The Lit-Up Doctrine Denied, in this Case

joint lubricationWhat is the “lit up” doctrine, you ask? In Washington, at least, the “lit up” doctrine means that if an accident at work lights up or activates a seemingly dormant or underlying condition, the resulting disability can be blamed on the work injury and not the preexisting condition.

Ana Zavala worked for Twin City Foods, but don’t let the name fool you because this all took place in Washington. She claims that before she injured her knee while she was cleaning in 2007 she had no knee pain and could walk just fine, but after the injury she has not been able to walk and is in pain. A month after her injury she was seen by an orthopedic surgeon, Dr. Kontogianis and an MRI showed that she tore the medial collateral ligament from the tibial insertion, as well as partially tore the posterior horn of the medial meniscus, and it found fluid in her knee. I’m no doctor but that doesn’t sound too good.

She applied for workers’ comp benefits in November of that year and her medical and time-loss benefits were approved by the Department of Labor and Industries.

That same doctor who checked her out after the accident did arthroscopic surgery to try and fix the damage, but during surgery they found that she had osteoarthritis. Also during surgery, the doctor gave her Synvisc to try and lubricate her knee and treat this osteoarthritis. She continued to receive time-loss benefits until June of 2008 when her claim was closed. She did receive permanent partial disability of 10 percent for the damage to her knee.

Zavala contested their decision to close her claim so it was reopened in December of 2008. Then closed again in August of 2009. But contested and reopened in October of 2009. Then Twin City Foods stepped in and said this is enough and tried to get her case closed once and for all. At the appeals hearing, her doctor said he attributed the torn medial meniscus to her injury at work but the degenerative change from the osteoarthritis came before that work injury. He said any further surgeries on her knee would be to fix her osteoarthritis, but that her industrial injury had reached MMI.

Another doctor, Dr. Patrick Bays, said he believed that the patient was reporting symptoms that did not really exist, as her reports do not fit with the normal anatomic pathways of her injury. Other doctors did not think that the industrial injury was aggravated by this work injury, and that she may have even had a prior injury that she did not report or fix. Her claim was closed by the courts, though she wanted them to pay for a total knee replacement that her doctors said would ease her pain. They did not think that her work injury, however, warranted the replacement but rather her osteoarthritis.

She appealed to the Franklin County Superior Court, saying that her work injury “lit up” her pre-existing condition. The judge said that since her condition was in place before the injury and it was a naturally progressing kind of disease, that degeneration of her knee would have happened anyway. Relying on the medical testimony, which convinced the courts much more than the testimony of her friends, the judge decided that her injury alone did not warrant a total knee replacement.

It was decided that Twin City Food could close her claim, because the damage from her industrial accident had reached its full healing potential and any other medical issues she had with her knee were from the pre-existing osteoarthritis, which was not aggravated by this injury.

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