Proving medical causation is essential to meeting your burden of proof in workers compensation and personal injury claims.
But persuading the court of causation becomes more difficult when you have a preexisting medical condition worsened by an occupational injury or illness or a motor vehicle crash.
Fortunately workers compensation and negligence laws follow the eggshell plaintiff rule. Under this rule, the defendant must compensate an injured person for harm (or wage loss) an ordinary person without preexisting impairment or vulnerability would not have suffered.
But the extent of workers compensation benefits and personal injury damages you recover depends on whether you suffered an aggravation or exacerbation of the preexisting condition.
For example, many state workers comp laws follow the aggravation rule.
The aggravation rule stands for the principle that when an occupational injury combines with a preexisting injury to result in a more significant disability than what would have resulted from the on-the-job injury alone, workers compensation pays for the total disability.
In contrast, courts and administrative agencies handling workers compensation claims often limit the defendant’s liability for future medical treatment, wage loss, or permanent partial disability when the injury only exacerbates.
This article explains the difference between aggravation and exacerbation in workers comp and auto accident cases. And how to get the evidence needed to prove an aggravation so you can increase the settlement value of your workers comp or personal injury claim.
Although these terms have similar meanings, the medical community and accident law distinguish an aggravation from an exacerbation. And focusing on the wrong one could cost you tens of thousands of dollars.
Keep reading for more information.
And call us at (804) 251-1620 or (757) 810-5614 or complete the online form if you want a consultation with a top-rated work injury attorney.
Outside of tort law, the terms aggravation and exacerbation are interchangeable. Indeed, they are synonyms.
For example, the Random House Dictionary of the English Language (Second Ed., unabridged) defines the terms as follows:
Aggravation: 1. an increase in intensity, seriousness, or severity; act of making worse; an aggravation of pain … 3. something that causes an increase in intensity, degree, or severity.
Exacerbate: 1. to increase the severity, bitterness, or violence of (disease, ill feeling, etc.); aggravate.
Likewise, Black’s Law Dictionary 82, 704 (11th ed. 2019) finds little difference between the two terms, which it defines as follows:
Aggravation: 1. The fact of being increased in gravity or seriousness.
Exacerbate: To make worse; specif., to render more violent, severe, or seriously upsetting.
These similar definitions in non-medicolegal contexts can create confusion in workers comp and car accident claims.
The American Medical Association (AMA), a professional association of physicians and health care providers, defines the terms aggravation and exacerbation in its published works.
For example, the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, states:
“Aggravation occurs when a preexisting injury or illness has been permanently and significantly changed.”
“Exacerbation is a transient worsening of a prior condition by an injury or illness, with the expectation that the situation will eventually return to baseline or preworsening level.”
These definitions are similar to those used in the AMA Guides to Evaluation of Permanent Impairment, Sixth Edition:
Aggravation: Permanent worsening of a preexisting condition. A physical, chemical, biological, or other factor results in an increase in symptoms, signs, and/or impairment that never returns to baseline, or what it would have been except for the aggravation (the level predetermined by the natural history of the antecedent injury or illness).
Exacerbation: Temporary worsening of a preexisting condition. Following a transient increase in symptoms, signs, disability, and/or impairment, the person recovers to his or her baseline status, or what it would have been had the exacerbation never occurred. Given a condition whose natural history is one of progressive worsening, following a prolonged but still temporary worsening, return to preexacerbation status would not be expected, despite the absence of permanent residuals from the new cause.
From a workers compensation and personal injury perspective, the terms aggravation and exacerbation refer to the worsening of a preexisting medical condition or past injury (such as degenerative disc disease, stenosis, osteoarthritis, or joint disease affecting the knees or shoulders).
But the terms differ in their description of how long the worsening continues.
An aggravation is a permanent increase in the severity of the preexisting condition, while an exacerbation is a temporary increase in symptoms that resolves, returning you to baseline.
Here are examples showing the difference between an exacerbation and an aggravation.
Suppose you are a nurse with minor soreness who underwent an MRI showing mild to moderate degenerative disc disease in your lower back, with some disc bulging.
