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OhioBWC - Basics: (Policy library) - File

Policy Name:

Aggravation and Substantial Aggravation of a Pre-Existing Condition

Policy #:

CP-01-09

Code/Rule Reference:

R.C. 4123.01(C); R.C. 4123.54(G)

Effective Date:

06/30/16

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance

Origin:

Claims Policy

Supersedes:

Policy #CP-01-09, effective 04/23/15

History:

New 04/23/15

Review date:

06/30/19

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that field staff recognizes what constitutes aggravation or substantial aggravation of a pre-existing condition and when each may be compensable, dependent upon the date of injury.  

 

II. APPLICABILITY

 

This policy applies to field staff.

 

III. DEFINITIONS

 

Aggravation: A medical finding that a condition that pre-existed an injury or occupational disease is worsened by the injury or occupational disease and has an adverse impact, no matter how slight.

 

Substantial Aggravation: A medical finding that a condition that pre-existed an injury or occupational disease is worsened considerably in amount, value or extent solely because of the injury or occupational disease.

 

IV. POLICY

 

A.    It is the policy of BWC to provide compensation and benefits for an aggravation or substantial aggravation of a pre-existing condition (based upon the date of the injury) when the injury or occupational disease causing the aggravation is sustained or contracted in the course of and arises out of employment.

 

B.    Substantial Aggravation: Date of injury on or after 08/25/2006

1.    Substantial aggravation of a pre-existing condition must be documented and substantiated by objective diagnostic findings, objective clinical findings or objective test results.

2.    Subjective complaints may be included as evidence of a substantial aggravation of a pre-existing condition, but subjective complaints alone, without objective findings, are insufficient to support a substantial aggravation.

3.    The pre-existing condition ceases to be compensable once it returns to the level that would have existed without the injury or occupational disease.

a.    BWC will maintain the condition in an allowed but not payable status.

b.    A motion may be filed to reopen a period of substantial aggravation of a pre-existing condition with supporting documentation meeting the standard of section IV.B.1 and 2 above.

 

C.   Aggravation of a Pre-Existing Condition: Date of Injury before 08/25/2006

An aggravation must be established by an objective adverse effect on the pre-existing condition, even if that effect is relatively slight.

BWC staff may refer to the corresponding procedure for this policy entitled “Aggravation and Substantial Aggravation of a Pre-Existing Condition” for further guidance.


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