Missouri Workers Compensation Benefits: Some Clarification for Injured Workers with Pre-Existing Injuries

July 25, 2011

Recently, a few court decisions, one by the Missouri Court of Appeals and another by the Industrial Relations Commission has provided a few nuggets that benefit injured workers. The decisions which do not mention each other are related in that they involve workers with pre-existing injuries that in some way are impacted by a work related injury.

In Lichtinger v. Swiss Meats, the Labor and Industrial Relations commission reversed the decision of the Adminisrative Law Judge finding that an employee who suffered a MI did not have a compensable injury. The employee had a pre-existing cardiovascular condition that had required him to change jobs. At his present job, the employee suffered a stabbing injury that required a fasciotomy. Subsequent to that procedure, the employee suffered additional symptoms that were subsequently diagnosed as a myocardial infarction that resulted in additional stenting and a pacemaker. In discussing one of the doctor's testimony that he could not say the work injury was the only factor, the commission notes,

"... the law does not require an employee to show a work accident was the only factor in causing the resulting medical condition and disability, but merely the prevailing factor, which is defined as "the primary factor, in relation to any other factor ..." See section 287.020.3(1) RSMo."

This distinction is an important consideration in work injuries. Simply put, the fact that an injured worker has a pre-existing condition does not prohibit a work injury from affecting the condition and being compensable.

Additionally, in finding that the MI was the related to the work injury, the commission also noted that future medical related to the treatment of the condition was the responsibility of the employer. It noted,

"Section 287.140.1 RSMo provides, as follows: 'In addition to all other compensation paid to the employee under this section, the employee shall receive and the employer shall provide such medical, surgical, chiropractic, and hospital treatment, including nursing, custodial, ambulance and medicines, as may reasonably be required after the injury or disability, to cure and relieve from the effects of the injury.'"

This decision is important to employees with pre-existing conditions. Its holdings are bolstered by the recent decision in the Western District of the Missouri Court of Appeals, in Tillotson v. St. Joseph Medical Center, WD 72948 June 14, 2001.

In this decision, the Court of Appeals reversed the LIRC and held that an employee with a pre-exisiting knee condition who suffered a knee injury at work had a compensable case. Further, the court noted that when the evidence establishes a work related injury, the fact that the pre-existing condition required a more complex surgery to repair the work injury - did not prohibit the claim. The court in relying on Sec. 287.140.1 stated,

"in determining whether medical treatment is "reasonably required" to cure or relieve a compensable injury, it is immaterial that the treatment may have been required because of the complication of pre-existing conditions, or that the treatment will benefit both the compensable injury and a pre-existing condition. Bowers v. Hiland Dairy Co., 188 S.W.3d 79, 83 (Mo. App. S.D. 2006). Rather, once it is determined that there has been a compensable accident, a claimant need only prove that the need for treatment and medication flow from the work injury. Id. The fact that the medication or treatment may also benefit a non-compensable or earlier injury or condition is irrelevant. Id."

In this case, the injured worker because of her pre-existing condition required a knee replacement to repair the torn meniscus suffered in the work injury. The court - rightly so - held that because the knee replacement flowed from the work injury, the employer was obligated to pay for the procedure.

The analysis in these two cases makes sense. If a worker was not planning on having a knee replacement and a work injury makes it expedient, then the insurance company should pay for it. Likewise, if a work injury causes an underlying condition, such as a cardiovascular condition, to erupt, then it should pay this treatment as well.

These are good decisions for employees. Hopefully, they will slow the needless denial of medical treatment for many similar situations.

Mike Sudekum is a workers compensation attorney in St. Louis, Missouri. He and his firm have a satellite office in Wentzville, Missouri. You may contact him here.