Then you feel sharp back pain when transferring a patient from a wheelchair to a hospital pain.
Since this incident, you have had constant, severe pain in the back radiating into both legs.
You report the work injury and choose an orthopedic surgeon from the panel of physicians.
The surgeon diagnoses a back injury (lumbar sprain/strain) and orders a new MRI showing multiple disc herniations affecting the spinal cord nerve roots. As a result, you need a spinal fusion. Otherwise you will permanently feel more intense back discomfort.
In this situation, you have suffered an aggravation of a preexisting condition.
Now suppose you are a warehouse associate at Amazon with occasional ankle pain because of an injury you suffered years ago in high school.
A box falls on your ankle while working, causing intense pain and three missed work days.
After resting during this period, your work-related ankle injury resolves, leaving you with the same occasional pain you had before the warehouse accident.
In this situation, you suffered an exacerbation of a preexisting condition because you returned to your baseline level of performance.
Initially your doctor may state that your occupational injury exacerbated your preexisting condition.
Then the doctor will start a course of conservative treatment, which may include physical therapy, chiropractic care, or steroid injections.
Neither medicine nor law recognizes a strict deadline for when the flare-up of a preexisting condition goes from temporary to permanent. But usually doctors will state that you suffered an aggravation if conservative treatment fails and you have not recovered within three months of the accident.
If you are reading this article, you know there is a difference between an aggravation and an exacerbation in workers comp and negligence cases. But you might wonder how this impacts your claim and the amount of money or type of medical treatment you receive.
Here are ways the different definitions of aggravation and exacerbation affect your claim in the real world:
First, the medical community recognizes these definitions of aggravation and exacerbation.
Many doctors handling workers compensation, traumatic brain injury (concussion, post-concussion syndrome, skull fracture), and spinal cord injuries, therefore, will know and use these terms as the AMA defines them.
You will need supportive evidence from your physicians (including doctor disability letters) to win your claim. As such, you should be familiar with the proper definitions when you seek this evidence.
Second, many disputed workers compensation claims and liability cases turn on medical evidence. And the Workers Compensation Commission and courts know how the medical profession defines the terms aggravation and exacerbation. Therefore, the term used by your doctor could be a critical factor in whether you win your case or recover all the damages sought.
For example, a finding that you suffered an exacerbation instead of an aggravation could result in the judge holding that the defendant does not have to pay for medical care or wage loss after a specific date.
Third, your state may require proof of a specific amount of worsening of a preexisting condition before finding a work injury compensable. For example, your state may allow benefits for only an aggravation (permanent worsening) of the preexisting condition but not an exacerbation. Further, the standard may differ for injury, occupational disease, or repetitive motion (cumulative trauma) claims.
Fourth, other factors equal the aggravation of an injury is a more valuable claim than an exacerbation.
Fifth, the claim adjuster (such as a representative from Sedgwick, Travelers, or Gallagher Bassett) or insurance defense attorney handling your claim knows the difference between aggravation and exacerbation. And that person will value your claim higher (and likely be more responsive to your initial workers comp settlement demand) if the work injury permanently worsened (aggravated) your preexisting condition.
Sixth, suppose you suffer a compensable injury and receive a Workers Comp Award Letter paying temporary total disability (TTD) benefits. But a few months later you hurt the same body part in an unrelated slip and fall accident. Whether you continue to receive workers comp may depend on whether the unrelated accident caused an aggravation or exacerbation of your work injury. Generally an intervening accident resulting in an exacerbation will not hurt you. But an aggravation causing permanent worsening of the occupational injury will absolve the insurer of ongoing liability.
Seventh, you may have difficulty proving permanent partial disability from the work accident and the proper apportionment if you suffered an exacerbation instead of an aggravation.
Personal injury law has many nuances.
And one of the most important nuances is how the law treats the aggravation of an injury compared to an exacerbation.
Instead of focusing on the technical requirements of your claim, contact us. We will handle the legal elements while you focus on healing.
Call now.