Document name
Pre-Existing Conditions – Aggravation or Acceleration
Document number
PRO 12/2017
Effective date: October 1, 2017
Approved date: February 17, 2010
Application: All injuries on and after the effective date where there is a pre-existing condition.
Policy subject: Decision making - Principals
Purpose:
To establish the process for adjudicating claims where pre-existing conditions exists.
BACKGROUND
POL 12/2017, Pre-Existing Conditions – Aggravation or Acceleration establishes guidelines for injury claims where pre-existing conditions exist.
PROCEDURE
- Once Operations staff determine the worker has a pre-existing condition that may affect their recovery from the work-related injury, they must determine:
- The extent of the work-related injury.
- The extent of the aggravation or acceleration of the pre-existing condition by the work-related injury.
- If the worker has recovered from the work-related injury.
- Operations staff will gather information about the pre-existing condition from:
- The worker.
- Health care providers by obtaining medical confirmation of the pre-existing condition.
- Past and present employers and coworkers, and other insurers, if necessary.
- Operations staff will review:
- Any history of prior problems in the same or nearby areas of the body as the work-related injury.
- The effect(s) of any pre-existing condition on the worker leading up to the work injury (i.e., pre-injury status).
- Relevant medical reports regarding the worker’s pre-existing condition.
- Operations staff may request a WCB Medical Consultant’s opinion to help clarify the extent of a work-related injury in relation to a pre-existing condition.
- Operations staff will notify workers when compensation benefits will be terminated once they have recovered from the injury and are able to return to pre-injury employment (POL 17/2010, Termination of Compensation Benefits – Notice).
Policy references
Section heading
Legislative Authority
Legislative Authority
The Workers’ Compensation Act, 2013
Sections 2(1)(r), 20, 26, 31, 49, 103
Section heading
Document History
Document History
(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).
Section heading
Complements
Complements
POL 12/2017 Pre-Existing Condition – Aggravation or Acceleration
POL 03/2017 Arising Out of and In the Course of Employment
POL 06/2009 Benefits – Clients 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
POL 04/2017 Injuries – Occupational Disease
PRO 07/2017 Records Management
POL 11/2017 Second Injury and Re-Employment Reserve
PRO 09/2017 Suspension of Benefits