You suffered an accident at work. You are hurting. You see the company doctor. Then, the insurance company denies your claim. The insurance company refuses to provide more treatment or benefits. The adjuster claims you cannot get benefits because you suffered a prior injury to the same part of your body. The adjuster claims your new injury is just a “recurrence” of a prior injury, years earlier. Of course, the time limit for filing a claim on the old injury has long since expired.
Many times, the adjuster is simply wrong. The insurance company wrongly denied your claim. And, you are likely entitled to work comp benefits.
This is a common problem. It’s not unusual to have a prior injury, especially if you are working a hard job. Keep in mind — Workers compensation benefits are NOT limited to people who were in perfect health. Although you may have hurt the same area of your body previously, you may still be entitled to benefits for your new accident. Even if your prior accident was pretty serious or left you with some problems, you may still be entitled to benefits for your new accident.
In the title of this post, I used the words AGGRAVATION and RECURRENCE. I used them because they are frequently used to label new work-related accidents when the worker has previously suffered an accident to same bodily area. You may hear the case nurse, insurance adjuster, or even the doctor, use these terms. They may even appear in your medical records. They are used by our courts when reviewing this type of work comp case. Before I move on, let me add that you should definitely NOT trust the label or term used by the insurance company or its case nurse.
Earlier this month, the Alabama Court of Civil Appeals again addressed the issue of Aggravation versus Recurrence in a workers’ compensation case. This case is titled United-Johnson Brothers of Alabama, LLC v. Luther Billups. What happened in this case? Luther Billups was a delivery truck driver. In February 2019, Billups was lifting a 200 pound gate on his truck when he felt a pop in his back and a lot of pain. When he could not continue working, Billups filed a work comp case for this 2019 accident and injury. What was the issue? Billups had previously suffered a back injury in October 2016, three years earlier.
Following his earlier 2016 injury, Billups required lumbar surgery. Although he eventually returned to work from that injury, he continued to require regular medical care from his orthopedic surgeon. Billups previously settled his work comp claim for that earlier 2016 injury.
Can Billups still get benefits for his later 2019 accident and injury? It depends. If the 2019 injury is a “new” injury, the answer is clearly yes. What if the 2019 injury is related to his prior 2016 injury? After all, it’s the same body part. And, Billups still had problems from the 2016 injury. This is where the terms aggravation versus recurrence come into play.
If the new injury is just a “recurrence,” then you cannot make a new claim for it. Our courts have stated that the new accident is a recurrence if it does not contribute (even slightly) to your disability. If the new injury is an “aggravation,” then you can make a new claim based on it. Courts find an accident to be an aggravation if it contributes at all to the level of disability. In the Billups case, the employee was able to obtain needed benefits for his new 2019 accident and injury. Keep this in mind — If the new injury even contributes slightly to your disability or limitations, you should be able to pursue a claim. I’ve pursued many of these cases over the years.
The issues of aggravation versus recurrence can be gray. If you suffered a serious accident but previously injured the same body part on the job, seek skilled legal counsel. These cases are won or lost on slight differences and small changes in your condition. The insurance company knows the rules and knows the language to use with the doctor. You need someone who understands this language as well.
The Blackwell Law Firm represents injured workers across Alabama. We have pursued workers compensation cases to verdict in counties across the state. If you have a question, let us know. We are happy to discuss your issue and provide advice.