“Pre-Existing” Degenerative Disc Disease Defenses In Wisconsin Worker’s Compensation Claims
If you are diagnosed with degenerative disc disease after a work-related back or neck injury in Milwaukee, your claim may be questioned. Insurance companies often look at MRI results, find signs of degeneration, and claim your pain is due to aging or a condition you had before the accident. However, this does not automatically mean your claim will be denied.
Wisconsin law says employers must accept employees as they are, even if they have spinal conditions that make them more likely to get hurt. The key issue is whether your job caused a new injury or made your existing condition worse than it would have been otherwise.
A Pre-Existing Condition Does Not Automatically Bar Compensation
Under Wis. Stat. § 102.03, Wisconsin Worker’s Compensation benefits may be available when an employee sustains an injury arising out of employment while performing services growing out of and incidental to employment. A worker does not have to enter the workplace with a perfectly healthy spine to qualify for benefits.
Wisconsin courts have addressed pre-existing degenerative conditions for decades. Under the standard established in Lewellyn v. Industrial Commission, a progressively deteriorating or degenerative condition may result in a compensable injury when work activity precipitates, aggravates, and accelerates that condition beyond its normal progression. Wisconsin courts continue to apply that rule to claims involving lumbar and other degenerative spinal conditions.
This difference is important when an insurance company claims that you already had degenerative disc disease, arthritis, spinal stenosis, or another long-term condition before your accident.
What The Insurance Company May Argue
The insurance company might say that the workplace accident only caused a short-term strain or a brief increase in symptoms. They may argue that any ongoing pain, surgery, work restrictions, or disability are due to the natural course of degenerative disc disease, not your job.
Wisconsin decisions recognize that merely experiencing symptoms of an already deteriorated condition while working is not necessarily enough. If employment simply provides the setting where the underlying condition becomes symptomatic, without accelerating the disease beyond its normal progression, compensation may be denied.
Insurers frequently support this position with an independent medical examination. The examining physician may conclude that the employee suffered a temporary sprain that resolved and that any continuing problems are attributable to pre-existing degeneration. Wisconsin courts have addressed precisely this type of dispute.
Medical Evidence Can Determine Whether The Claim Is Compensable
Because the disagreement often involves medical causation, medical opinions can become some of the most important evidence in the case. We look closely at whether the treating physician believes the accident or work activity precipitated, aggravated, and accelerated the degenerative condition beyond normal progression.
Medical records may also show whether the employee was working without significant restrictions before the injury, whether symptoms changed immediately afterward, whether objective findings changed, and whether surgery or other treatment became necessary after the workplace incident.
When physicians disagree, the dispute may ultimately require a determination by the Wisconsin Worker’s Compensation Division. Wisconsin courts have repeatedly recognized that competing medical opinions concerning the effect of employment on degenerative conditions can present factual questions for the agency deciding the claim.
Benefits May Include Treatment And Disability Compensation
If the work injury is established, Wis. Stat. § 102.42 generally requires te employer or insurer to provide reasonable and necessary medical treatment related to the compensable injury. Wisconsin DWD guidance confirms that covered medical expenses can include physician care, hospital treatment, medication, medical supplies, and other necessary treatment.
Depending on the circumstances, an injured worker may also qualify for temporary disability benefits, permanent disability benefits, or other compensation under Chapter 102. DWD guidance further recognizes that an employer is not responsible for disability clearly shown to have existed before the compensable injury, but that susceptibility caused by a pre-existing condition does not by itself eliminate liability for the effects of a new work injury.
For that reason, an MRI report stating “degenerative disc disease” should not be treated as the end of the analysis. We examine what happened at work, the employee’s medical history, prior symptoms, post-injury symptoms, diagnostic findings, treatment recommendations, and medical causation opinions before determining how a pre-existing condition affects the claim.
Frequently Asked Questions About Pre-Existing Degenerative Disc Disease And Wisconsin Worker’s Compensation
Can I Receive Wisconsin Worker’s Compensation If I Had Degenerative Disc Disease Before My Work Injury?
Yes, depending on the medical evidence and circumstances. Having degenerative disc disease before an accident does not automatically prevent you from receiving Wisconsin Worker’s Compensation benefits.
Wisconsin follows the principle that employers take employees as they find them. DWD guidance specifically states that when a worker is more susceptible to injury because of a pre-existing condition, the employer may still be responsible for the effects of a compensable injury.
The major issue is whether your employment caused a new injury or precipitated, aggravated, and accelerated your degenerative condition beyond its normal progression. That determination often depends heavily on medical evidence.
What Does “Aggravated Beyond Normal Progression” Mean?
Degenerative disc disease can gradually worsen over time even without an accident. Wisconsin Worker’s Compensation law therefore distinguishes between the natural progression of the disease and a measurable worsening associated with employment.
Under Wisconsin case law, compensation may be appropriate when work activity precipitates, aggravates, and accelerates a degenerative condition beyond its normal progression.
For example, a worker might have degenerative changes visible on an MRI but be performing a physically demanding job without disabling symptoms. After lifting, falling, twisting, or another workplace event, the worker may develop severe symptoms, require extensive treatment, or become unable to perform the same work. A physician may then be asked whether the employment accelerated the underlying spinal condition beyond what would otherwise have occurred.
Can The Insurance Company Deny My Claim Because My MRI Shows Arthritis Or Degeneration?
An insurer can dispute a claim, but an MRI showing degeneration does not automatically establish that the workplace injury is unrelated to your condition.
