First insurer liable for cleaner's aggravation of knee injury from fall

In Utah, an employer's previous insurer can be liable for a worker's benefits even if it was not the insurer at the time of the injury.

Case name: Certified Building Maintenance v. Labor Commission, No. 20110549-CA (Utah Ct. App. 08/23/12).

Ruling: The Utah Court of Appeals held that an employer's first insurer was liable for a cleaner's benefits because it was the insurer at the time of his injury.

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What it means: In Utah, an employer's prior insurer can be liable for a worker's benefits even if it was not the insurer at the time of the injury if the injury was an aggravation of an injury the worker sustained while the insurer provided coverage to the employer.

Summary: A commercial building cleaner injured his left knee when he slipped on ice while working. The employer's insurer covered his benefits. He returned to work after surgery but continued to suffer knee pain and swelling. He received a steroid injection that alleviated his pain until three days later when he slipped on ice and fell onto his back while carrying chemicals at work. The pain in his left knee spiked after the fall but eventually subsided to its preinjection chronic level. The employer was insured by a second injurer at the time of the cleaner's second fall. The first insurer denied coverage of the claim, asserting that the second fall resulted in a new injury. The second insurer also refused to cover the cleaner's medical expenses, asserting that the second fall aggravated the underlying injury caused by the first fall. The Utah Court of Appeals held that the first insurer was liable for the cleaner's benefits.

The court noted that the cleaner suffered chronic knee pain after his first fall, the pain subsided after his injection, and the pain returned after the second fall. The medical panel acknowledged that the second fall caused "increased pain." The panel also determined that the increase was a "temporary aggravation" that "returned to baseline," and the baseline was causally related to the first fall. The panel was provided the medical record and permitted to conduct its own physical examination and interview of the cleaner.

Read more at the WorkersComp Forum homepage.

October 25, 2012

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