Pre-Existing Conditions – Aggravation or Acceleration
Effective date: October 1, 2017
Application: All injuries on and after the effective date where there is a pre-existing condition.
Policy subject: Decision making - Principles
To establish adjudication guidelines for claims where pre-existing conditions exist.
Pre-existing condition means a non-work related medical, physical or psychological condition that existed prior to the work-related injury. The existence of the condition must be medically confirmed, either pre-injury or post-injury, and may have been evident prior to the occurrence of the work injury or it may become evident afterwards.
Aggravation means, as the result of a work-related injury, a pre-existing condition is temporarily worsened.
Acceleration means, as the result of a work-related injury, a pre-existing condition is permanently worsened.
- Section 2(1)(r) of The Workers’ Compensation Act, 2013 (the “Act”) specifies that an “injury” means all or any of the following arising out of and in the course of employment:
- The results of a willful and intentional act, not being the act of the worker;
- The results of a chance event occasioned by a physical or natural cause;
- A disabling or potentially disabling condition caused by an occupational disease;
- Any disablement.
- The Workers’ Compensation Board (WCB) has exclusive jurisdiction to determine all matters arising pursuant to the Act, specifically (Section 20):
- Whether any condition or death was caused by an injury,
- Whether an injury has arisen out of and in the course of employment, and
- The existence, degree and permanence of any functional impairment resulting from an injury.
- The WCB will not reject the claim of a worker or a dependant for compensation or reduce the amount of compensation payable by reason of a pre-existing condition of the worker, if the injury materially aggravates or accelerates the pre-existing condition to produce a loss of earnings or death (Section 49).
- The decision to accept a claim is based on if the injury arose out of and in the course of employment (POL 07/2021, Arising Out of and In the Course of Employment). A worker’s pre-existing condition is not considered in the initial determination to accept a claim.
- While the WCB does not assume any responsibility for a worker’s pre-existing condition, the WCB will determine if a work-related injury resulted in either an aggravation or acceleration of a worker’s pre-existing condition.
- The WCB will review all available information about a worker’s pre-existing condition to determine the extent of benefits (e.g., wage loss, medical, etc.) a worker is eligible to receive.
- If the work-related injury results in an aggravation of the pre-existing condition, the WCB is responsible for benefits until the worker has recovered from the effects of the work-related injury.
- If the work-related injury results in an acceleration of the pre-existing condition, the WCB is responsible for any benefits related to the combined effects of the injury and any ongoing impacts the work-related injury has on the pre-existing condition.
- To confirm that an acceleration of a pre-existing condition has occurred, medical confirmation is required through diagnostic testing (e.g., x-ray, computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan, mental health assessment).
- An employer may be eligible for cost relief for claims involving a pre-existing condition under POL 03/2021, Second Injury and Re-employment Reserve.
(1) POL and PRO 01/2000, Pre-Existing Condition – Section 49 (effective May 1, 2000 to September 30, 2017).
(2) POL 17/94, Pre-Existing Conditions (effective August 16, 1994 to April 30, 2000).
PRO 12/2017 Pre-Existing Condition – Aggravation or Acceleration
POL 07/2021 Arising Out of and In the Course of Employment
POL 06/2009 Benefits – Customers in Transition from WCB to SGI Benefits
POL 02/2019 Decision Making
PRO 02/2019 Decision Making
POL 05/2013 Injuries – Heart Attack
PRO 02/2016 Injuries – Hernia
PRO 04/2017 Injuries – Occupational Disease
PRO 07/2017 Records Management
POL 03/2021 Second Injury and Re-Employment Reserve
PRO 10/2021 Suspension of Benefits