Regarding Workers' Compensation (WC) Insurance, ignorance is definitely not bliss. In fact, ignorance can cost your company a lot of money when it comes to WC claims. Therefore, the more you understand medical terminology, the better you'll be able to control Workers' Compensation costs.
Two terms you may see physicians use in a WC claim are "aggravation" and "exacerbation." Sometimes, the terms are used interchangeably, but there is a subtle difference in the definition of each. Both describe the worsening of an existing medical condition.
Aggravation Vs. Exacerbation
The difference is that Exacerbation is "a temporary increase in the symptoms of a pre-existing condition that returns to its prior level within a reasonable period of time (typically two to eight weeks)." An aggravation is "an increase in the severity of a pre-existing condition where the underlying pathology is permanently moved to a higher level."
In Pennsylvania, pre-existing injuries or conditions that are aggravated or exacerbated on the job typically qualify for Workers' Compensation benefits. An injury that is exacerbated or aggravated at work does not change the diagnosis or location of the injury or condition; it just means it was made worse by a work-related activity. However, an aggravated injury will have a bigger impact on the cost of a WC claim.
So, regarding Workers' Compensation claims, the question becomes, "When will the symptoms end?" Are WC benefits limited to a few weeks or indefinite? Medical costs are constantly rising, so insurance carriers don't want to pay for treatments that do not fall within the purview of their responsibility.
Therefore, adjusters will always review medical records, especially with an aggravated injury. Often, they will request an Independent Medical Evaluation (IME) to determine whether the pre-existing condition has been aggravated or exacerbated, which will either move the case along or cause it to be disputed.
Common Causes Of Aggravated and Exacerbated Injuries and Conditions
Any injury or condition that is made worse by a work-related activity can result in a WC claim for an aggravated or exacerbated injury or condition. However, various forms of arthritis are pre-existing medical conditions commonly exacerbated or aggravated at work.
There are more than 150 types of arthritis, such as degenerative disc disease, bone spurring, osteophytes, spondylolistheses, and spondylosis. Many can be caused by disease, infection, genetic defect, injury, or overuse; sometimes, the cause is unknown. Arthritis symptoms include pain, stiffness, inflammation, reduced mobility, and skin redness around a joint.
According to the Centers for Disease Control and Prevention (CDC), an estimated 53.2 million (21.2%) American adults have been diagnosed with some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. Furthermore, while many people might assume that arthritis is limited to older workers, 5% of people ages 18-44 and 26% of people ages 45-64 have been diagnosed with arthritis.
Repetitive stress injuries, such as chronic back pain, tennis elbow, and carpal tunnel syndrome, are another common cause of aggravated or exacerbated WC claims. Federal laws require that employers accommodate employees to help prevent repetitive stress injuries. Furthermore, minimizing the risk of a repetitive stress injury can help lower employee absenteeism, improve productivity, lower the risk of aggravated or exacerbated injuries, and lower WC costs, making it a win-win situation.
Lower Your Workers' Compensation Insurance Costs!
Understanding the difference between aggravated and exacerbated injuries and conditions is just one way to lower Workers' Compensation costs. Another way is to work with one of the experienced agents at American Insuring Group, who specializes in WC insurance.
As independent agents, we work hard to get you the lowest price on all your insurance needs by comparing costs among many competing insurance companies.
So call us today at (800) 947-1270 or (610) 775-3848, or connect with us online.
