Worker's Comp Assistance

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element

"Causal
Relationship"

Causal relationship involves establishing a connection between the
condition -- ie. injury -- and your employment. This factor is based
entirely on medical evidence provided by physicians who have examined and
treated the employee. Opinions of the employee, supervisor or witness are
not considered, nor is general medical information contained in published
articles.

A. Kinds of Causal Relationship. An injury or disease may be related to
employment factors in any one of four ways:

(1) Direct Causation. This term refers to situations where the
injury or factors of employment result in the condition claimed through a
natural and unbroken sequence.

(2) Aggravation. If a pre-existing condition is worsened, either
temporarily or permanently, by a work-related injury, that condition is
said to be aggravated.

(a) Temporary aggravation involves a limited period of medical
treatment and/or disability, after which the employee returns to his or
her previous medical status. Compensation is payable only for the period
of aggravation established by the medical evidence, and not for any
disability caused by the underlying disease. This is true even if the
employee cannot return to the job held at time of injury because the
pre-existing condition may be aggravated again. For example, if exposure
to dust at work temporarily aggravates an employee's pre-existing allergy,
compensation will be payable for the period of work-related disability but
not for any subsequent period, even though further exposure in the work
place may cause another aggravation.

(b) Permanent aggravation occurs when a condition will persist
indefinitely due to the effects of the work-related injury or when a
condition is materially worsened by a factor of employment such that it
will not return to the pre-injury state.

(3) Acceleration. A work-related injury or disease may hasten
the development of an underlying condition, and acceleration is said to
occur when the ordinary course of the disease does not account for the
speed with which a condition develops.

(4) Precipitation. This term refers to a latent condition which
would not have manifested itself on this occasion but for the employment.
For example, an employee's latent tuberculosis may be precipitated by
work-related exposure.

B. Medical Evidence. The issue of causal relationship almost always
requires reasoned medical opinion for resolution. This opinion must come
from a physician who has examined or treated the employee for the
condition claimed. Where a pre-existing condition involving the same part
of the body is present, the physician must provide rationalized medical
opinion which differentiates the effects of the employment-related injury
or disease from the pre-existing condition. Such evidence will permit the
proper kind of acceptance (temporary vs. permanent aggravation, for
instance).

To establish causal relationship, additional medical opinion may be
requested of OWCP's District Medical Director/Adviser or from a specialist
in the medical field pertinent to the injury or disease. In a claim for a
psychiatric condition, a report from a psychiatrist or clinical
psychologist will be required. In claims for hearing loss and pulmonary
disease, OWCP will refer the employee for examination by an appropriate
specialist after exposure to the hazardous condition or substance has been
established. Chapter 6 contains further information about medical
examinations.

C. Consequential and Intervening Injuries. Sometimes an injury
occurring outside the performance of duty affects the compensability of a
work-related injury.

(1) A consequential injury is a new injury which occurs as
the result of a work-related injury (for example, because of weakness or
impairment caused by a work-related injury). Included in this definition
are injuries sustained while obtaining medical care for a work-related
injury. Consequential injuries are compensable.

(2) An intervening injury is one which occurs outside the
performance of duty to the same part of the body originally injured. The
resulting condition will be considered related to the original injury
unless the second injury and any other factors unrelated to the original
injury are established as its cause.

For instance, an employee with an accepted claim for back strain later
begins to have pain which suggests disc involvement. Later, while at home,
he suffers pain in his back when he leans over the tub to clean it. Unless
the incident at home is medically competent to cause the resulting
condition, and it breaks the chain of causation of an earlier injury, OWCP
will consider the resulting condition to be causally related to the
original injury.

Information taken from the PUblication CA 810

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