Pre-Existing Conditions – Adjusters Deny Workers Comp Claims

The Case on pre-existing conditions:  JBS Carriers v hickey

Industrial accidents happen every day, and workers comp adjusters deny claims every day.  A new Utah Supreme Court case clarifies the law on whether an insurance adjuster should deny workers comp claims due to pre-existing conditions.  In JBS Carriers v Hickey, a truck driver drove for 9 hours with only one short break.  Shortly thereafter, he developed a deep vein thrombosis (DVT) in his left leg and lost time from work for medical treatment.  The workers comp adjuster denied the claim because the driver was overweight (he had a pre-existing condition) and driving 9 hours is not that unusual.  After all, the adjuster said, people will binge watch movies (i.e., Star Wars) and make 10-hour flights from New York to Tokyo.  The Court of Appeals held that the driver failed to prove that his job required him to sit still without moving his left leg.  But, the Utah Supreme Court held as follows:

Holdings from the Court

–Workers compensation benefits are payable where a worker’s employment “increases the risk of injury.”

–It is improper for the adjuster to deny a claim because a worker fails to perform some task in a particular way.

–It is improper for the adjuster to deny a claim because a worker is allegedly partly to blame for his injury.

–Driving a semi truck “is more complex and demanding than operating or traveling in a personal vehicle.”

–Most importantly, “the fact that some people sometimes do these things [i.e., binge watch TV or take long flights] does not make them typical of everyday life.”  This is the most important holding in the case.

What It Means

Many old workers comp cases would be overturned and benefits paid if the Labor Commission had used this standard.  For example, when a miner who was standing on an unstable slab of coal unexpectedly dropped about 10 inches down, injuring his back, the Labor Commission said this was “similar to missing a step at the bottom of a flight of stairs” which is not unusual, and thus benefits were denied.  Today’s Utah Supreme Court would say that missing a step is unusual; it is a bad day when you miss a step and get hurt.  Just because someone in the world missed a step today does not make it “typical of everyday life.”

When I read this case, I said Hallelujah!  This case is a great benefit to injured workers because so many of us have some sort of pre-existing condition.  We must still comply with the higher standard of legal causation set forth in Allen v. Industrial Commission, 729 P.2d 15, 27 (Utah 1986), but the bar is not as high as the insurance company says it was.

Free Case Review – Call 435.592.1235

As usual, Tim Daniels Law Services provides free case reviews for injured workers.  Please call us at (435) 592-1235 with your questions.  For a thorough case review, we will likely need to review your medical records, but we are happy to discuss your situation with you and answer your questions.