Reinisch Wilson Weier PC Workers' Compensation Defense and Employment Law

New/Omitted Condition Claims

By Reinisch Wilson Weier PC, Apr 01, 2013

Brian D. Downing, 65 Van Natta 577 (March 18, 2013). The carrier accepted a left shoulder strain combined with preexisting AC joint arthropathy and later denied the compensability of the “current” combined condition, contending that the combined condition had resolved. The claim was closed and there no appeal of the current combined condition denial.

Claimant later filed an “omitted” medical condition claim for “chronic left acromioclavicular sprain; left superior/inferior acromioclavicular instability; left posterior shoulder laxity; left rotator cuff tendinosis; combination of any and all preexisting conditions with the foregoing conditions.” The carrier denied the omitted condition claim.

The Board affirmed the carrier’s denial of claimant’s omitted medical condition claim. The Board first noted that the record does not establish that left shoulder laxity and tendinosis conditions caused disability or need for treatment. Therefore, the Board held these conditions are not compensable. Next, the Board held that there was insufficient evidence the AC instability existed. Finally, the Board noted that the AC joint arthropathy was previously accepted as the “otherwise compensable injury” component of a combined AC joint arthritic condition, that combined condition has been denied, and that denial was not appealed and is final. The Board went on to hold that the unappealed denial precludes a later claim for the previously denied condition.



« Back to Workers’ Compensation Defense Blog