Casual Relationship: To a physician, “cause” ordinarily
means only the direct or principal medical cause.
However, under workers’ compensation law the physician
must establish the contribution employment causes. Under
the FECA a medical condition or disability is
compensable only when it is proximately caused or
materially aggravated by the conditions of employment. A
proximate cause is that workplace factor which in a
natural and continuing sequence (unbroken by and other
cause) produces the medical condition or disability and
without which the problem would not have occurred.
However, simply the natural progression of a disease
while a person is working does not constitute a causal
relationship. Before conditions of employment can be
considered as “casual” in regards to an underlying or
pre-existing medical condition the employment factors
must aggravate, accelerate, or precipitate that
underlying medical condition. These terms are defined as
follows:
Aggravation: A documented medical process by which a
single employment incident, or series of incidents, can
be shown to have worsened or intensified the severity of
the physical or mental condition which pre-existed the
employment incident. There are two kinds of aggravation:
Temporary: A worsening or increase in severity of the
pre-existing condition for a specific period of time
with no residual alteration of the underlying condition,
and without leaving any impairment or disability
continuing beyond the time of the temporary aggravation.
The employee ultimately returns to his or her previous
medical status.
Permanent: A continuing and irreversible change in the
underlying condition adversely altering the medical
course of the physical or mental problem. The employee’s
condition does not return to its previous medical
status.
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Acceleration: A Documented medical process by which a
single employment incident, or series of incidents, can
be shown to have increased the expected speed of the
progression of a pre-existing condition established as
progressive in nature. Such medical progression carries
no limit on its duration or severity.
Precipitation: A documented medical process by which a
single incident, or series of incidents, can be shown to
have hastened the occurrence of a condition; or caused
it to happen or come to crisis suddenly, unexpectedly,
or sooner than normally would have been expected. Such
medical precipitation could be either temporary in
nature of could have no time limit on duration.
Medical Rational: A logical and through explanation of
the physician’s underlying medical opinions including
the physician’s clearly stated reasons and beliefs
concerning casual relationship. To the degree possible
the statement of causality should be expressed as a
medical certainly and not simply expressed as a
“possibility” or supposition.
Consequential Injury: This type of medical condition
occurs because of a weakness or impairment that has been
caused by an accepted work-related injury or illness. It
can involve the same part of the body as the original
injury, or it can be to an entirely different part of
the body. This type of injury does not have to occur at
work to be compensable. For example, if you have an
accepted foot condition which requires the use of
crutches, and the crutches cause a shoulder condition,
then the shoulder condition could be claimed as a
consequential injury. No special CA Form is required.
Just submit a full medical report from the physician
that explains the connection. |