Degenerative changes are common, particularly as people age. The legal and medical issue is what role the workplace accident or work exposure played in causing your disability and need for treatment.
An insurer may obtain an independent medical examination and argue that the workplace event caused only a temporary strain. If your treating physician reaches a different conclusion, the case may involve competing medical opinions. Wisconsin decisions recognize that such disputes frequently turn on which medical opinion the fact finder finds more persuasive.
What If I Had Back Pain Before The Workplace Accident?
Prior back pain does not necessarily prevent a successful Wisconsin Worker’s Compensation claim. However, prior symptoms and treatment can become important evidence.
The insurer may obtain earlier medical records to determine whether you had similar symptoms, restrictions, diagnostic findings, injections, physical therapy, surgery recommendations, or other treatment before the workplace event.
We compare those records with what happened after the injury. A significant change in symptoms, ability to work, treatment needs, or physical limitations can be relevant to determining whether employment caused an additional injury or accelerated the underlying condition.
Accuracy about prior treatment is extremely important. Trying to hide an earlier back problem can damage credibility and make an otherwise legitimate claim more difficult to prove.
What If The Insurance Company’s Doctor Says My Work Injury Was Only Temporary?
This is a common dispute in claims involving degenerative disc disease. The insurer’s physician may conclude that you suffered a temporary lumbar or cervical strain and later returned to your pre-injury condition.
That opinion may allow the insurer to argue that it is no longer responsible for treatment or disability after a particular date.
Your treating physician may instead conclude that the accident permanently aggravated and accelerated the degenerative condition. Wisconsin appellate decisions have addressed cases involving exactly these competing theories.
We examine the medical reports, diagnostic testing, treatment history, physical restrictions, surgical recommendations, and the factual assumptions relied upon by each physician when evaluating this type of dispute.
Can Worker’s Compensation Pay For Back Surgery When Degenerative Disc Disease Existed Before The Injury?
Potentially, yes. If surgery is reasonable and necessary treatment for a condition causally related to the compensable workplace injury, Wis. Stat. § 102.42 may require the employer or insurer to pay the associated medical expenses.
Wisconsin cases have upheld compensation where medical evidence established that a workplace injury aggravated and accelerated a pre-existing degenerative spinal condition beyond normal progression and contributed to the need for surgery.
The critical question is causation. The insurer may argue that surgery would have become necessary because of degeneration regardless of the workplace accident. The treating physician’s analysis of why surgery became necessary and how the employee’s condition changed following the accident can therefore be particularly important.
Can Repetitive Work Cause A Degenerative Back Condition To Become Compensable?
Yes, under appropriate circumstances. Wisconsin Worker’s Compensation is not limited to injuries resulting from one sudden accident.
Repetitive physical work may potentially contribute to an occupational injury when employment activity causes a degenerative condition to progress beyond its normal course. Wisconsin courts have recognized claims involving ongoing work exposure that aggravated and accelerated degenerative spinal conditions beyond normal progression.
These claims can involve years of lifting, bending, twisting, carrying, construction work, manufacturing activity, health care work, or other physically demanding employment. Medical evidence establishing a connection between the cumulative work exposure and the employee’s condition is generally critical.
What Evidence Can Help Counter A Pre-Existing Condition Defense?
Medical documentation is often the foundation of the claim. We may review records from before and after the workplace injury, imaging studies, physician reports, physical therapy records, work restrictions, surgical records, and medical causation opinions.
Your work history can also matter. Evidence that you regularly performed your job before the injury but became unable to perform the same duties afterward can help provide context for the medical evidence.
We also look carefully at the history given to physicians. The medical opinion is only as reliable as the factual information on which it is based. A complete description of the accident, prior symptoms, prior treatment, and the progression of symptoms afterward can therefore be important.
Should I Report A Work Injury Even If I Already Have Degenerative Disc Disease?
Yes. DWD advises employees to report a workplace injury or suspected occupational disease promptly to a supervisor, human resources department, or another designated employer representative.
Do not assume that a pre-existing diagnosis makes the injury ineligible for Wisconsin Worker’s Compensation. An employee may have degeneration and still experience a separate compensable workplace injury.
You should also obtain appropriate medical treatment and accurately explain both what happened at work and any relevant prior medical history.
Contact Gillick, Wicht, Gillick & Graf About A Wisconsin Degenerative Disc Disease Work Injury Claim
A pre-existing degenerative disc disease diagnosis can give an insurance company a reason to challenge whether your back or neck condition is work-related, but the existence of degeneration does not automatically defeat your claim. Wisconsin law requires a closer examination of whether employment caused a new injury or precipitated, aggravated, and accelerated an underlying degenerative condition beyond its normal progression.
At Gillick, Wicht, Gillick & Graf, we represent injured workers in Milwaukee and throughout Wisconsin. We examine the medical evidence, prior treatment history, workplace accident or occupational exposure, independent medical examination findings, disability issues, and the insurer’s causation arguments to determine how Wisconsin Worker’s Compensation law applies to the claim.
If your benefits have been denied, an insurance company is blaming your symptoms on degenerative disc disease, or you have questions about whether a pre-existing back or neck condition affects your right to benefits, contact our Milwaukee worker’s compensation lawyers at Gillick, Wicht, Gillick & Graf by calling 414-257-2667 to receive a free consultation. Our law offices are located in Milwaukee, and we represent injured workers throughout all of Wisconsin.
