Cox v Labor Commission and Workers Compensation Medical Causation

In 2017, the Utah Court of Appeals addressed the case “Cox v Labor Commission.” This case clarified the standard of “medical causation” in worker’s compensation cases. The Court explained that an injured worker must show that “(1) the industrial accident contributed in any degree to the claimant’s condition, such as by aggravating a pre-existing condition, and (2) the aggravation is permanent, i.e., the claimant’s medical condition never returned to baseline, meaning the claimant’s condition immediately before the accident.”

In layman’s terms…

(1) You (the injured worker) need to prove that your accident at work had a part in causing your injury or making your pre-existing condition worse. Even if your accident caused only a minor part in your getting hurt, that’s enough for an injury to qualify as compensable.
(2) You need to prove that your condition is permanently worse because of your workplace accident. If your functioning was limited by a pre-existing condition before you got hurt, you need to show that you’ll never be able to return to that level of functioning because of your injury. You likely won’t qualify for full worker’s compensation if you can return to your pre-injury limitations.

Here’s a common scenario:

Mrs. Worker has had some lower back pain in the past and perhaps gone to the chiropractor a few times. While she routinely experiences a certain level of back pain at work, it always goes away and never gets to be bad enough that she can’t do her job. Then, Mrs. Worker injures her back at work while trying to move a heavy object. This time, the pain is different and does not go away. Physical therapy does not stop the pain. She undergoes a lumbar MRI, which reveals a herniated disc at L4-5 compressing a nerve root. Mrs. Worker now needs a discectomy surgery.
Mrs. Worker’s scenario satisfies both requirements from the Cox case. First, her injury at work clearly made her back pain worse. It therefore had a part in making her pre-existing condition worse. Secondly, Mrs. Worker now has increased limitations. She requires a surgery that she didn’t need before. Even after that surgery, she won’t be able to perform the same work duties she did before. Her condition is permanently worse following the injury. Thus, Mrs. Worker should receive full compensation for the surgery and, most likely, the physical therapy required afterwards.

Conclusion

Unfortunately, insurance adjusters are not going to tell you all this when they deny your claim. They’ll misrepresent your injury in a way that justifies denial. By calling us for a free legal consultation, you will learn how to receive just compensation by applying court decisions like this one to your case. For the last decade, we’ve helped injured workers from Blanding and Moab, up to Richfield, over to Beaver and Cedar City, and down to Hurricane, Kanab and St George, Utah.