Policy
WorkSafeNB adjudicates all claims for entitlement to compensation using subsections 7(1) and then 7(2) or 7(2.1), as applicable, of the WC Act and the criteria set out in Policy 21-100 Conditions for Entitlement – General Principles. Subsection 7(5) is not used when determining initial entitlement to compensation for claims involving a worker’s pre-existing condition.
Entitlement for claims involving a worker’s pre-existing condition is accepted when:
Once entitlement is accepted, WorkSafeNB determines the clinical effect of the accepted injury on the worker’s pre-existing condition in order to determine the scope and nature of compensation to be provided.
When the clinical effect of an accepted injury is an exacerbation of a worker’s pre-existing condition, WorkSafeNB provides medical aid and/or loss of earnings benefits until the exacerbation has returned to its usual, pre-injury state.
When the clinical effect of an accepted injury is an aggravation of a worker’s pre-existing condition, WorkSafeNB treats the aggravation with the appropriate medical aid and establishes the impact, if any, of the aggravation on the worker’s loss of earnings.
WorkSafeNB does not pay for medical aid or loss of earnings benefits resulting from the natural progression of a worker’s pre-existing condition.
Interpretation
- In instances where a primary compensable injury has impacted the pre-existing condition to the point that it has caused a secondary injury, all conditions for entitlement under subsection 7(1) of the WC Act and Policy 21-100 Conditions for Entitlement – General Principles have been met by virtue of the primary compensable injury.
- WorkSafeNB determines entitlement to compensation related to a worker’s pre-existing condition regardless of whether the worker was previously aware of their pre-existing condition, experienced symptoms or had been treated for the pre-existing condition.
- To determine entitlement, WorkSafeNB gathers and weighs evidence. WorkSafeNB also gathers and weighs evidence to determine whether the clinical effect of the accepted injury is an exacerbation or aggravation of the worker’s pre-existing condition. See Policy 21-113 Decision-making.
- When evidence supports that probability, WorkSafeNB provides medical aid and/or loss of earnings benefits it considers necessary related to the exacerbation or aggravation.
- WorkSafeNB has the authority to make determinations on the nature of a worker’s injury on an ongoing basis pursuant to section 46 of the WC Act. This means that as part of the ongoing management of a worker’s claim, WorkSafeNB may obtain evidence confirming that an exacerbation of a pre-existing condition has become an aggravation of a pre-existing condition.
- Evidence may also show the pre-existing condition was the cause of the workplace accident. In this case, WorkSafeNB may accept a claim for the injury sustained by the accident if the inherent risks of the industry or the work contributed to the severity of the injury.
- When a pre-existing condition has not been impacted but becomes the dominant cause of a worker’s inability to return to work or participate in rehabilitation, WorkSafeNB determines if benefits should continue. See Policy 21-214 Determining Continued Eligibility for Loss of Earnings Benefits.
- Employers may be entitled to cost-relief for claims involving pre-existing conditions. See Policy 21-300 Allocation of Claim Costs.
Aggravation – with respect to an injury by accident, means a permanent clinical effect of the injury on a pre-existing disease or condition. (WC Act)
Clinical effect – a clinically observable adverse impact.
Exacerbation – with respect to an injury by accident, means a temporary clinical effect of the injury on a pre-existing disease or condition. (WC Act)
Pre-existing condition – a medical condition that existed prior to the compensable injury.
