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Preexisting Conditions and Limitations on Ohio Workers' Compensation

Krugliak, Wilkins, Griffiths & Dougherty Co., L.P.A.

A recent development in case law interpreting Ohio Workers’ Compensation laws indicates that employers should closely monitor claims based on substantial aggravations of  pre-existing conditions.

Prior to 2006, workers’ compensation benefits were payable where an employee proved that a pre-existing injury was aggravated at work. However, in 2006, this rule was amended, and two requirements were added: (1) the aggravation of the preexisting condition had to be substantial, and (2) the substantial aggravation had to be documented by objective diagnostic findings, objective clinical findings, or objective test results; subjective complaints and symptoms alone were not enough.  Additionally, the 2006 amendments provided that compensation and benefits were no longer payable once the substantial aggravation of the pre-existing condition returned to its pre-aggravation state. Therefore, once the substantial aggravation returns to the baseline, the Industrial Commission can halt the payment of benefits.

The procedural framework of substantial aggravations has been further clarified based on the Ohio Supreme Court’s ruling in Clendenin v. Girl Scouts of Western Ohio.  In Clendenin, the Ohio Supreme Court was presented with the question of whether the termination of benefits based on a return to a baseline level prior to the substantial aggravation was appealable to the Court of Common Pleas.
In Clendenin, an employee suffered a substantial aggravation to a pre-existing injury during the course and scope of her employment. 

Five years later, the Bureau of Worker’s Compensation filed a motion to terminate benefits, asserting that the substantial aggravation had returned to the baseline or pre-aggravation state. After hearing, the Industrial Commission granted the motion, and halted payment of benefits to the employee. The employee filed a notice of appeal to the Court of Common Pleas, arguing that her condition had not returned to its pre-aggravation state, and therefore, that she was entitled to continued benefits.

The Bureau moved to dismiss the employee’s appeal, claiming that the Industrial Commission’s decision to halt payment of benefits wasn’t appealable pursuant to ORC 4123.512. Pursuant to Ohio law, Courts of Common Pleas are allowed to review decisions that relate to a claimant’s right to participate or to continue to participate in the workers’ compensation fund. Ohio has defined the “right to participate” as a decision relating to whether an injury occurred in the course of and arising out of the claimant’s employment. Therefore, decisions relating to whether an injury was in the course of and arising out of the claimant’s employment are appealable to Ohio’s Courts of Common Pleas. However, issues relating to the extent of a claimant’s disability, which has been interpreted as the amount of compensation and benefits payable for allowed conditions under workers’ compensation law, are not appealable pursuant to ORC 4123.512.

In Clendenin, the Ohio Supreme Court found that issues relating to an employee’s return to a pre-aggravation state were extent-of-disability claims, and not appealable to the Court of Common Pleas pursuant to ORC 4123.512. As such, an employee’s sole right to appeal in this scenario is an action in mandamus. The distinction is significant because an action in mandamus is more difficult to maintain, and will be unsuccessful as long as there is “some evidence” in the record to support the Industrial Commission’s decision.

The court in Clendenin went on to note that the phrasing of a claimant’s motion to appeal is not dispositive of whether the claim will be considered an extent of disability, and that the courts are to look at the issue as framed and ordered by the Industrial Commission.

As a result, Ohio employers are provided with an opportunity to examine the status of injuries which support claims for substantial aggravations of pre-existing conditions. Where the substantial aggravations have returned to the baseline, employers may file a motion requesting a finding that the condition has returned to its pre-aggravation state.  If successful, employers may halt the payment of benefits. Furthermore, according to the Clendenin case, a successful order by the Industrial Commission may not be appealed to the Court of Common Pleas, but rather, the employee must maintain an action in mandamus. 

NOTE: This general summary of the law should not be used to solve individual problems since slight changes in the fact situation may require a material variance in the applicable legal advice.

 
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