When a worker is injured on the job, but the injury occurs as a result of a preexisting condition or certain acts by the employee, an employer may have cause to dispute the compensability of a workers’ compensation claim filed in West Virginia (WV). WV workers’ compensation compensability can be a complex matter, and working with an experienced WV workers’ compensation defense attorney is often the best way to ensure a positive outcome.
Understanding WV Workers’ Compensation Compensability
This is the second blog in a series of three on the topic of the compensability of workers’ compensation claims in WV. The first blog discussed what constitutes a compensable workplace injury in WV as well as other procedural factors, including the burden of proof, preponderance of evidence, the statute of limitations for claims, and liability for occupational disease claims. The Jenkins Fenstermaker publication, “Brief Facts 2: West Virginia Workers’ Compensation—Compensability,” is a quick reference sheet for the information included here and in the additional blogs in this series. Download the fact sheet and sign up for the Jenkins Fenstermaker workers’ compensation newsletter to get new editions on various topics of interest.
This second blog addresses some of the more complex issues that can arise related to the compensability of claims, including the following:
- Preexisting conditions and WV workers’ compensation compensability;
- Pending employment changes; and
- Compensability of idiopathic falls.
Preexisting Conditions and WV Workers’ Compensation Compensability
A preexisting condition or injury to a previously injured part of the body does not necessarily prohibit a claimant from filing for or receiving benefits for a new workers’ compensation claim in WV. When a preexisting condition was asymptomatic and new symptoms arose after an incident and injury at work, a claimant’s disability is presumed to be compensable as long as medical evidence and the facts surrounding the case support it. However, this presumption is not conclusive, and the employer does have the option to rebut the claim if it believes there is cause to do so.
Pending Employment Changes
When an employee who is aware of a pending layoff, termination, or other work stoppage files a WV workers’ compensation claim, WV Code § 23-4-1c provides that the employee’s knowledge of job changes may be given probative weight in considering the compensability of workers’ compensation claims in WV. WV law states that a workers’ compensation insurer should consider the following:
- Any work shutdown scheduled within one week of the date a claim is filed;
- Notices of termination or layoffs that occurred within 60 days of the filing; and
- Receipt of unemployment benefits by the claimant at the time of or within 60 days of filing.
The existence of these conditions does not guarantee that WV workers’ compensation compensability may be denied, but the information can be part of the employer’s defense against claims filed when an employee is aware of a pending work stoppage or termination.
Compensability of Idiopathic Falls
Many workers’ compensation cases involving idiopathic falls are difficult to reconcile. When a fall occurs for unknown reasons or due to a preexisting or non-work-related condition, such as syncope or a transient ischemic attack (TIA), a resulting workers’ compensation claim may be rejected.
However, if a fall occurs in the course of employment and there is no evidence of an unrelated condition that caused the fall to occur, the claim is generally compensable. Due to the need for evaluation of the specific circumstances of cases involving idiopathic falls, consultation with an experienced WV workers’ compensation defense attorney is recommended in these cases.
Contact a Workers’ Compensation Defense Attorney at Jenkins Fenstermaker
The third and final installment in this series on workplace injury compensability will address these issues:
- Zone of employment for a compensable workplace injury in WV;
- Compensability of mental health claims;
- Compensability of workers’ compensation claims involving horseplay or intoxication; and
- The consequences of unreasonable denial of a WV workers’ compensation claim or benefits.
The WV workers’ compensation compensability matters discussed here and in the two related blogs can be complex and often require individual assessment on a case-by-case basis. If you need to consult with a WV workers’ compensation defense attorney regarding policies, protocols, or a specific claim, the workers’ compensation team at Jenkins Fenstermaker, PLLC is happy to help. Please reach out to us by calling (304) 523-2100 or completing our online contact form.