Pre-Existing Conditions – Aggravation or Acceleration
Effective date: October 1, 2017
Approved date: February 17, 2010
Application: All injuries on and after the effective date where there is a pre-existing condition.
Policy subject: Decision making - Principals
To establish the process for adjudicating claims where pre-existing conditions exists.
POL 12/2017, Pre-Existing Conditions – Aggravation or Acceleration establishes guidelines for injury 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 (POL 17/2010, Termination of Compensation Benefits – Notice).
The Workers’ Compensation Act, 2013
Sections 2(1)(r), 20, 26, 31, 49, 103
(1) POL and PRO 01/2000, Pre-Existing Condition – Section 49 (effective May 1, 2000 to September 30, 2017).
(2) POL 17/94, Pre-Existing Conditions (effective August 16, 1994 to April 30, 2000).
POL 12/2017 Pre-Existing Condition – Aggravation or Acceleration
POL 03/2017 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 11/2017 Second Injury and Re-Employment Reserve
PRO 09/2017 Suspension of Benefits
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