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Court upholds denial of benefits for worker with preexisting conditions

Posted On: Jan. 24, 2023 10:11 AM CST

WV supreme court

A divided West Virginia Supreme Court on Thursday upheld a denial of benefits to a health care worker for her back conditions, finding they had not arisen out of a workplace accident but instead aggravated a preexisting 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 medical records, according to Carter v. Davis Health System.

Her physician stated that she injured her back due to a muscle strain from pulling and lifting and that her condition was a direct result of an occupational injury, noting that it aggravated a prior injury. Another doctor reported that Ms. Carter's most recent symptoms began after moving patients in the operating room while at work and that she needed surgery.

A claims administrator for the health system’s insurance carrier denied Ms. Carter’s claim, stating that medical records pointed. to a preexisting condition.

The Office of Judges upheld the rejection of Ms. Carter’s claim, and the Board of Review affirmed.

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

A dissenting justice wrote the case “presents us with an opportunity to correct a structural fault in our workers' compensation review procedures: an age-related bias against workers such as the petitioner, who are far more likely to have degenerative musculoskeletal conditions after a lifetime of physical labor.”

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