In California workers’ compensation cases, the distinction between exacerbation of an injury and aggravation of an injury can have a significant impact on a claim’s outcome. While these terms may sound similar, they are legally distinct, and understanding their differences is crucial for injured workers, employers, and claims adjusters.
What Is an Exacerbation of an Injury?
An exacerbation occurs when a pre-existing injury or condition temporarily worsens due to work-related activities. Importantly, this temporary worsening is not considered a new injury but rather an intensification of symptoms that eventually return to their pre-worsened state.
Example:
A worker with chronic back pain lifts a heavy object at work, causing a temporary flare-up of pain. After a few weeks of rest or treatment, their condition returns to its baseline level of discomfort.
Key Characteristics:
- Temporary worsening of symptoms.
- No permanent change to the underlying condition.
- Does not generally result in increased permanent disability.
What Is an Aggravation of an Injury?
An aggravation refers to a work-related event or activity that causes a permanent worsening of a pre-existing condition. This is treated as a new injury under California workers’ compensation law and may increase the worker’s overall disability rating or require additional medical treatment.
Example:
A worker with pre-existing arthritis in their knee suffers a workplace fall, permanently damaging the joint and accelerating the progression of their arthritis.
Key Characteristics:
- Permanent worsening of the condition.
- Creates additional medical issues or disability beyond the pre-existing state.
- Treated as a compensable new injury in most cases.
Why the Distinction Matters
The difference between exacerbation and aggravation is critical when determining eligibility for benefits, liability for medical treatment, and potential compensation.
- Medical Treatment: In cases of exacerbation, an employer may be responsible only for addressing the temporary flare-up. For aggravation, however, the employer could be liable for the full extent of treatment related to the worsened condition.
- Permanent Disability Benefits: An aggravation may lead to increased disability payments, while an exacerbation usually does not affect the worker’s permanent disability rating.
- Apportionment of Disability: Under California law, if a worker’s permanent disability results from an aggravation of a pre-existing condition, the disability may be apportioned, meaning the employer may not be liable for the entirety of the worker’s condition.
Proving Exacerbation vs. Aggravation
Medical evidence is often the key to determining whether a case involves an exacerbation or an aggravation. Workers should seek an evaluation from a Qualified Medical Evaluator (QME) or an Agreed Medical Evaluator (AME) to establish the nature and extent of the injury. This distinction can be contentious and may require detailed documentation and expert testimony.
