Ohio Workers’ Compensation: Pre-Existing Conditions and the Right to ParticipateMay 22, 2017 – Articles
An area of both judicial and legislative focus for many years in the Ohio Workers’ Compensation system concerns the extent to which workers’ compensation benefits should be payable when an employee’s pre-existing condition is aggravated by an injury at work. Prior to 2006, an injured worker was not required to prove the aggravation of a pre-existing condition by a work-related injury was substantial in order to obtain workers’ compensation benefits.
However, in 2006, significant changes were made to the workers’ compensation statute with respect to compensation for pre-existing conditions. Since that time, an employee must prove a pre-existing condition was substantially aggravated to obtain workers’ compensation benefits for that condition. Additionally, the substantial aggravation must be proven by objective medical evidence. The 2006 amendments also added an important limitation to compensation for pre-existing conditions, providing that once the condition has returned to a level that would have existed without the injury, no further compensation or benefits are payable for the pre-existing condition.
On May 18, 2017, the Ohio Supreme Court issued its decision in a case which will have important implications concerning compensation for pre-existing conditions, Clendenin v. Girl Scouts of Western Ohio. In the Clendenin case, the plaintiff, Audrey Clendenin, suffered a work-related injury in 2008, and her workers’ compensation claim was subsequently allowed for various conditions, including the substantial aggravation of a pre-existing condition. In 2013 the Ohio Bureau of Workers’ Compensation filed a motion seeking to halt the payment of any further compensation and benefits for the condition, contending it had returned to its baseline pre-injury level. The Industrial Commission granted the bureau’s request and ordered compensation and benefits would no longer be payable in Ms. Clendenin’s claim for the substantially-aggravated condition.
Ms. Clendenin then attempted to appeal the Industrial Commission’s order to the Court of Common Pleas, arguing that, by finding her pre-existing condition had returned to pre-injury status, the Industrial Commission had effectively terminated her right to participate in the claim for the condition. At the request of the Bureau of Workers’ Compensation, the trial court dismissed Ms. Clendenin’s complaint, finding the Industrial Commission’s order concerned the extent of her disability rather than the right to participate and was therefore not appealable to the Court of Common Pleas. Ms. Clendenin appealed that decision to the First District Court of Appeals. The Court of Appeals reversed, finding that the Industrial Commission’s order had effectively terminated the claimant’s right to participate for the condition and was therefore appealable to the Court of Common Pleas.
However, in its recent decision, the Supreme Court disagreed, reversing the Court of Appeals and reinstating the trial court’s decision. The Supreme Court ruled the Industrial Commission order had not disallowed the condition but instead simply limited the amount of benefits Ms. Clendenin could obtain for the pre-existing condition. As such, the court ruled Ms. Clendenin’s only means of appealing the Industrial Commission ruling would be in a much more difficult mandamus appeal in which an Industrial Commission order will be upheld so long as there is “some evidence” in the record to support the Industrial Commission’s ruling.
Based upon the Supreme Court’s decision in Clendenin, Ohio employers should carefully review any claim allowed for substantial aggravation of a pre-existing condition to determine whether a motion should be filed requesting a finding that the condition has returned to pre-injury status. If successful on such a motion, there will be no further exposure in the claim for compensation or medical benefits relating to the pre-existing condition. In addition, since such a ruling cannot be appealed to the Court of Common Pleas, it is unlikely a claimant would be successful having such an order overturned.