A consequential condition is a medical condition that was caused as a result of a workplace injury or illness. The RMB Compensation Division explains.
It is well recognised that workplace injuries may cause a chain of events leading to an additional condition.
The most common consequential conditions include overuse or substituted limb injuries, for example an original injury to the left shoulder may cause or materially contribute to a consequential condition to the right shoulder or cervical spine due to overcompensation or the use of a sling for a prolonged period.
A claim for a consequential condition may be made if the causal chain is not broken - meaning there were no external factors such as a recreational accident.
To establish such a condition, the injured worker bears the onus to prove on the balance of probabilities that the initial injury caused or materially contributed to the claimed condition.
Often, insurers will decline consequential conditions. But there are avenues to challenge a declination notice. You can request an internal review of the decision and the insurer will have 14 days to review submissions and/or material and provide you with a decision to overturn or uphold their declination.
If the insurer fails to respond or upholds their declination, you can file an Application in the Personal Injury Commission to have a member make a decision in respect of the condition/s.
Each case will be determined on its own facts; however, medical evidence including medico-legal evidence and contemporaneous medical notes providing the link between the initial injury and the development of the consequential condition are crucial.
In the matter of Giacalone v Trustees for the Leighton Family Trust [2021] NSW PIC the injured worker sustained an injury to his right knee in a fall during the course of his employment as a cabinet maker in 2018. He then sustained a second injury to his right knee, right hip and lumbar spine in late 2018 in another fall.
The insurer for the employer eventually accepted the injury to the right knee, right hip and lumbar spine.
The worker developed a consequential condition to his left knee following a total right knee replacement, that had not been approved by the insurer in a timely fashion. The insurer declined the consequential condition, but the decision was overturned when the worker provided medical notes and expert reports that he had had difficulty weight-bearing since the injury and had calf wasting on that side.
We strongly recommend contacting our workers compensation experts to discuss your workers compensation rights, you can contact our office by phone on Freecall 1800 681 211 for a consultation, or use our 'Ask a Question' tool on our website.