Pre-Existing Conditions – Aggravation or Acceleration
Effective date: October 1, 2017
Application: Applies to all injuries on and after the effective date where there is a pre-existing condition.
Policy subject: Decision making - Principles
To establish adjudication guidelines for claims where pre-existing conditions exist.
- 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 or suitable productive employment (POL 11/2021, Terminating Benefits – Notice Period).
(1) November 1, 2021. Clarification added for when the termination of compensation benefits may occur for workers in accordance with POL 11/2021, Terminating Benefits – Notice Period.
(2) POL and PRO 01/2000, Pre-Existing Condition – Section 49 (effective May 1, 2000 to September 30, 2017).
(3) POL 17/94, Pre-Existing Conditions (effective August 16, 1994 to April 30, 2000).
POL 12/2017 Pre-Existing Condition – Aggravation or Acceleration
POL 07/2021 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 03/2021 Second Injury and Re-Employment Reserve
PRO 10/2021 Suspension of Benefits