Arthritis definition curbs comp for caretaker

In Oregon, in defining preexisting conditions for workers' compensation claims, the term "arthritis" means the inflammation of one or more joints due to infectious, metabolic, or constitutional causes, resulting in breakdown, degeneration, or structural change.

Case name: Hopkins v. SAIF Corp., No. SC S058081 (Or. 12/09/10).

Ruling: The Oregon Supreme Court held that a caretaker was not entitled to benefits because she had preexisting arthritis.

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What it means: In Oregon, in defining preexisting conditions for workers' compensation claims, the term "arthritis" means the inflammation of one or more joints due to infectious, metabolic, or constitutional causes, resulting in breakdown, degeneration, or structural change.

Summary: A caretaker at an assisted living facility was preparing medications for the residents when she bent down to retrieve medication from a drawer about 8 inches from the ground. She felt a sharp pain in her hip. When she stood up, her legs felt numb and tingly. The next day, an MRI of her thoracic spine revealed disk herniations. The caretaker underwent multiple surgeries. She filed a workers' compensation claim for her thoracic spine condition. Four doctors opined that the caretaker had arthritis. The Oregon Supreme Court held that she had preexisting arthritis and denied her benefits.

In Oregon, if a compensable injury combines with a preexisting condition to cause or prolong disability or a need for treatment, the combined condition is compensable only if the compensable injury is the major contributing cause of the disability or the need for treatment. By proving that a worker suffers from arthritis, an employer does not have to show the condition was diagnosed or treated before the work injury.

The parties argued about the legal definition of arthritis. The court noted that the legislature intentionally left the term undefined. The court considered medical dictionaries before defining "arthritis" as the inflammation of one or more joints due to infectious, metabolic, or constitutional causes, and resulting in breakdown, degeneration, or structural change.

The caretaker argued that the term should be limited to moveable joints and that the intervertebral disks of the spine cannot be affected by arthritis, but the court disagreed.

The court concluded that the caretaker's condition resulted from progressive degeneration that manifested in the erosion of the intervertebral disks in her spine. Substantial evidence supported a finding that the inflammation of her disks was not caused by trauma.

Read more at the WorkersComp Forum homepage.

February 7, 2011

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