What is a Concurrent Condition and How Does it Affect Temporary Disability Benefits?
On June 6, 2017, the WCB Alberta announced changes to policies regarding the application of cost relief for concurrent conditions, directly affecting Policy 04-02, Part II, Application 1, paragraph 11 and Policy 05-02, Part II, Application 1. The proposed changes were put forward on December 8, 2016 and the WCB welcomed comments and input until March 9, 2017. More details on the possible implications of the proposed changes can be found on our blog.
Now that the policy changes have been implemented, what exactly has changed, and how does it affect employers? Let’s take a closer look:
By WCB definition, a concurrent condition refers to a non-compensable condition that exists at the same time as a compensable disability. The onset or identification of a concurrent condition can occur either before or after a compensable accident and may or may not have an impact on a worker’s recovery from a compensable injury.
Concurrent conditions include underlying disease processes (like diabetes, cancer, kidney disease, etc.) and short term medical situations (such as pregnancy, gallbladder surgery and non-compensable injuries to other parts of the body).
In many cases, concurrent conditions do not affect work-related injuries at all; the treatment plan, healing period, recovery and rehabilitation processes are exactly the same as if the concurrent condition did not exist. In theses instances, the costs associated with a claim are all directly attributable to the work-related injury sustained.
However, there are times when a concurrent condition, or personal risk factor as noted above, will impede or interfere with an injured worker’s recovery and/or return to work. This is when employers need to pay particular attention to their WCB claims.
Although the WCB does not recognize personal risk factors like obesity, smoking and drug or alcohol addiction as concurrent conditions per se, it does recognize that a concurrent condition can be a disease that arises as a result of personal risk factors (such as Type 2 Diabetes, lung cancer, cirrhosis of the liver). It is when these diagnoses or diseases impact the recovery from a work-related injury or illness that employers are able to seek cost relief on a claim.
The changes in policy now more clearly define when cost relief may be applicable and instances where personal risks factors may allow for the provision of cost relief. Policy 05-02 Part II, Application 1, Question 3 states, in part:
Cost relief is not provided for personal risk factors such as obesity, smoking, and alcohol or drug addiction, unless the risk factor results in a delay in the worker’s ability to participate in treatment for the compensable injury or return-to-work services. Examples include a delay in undergoing surgery until the worker ceases smoking; a delay in surgery or other treatment until the worker loses weight; a delay in participation in return-to-work services while the worker is undergoing treatment for addiction.
The workers’ compensation system was designed to provide benefits, including wage loss, health care, rehabilitation and vocational services related to compensable injuries and illnesses. It was never intended to be a replacement for provincial health care, government assistance and/or company-provided short or long term disability benefits.
Responsibility lies with the employer to ensure that all the costs associated with their WCB claims are related to the injuries sustained. With these policy changes, it becomes even more important than ever that employers scrutinize their WCB claims and advocate for fairness with regard to their claims costs.
Employers need to be diligent in situations such as these to help ensure that exorbitant claim costs are not accrued as a result of concurrent/non compensable conditions. These amounts can certainly lead to an increase in experience rated claims costs and associated premiums.
The WCB does not automatically apply cost relief policies during the claim process. Most often it is employers or their representatives that must initiate cost relief requests and at times, pursue subsequent review and appeal actions to the Dispute Resolutions and Decision Review Board (DRDRB) and the Appeals Commission (AC) for Alberta Workers’ Compensation, in order to get extraneous costs removed.
If you would like further information regarding changes to the WCB policies, how concurrent conditions are impacting your WCB claims and associated premiums or if you require assistance with your WCB concerns, you can contact us directly at [email protected], [email protected], by phone, at 1-844-377-9545 or you can connect with us on Facebook , Twitter , or LinkedIn.