3-5. Causal Relationship.
After the four factors described above have been considered, causal relationship between the condition claimed and the injury or disease sustained is examined. Unlike fact of injury, which is discussed in paragraph 3-3 above and which involves the determination that a medical condition is present, causal relationship involves establishment of a connection between the injury and the condition found. This factor is based entirely on medical evidence provided by physicians who have examined and treated the employee. Opinions of the employee, supervisor or witness are not considered, nor is general medical information contained in published articles.
A. Kinds of Causal Relationship. An injury or disease may be related to employment
factors in any one of four ways:
(1) Direct Causation. This term refers to situations where the injury or factors of
employment result in the condition claimed through a natural and unbroken sequence.
(2) Aggravation. If a pre-existing condition is worsened, either temporarily or
permanently, by a work-related injury, that condition is said to be aggravated.
(a) Temporary aggravation involves a limited period of medical
treatment and/or disability, after which the employee returns to his or her previous medical
status. Compensation is payable only for the period of aggravation established by the medical
evidence, and not for any disability caused by the underlying disease. This is true even if the employee cannot return to the job held at time of injury because the pre-existing condition may be aggravated again. For example, if exposure to dust at work temporarily aggravates an employee's pre-existing allergy, compensation will be payable for the period of work-related disability but not for any subsequent period, even though further exposure in the work place may cause another aggravation.
(b) Permanent aggravation occurs when a condition will persist
indefinitely due to the effects of the work-related injury or when a condition is materially
worsened by a factor of employment such that it will not return to the pre-injury state.
(3) Acceleration. A work-related injury or disease may hasten the development of
an underlying condition, and acceleration is said to occur when the ordinary course of the disease does not account for the speed with which a condition develops.
(4) Precipitation. This term refers to a latent condition which would not have
manifested itself on this occasion but for the employment. For example, an employee's latent
tuberculosis may be precipitated by work-related exposure.
B. Medical Evidence. The issue of causal relationship almost always requires reasoned
medical opinion for resolution. This opinion must come from a physician who has examined or
treated the employee for the condition claimed. Where a pre-existing condition involving the
same part of the body is present, the physician must provide rationalized medical opinion which differentiates the effects of the employment-related injury or disease from the pre-existing condition. Such evidence will permit the proper kind of acceptance (temporary vs. permanent aggravation, for instance).
To establish causal relationship, additional medical opinion may be requested of OWCP's
District Medical Director/Adviser or from a specialist in the medical field pertinent to the injury or disease. In a claim for a psychiatric condition, a report from a psychiatrist or clinical psychologist will be required. In claims for hearing loss and pulmonary disease, OWCP will refer the employee for examination by an appropriate specialist after exposure to the hazardous condition or substance has been established. Chapter 6 contains further information about medical examinations.
C. Consequential and Intervening Injuries. Sometimes an injury occurring outside the
performance of duty affects the compensability of a work-related injury.
(1) A consequential injury is a new injury which occurs as the result of a
work-related injury (for example, because of weakness or impairment caused by a work-related
injury). Included in this definition are injuries sustained while obtaining medical care for a
work-related injury. Consequential injuries are compensable.
(2) An intervening injury is one which occurs outside the performance of duty to
the same part of the body originally injured. The resulting condition will be considered related to the original injury unless the second injury and any other factors unrelated to the original injury are established as its cause.
For instance, an employee with an accepted claim for back strain later begins to
have pain which suggests disc involvement. Later, while at home, he suffers pain in his back
when he leans over the tub to clean it. Unless the incident at home is medically competent to
cause the resulting condition, and it breaks the chain of causation of an earlier injury, OWCP
will consider the resulting condition to be causally related to the original injury.
3-6. Statutory Exclusions
Sometimes the circumstances of a case raise the issues of willful misconduct, intention to bring about the injury or death of oneself or another, or intoxication. If any of these factors is the cause of the injury or death, benefits are denied. Agency or OWCP staff must assert and prove these factors.
A. Willful Misconduct. The question of deliberate willful misconduct may arise when the employee violated a safety rule, disobeyed orders of the employer, or violated a law. Because safety rules have been established for the protection of the worker rather than the employer, simple negligent disregard of such rules is not sufficient to deprive an employee or beneficiary of entitlement to compensation. Disobedience of such orders may destroy the right to compensation only if the disobedience is deliberate and intentional as distinguished from
careless and heedless.
B. Intoxication. In any case involving intoxication (whether by alcohol or illegal drugs), the record must establish both the extent to which the employee was intoxicated at the time of the injury and the particular manner in which the intoxication caused the injury. It is not sufficient just to show that the employee was intoxicated; it must be shown that the intoxication proximately caused the injury. This requirement does not, however, provide agency personnel with any additional authority to test employees for drug use beyond that which may exist under other statutes or regulations.
C. Intent to Bring About Injury or Death to Oneself or Another. Where it appears that the employee brought about his or her own injury or death, or that of another, intent must be established. If the factual and medical evidence show that the employee was not in full possession of his or her faculties, the injury may be compensable. Thus, suicide may be
compensable if the injury and its consequences directly caused a mental disturbance or physical condition which produced a compulsion to commit suicide and prevented the employee from exercising sound discretion or judgment so as to control that compulsion.
Back to Worker's Comp Assistance Page
Home

Webmeister Jennifer Amos. © Western Michigan Area Local
E-mail Jennia1957@aol.com with comments or suggestions