the employer or workers’ compensation carrier argues that the injury was not caused by work; rather, the insurance carrier may argue that the worker’s current symptoms are the result of a condition that was preexisting rather than the workplace accident.  This is one of the most misunderstood-and misrepresented- areas of Alabama workers’ compensation law. Many injured workers are told that their workers’ compensation claim is being denied because: “Your MRI shows arthritis,” or “You had a prior back injury.”

Some workers assume that means they have no claim, but that is often incorrect.

Under Alabama law, a worker does not have to be in perfect health before suffering a workplace injury.  If a worker has a preexisting condition that was not preventing them from performing their job and a workplace accident aggravates, accelerates, or worsens that condition, workers’ compensation benefits may still be owed.

The important question is often not whether the condition existed before the accident; the important question is: Did the work injury contribute to the worker’s current disability or need for treatment?

Why Isn’t My MRI Result Enough?

This is another common misunderstanding.  Many injured workers believe that diagnostic tests such as an MRI automatically proves their case, but MRI findings can often raise additional questions.

For example:

• Disc bulges
• Disc herniations
• Arthritis
• Degenerative changes

may exist in people who have no symptoms at all.  The fact is, many of us walk around with these conditions without knowing it as they are asymptomatic.  As a result, the dispute often becomes whether the workplace accident caused the condition, aggravated it, or merely revealed an underlying problem that already existed, and causation has to still be established.

What Does a Failed Drug Test Have to Do With Causation?

Many workers assume that testing positive for drugs after an accident automatically destroys a workers’ compensation claim. That is not necessarily true, the real issue is causation-not simply whether drugs were present. The question is whether intoxication caused or contributed to the accident.  Consider the following example we used in oral argument before the Court in a case years ago.  Our client had suffered a work-related injury, and in the post-accident drug test-our client tested positive for marijuana, and the workers’ compensation carrier denied liability.  We filed suit, and the defendant filed a Motion to Dismiss due to our client failing their post injury drug screen.  During oral argument, we asked the judge to consider a hypothetical.

Assume a worker is injured when the steel beam they are standing on breaks in two, causing him to fall 10 feet and suffer an injury.  In the hospital, the worker tests positive for marijuana after a workplace accident.  What effect did marijuana have on the job accident and subsequent injury?

If the worker falls because they are impaired, causation may become a significant issue; however, if the worker is standing on a steel beam that suddenly breaks and collapses, causing injury, the presence of marijuana had nothing to do with why the accident occurred.  In that situation, the employer was unable establish a causal connection between the alleged injury and the accident itself, and our client received the medical care they needed.

A positive drug test does not automatically mean a worker loses their claim because causation still matters.

How Is Medical Causation Proven?

Medical causation is often established through a combination of medical records, physician opinions, diagnostic studies, witness testimony, accident reports and the worker’s own testimony.

Medical causation is one of the most important concepts in Alabama workers’ compensation law. The issue is not always whether an injured worker has a medical condition, but whether the workplace accident caused, contributed to, or worsened that condition.

At Powell and Denny, we have spent decades helping injured workers prove the connection between their workplace accidents and the benefits to which they are entitled under Alabama law.

If you have suffered a job injury and you have questions about your rights and benefits under Alabama’s workers compensation laws -don’t hesitate to contact and speak with one of the experienced Alabama Workers Compensation and Social Security Disability attorneys at Powell and Denny today for a free consultation. Appointments are available in person, or virtually via Zoom if more convenient.  Powell and Denny would appreciate the opportunity to help.  And remember, there is no fee unless you win.

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Offices in Birmingham and Huntsville, Alabama