The ability to distinguish between an aggravation versus an exacerbation of an injury is critical to the successful defense of a California workers’ compensation claim.
Understanding the Terms
A condition is aggravated when its increased severity results in the permanent movement of the pathology to a higher level. This may also be referenced as the lighting up or acceleration of a pre-existing condition. Conversely, a condition is exacerbated when the symptoms’ increased severity return to their prior levels within a reasonable period. Thus, the distinction hinges on the determination of permanency.
The level or degree of treatment and resulting disability are the easiest metrics to identify permanency. In short, if the level of treatment or disability does not return to the pre-injury baseline, there is permanent aggravation and thus a new injury. Alternatively, if there is a return to the pre-injury baseline, there is no new injury.
Thoroughly and Objectively Analyze the Facts
Aggressive discovery is the cornerstone of a proactive defense strategy. Swift and thorough investigation of the applicant’s medical history, prior injuries, and current workplace conditions are essential. Depositions, interrogatories, and subpoenas should be utilized strategically to uncover any further information that would shed light on the applicant’s baseline.
With a comprehensive discovery approach, it may be easy to lose sight of the forest for the trees. However, the focus must remain on analyzing the case holistically. Keeping essential issues and facts plainly noted in the file ensures that they are always kept top of mind. Some key areas of focus to ensure the baseline and subsequent determinations are made smoothly are:
Understanding Prior Injuries or Conditions
The applicant’s past medical history must be analyzed and understood. This is the only way to establish a reliable baseline with which the current condition can be compared to.
Utilizing Objective Medical Evidence
Objective medical evidence like imaging studies, ROM measurements, and blood pressure readings provide a snapshot of the applicant’s present state. Juxtaposing these current records against the past baseline will make quick work of the determinations between an aggravation and exacerbation.
Exploring the Benefits Printout
The benefits printout is an excellent tool to quickly discern the progression of the applicant’s condition. Reviewing the annualized cost of care allows for the creation of a numerical baseline where price spikes and new plateaus are readily identified. The focus can then be honed to a quarterly or monthly view to allow for greater clarity on the progression of the applicant’s care.
Connecting with the Employer
The employer is an invaluable resource with insights into the applicant and their work. They may be able to add a bit of light or direction when conducting discovery. Establishing a trusting relationship with the employer will pay dividends that will aid in the progression of the claim.
Seek Apportionment and Secure Substantial Medical Evidence
Once the injury or condition has been aggravated, the issue of apportionment must be discussed by a medical professional. A determination must be made on whether a portion of the ultimate disability would have resulted from the normal progression of the underlying disease or condition. Thus, for the best chance at success, secure substantial medical evidence by sending a pointed position statement containing all relevant evidence to the medical examiner.
Conclusion
Successfully navigating the distinction between aggravation and exacerbation of an injury or condition requires diligent discovery with objective and thorough analysis. Savvy defendants utilize the applicant’s changing condition to their benefit, when possible. At Karbassyoon Law, we analyze the facts to establish an aggressive strategy utilizing aggravations and exacerbations effectively to mitigate liability, seek reimbursement, and move the claim to closure. We welcome the opportunity to review your case and secure you the best possible outcome.
This post provides a brief overview of the distinction between aggravation and exacerbation. Each case is different and therefore, due consideration should be given to the specific facts. For more information and a detailed review of your case, contact Naveed Karbassyoon at: NaveedK@KarbassyoonLaw.com or by telephone at: (949) 617-1757.