For workers compensation coverage the injured worker must prove two things: 1. Medical causation is a written medical record which states that an accident, activity or exposure at work medically caused or contributed to the condition being treated. Even if the accident only made a preexisting condition worse, it is enough for medical causation because the accident at work contributed to the need for medical care. 2. Legal causation means something happened at work that caused the injury, such as an accident, event or exposure. There are two levels of legal causation and the medical records determine which level applies:
Normal legal causation: If the medical records state there is no preexisting condition which contributes to the industrial injury, then any kind of accident, activity or exposure at work meets legal causation. Note that this applies even with a prior injury, prior accident or prior treatment to the same body part if the prior injury did not contribute to the current problem.
Higher Standard of Legal Causation: If the medical records state that a preexisting condition contributes to the industrial injury, even if that prior condition was asymptomatic or unknown before the industrial accident, then the action at work must meet the higher standard of legal causation. This is often referred to as the "Allen test," named after the Utah Supreme Court case that developed it. The higher standard of legal causation is designed to ensure that work had enough to do with the injury to make the employer/carrier responsible for the costs of the injury. Activities similar to what the average person does at home will not meet this requirement. For example, if someone with a bad back simply picks up a pencil from a table and throws their back out at work, it will not qualify for workers compensation coverage. When the injured worker has a preexisting condition, the work related activity must be an extraordinary or unusual exertion. Generally, this means lifting over 50lbs, a significant fall, twisting or torque that is unusual, etc. Both Medical Causation and Legal Causation must be shown in order to qualify for workers compensation benefits.
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