Nothing in this article should be taken as legal advice. Every case is different.
Yes. In Virginia, if your work injury causes a second injury, such as a knee or hip that wears down from months of limping on a broken ankle, the second injury can be covered under your workers’ comp claim. Virginia calls this a “compensable consequence.” The catch is proof: a doctor has to connect the new problem directly to the original injury, and the insurance company will usually argue it came from age, arthritis, or something else.
What Is a Compensable Consequence in Virginia?
A compensable consequence is a new injury or condition that flows directly from an injury already covered by workers’ comp. The Supreme Court of Virginia has said that every natural consequence that flows from a work injury is compensable if it is a direct and natural result of that injury (Leonard v. Arnold, 218 Va. 210 (1977)). The second injury is treated as if it happened on the job, even if it actually happened at home.
My Other Knee Hurts From Limping. Is That Covered?
It can be, if your doctor says the limp more likely than not caused or worsened the knee problem. When you protect one leg for months, the other leg, your hips, and your back carry the extra load.
Virginia courts have covered this kind of slow, wear-and-tear consequence. In a published case, a worker with a back injury developed a serious condition in both hips. His doctor wrote that the hips had been made worse by his back surgery and by the way he had to protect his back. The Court of Appeals held that the employer was responsible for the hip treatment and the time out of work (Williams Industries, Inc. v. Wagoner, 24 Va. App. 181 (1997)).
In another published case, a worker’s back injury changed the way he walked, and his treating doctor tied his knee pain to those “gait deviations.” The Court of Appeals held the knee was a compensable consequence, even though it developed gradually (Allen & Rocks, Inc. v. Briggs, 28 Va. App. 662 (1998)).
The same idea runs in any direction. In one Commission case, a worker’s injured knee caused frequent falls, and in one of them she hurt her ankle, and the Commission held the ankle was a compensable consequence of the knee. It also ordered the insurance company to pay for a stair lift or downstairs bathroom because she could no longer safely use her stairs (Johnson v. Hall Chevrolet, VWC No. VA00001414230 (Mar. 15, 2021)). Commission opinions like this one are not binding on later cases.
What Other Injuries Count as Compensable Consequences?
Virginia courts and the Commission have covered several kinds of second injuries that grow out of a work injury:
| What happened | Covered? | Source |
|---|---|---|
| Your injured knee or ankle gives way and you fall, hurting another body part | Yes, if the original injury caused the fall | Bartholow Drywall Co. v. Hill, 12 Va. App. 790 (1991) (back weakness caused a fall that injured a wrist); Amoco Foam Products Co. v. Johnson, 257 Va. 29 (1999) (ankle gave way, knee injury covered) |
| You fall while on crutches the doctor gave you | Yes | Leonard v. Arnold |
| You are hurt in a car wreck on the way to authorized treatment for the work injury | Yes, in the leading case | Immer & Co. v. Brosnahan, 207 Va. 720 (1967), as described in Merck & Co. v. Vincent (Va. 2021) |
| Medication for the work injury makes you dizzy and you fall | Covered in one case, where a deputy commissioner’s award was not appealed | Merck & Co. v. Vincent |
| Stress from the injury causes depression, or makes existing depression worse | Yes, the resulting disability can be covered | Farmington Country Club, Inc. v. Marshall, 47 Va. App. 15 (2005) |
The Supreme Court has also described the rule as growing out of cases where a worker was hurt during medical treatment for the original injury (Merck & Co. v. Vincent). An injury during physical therapy for the work injury fits that description, though each case turns on its facts.
Where the Chain Breaks: A “Consequence of a Consequence”
Virginia does not cover an injury that traces back to the work accident only through another consequence. Each new injury has to be directly linked to the original work injury, not linked to it only through a second injury.
The leading case is an ankle-to-knee case. A worker injured her left ankle at work. While recovering from ankle surgery, the ankle gave way, she fell, and she hurt her right knee. That knee injury was covered. About 15 months later, her right knee buckled, she fell again, and she hurt the knee further. Her own doctor blamed the second fall on the pain from the first knee injury. The Supreme Court of Virginia held the second knee injury was not covered, because the link of causation must directly connect the original work injury with the new injury (Amoco Foam Products Co. v. Johnson, 257 Va. 29 (1999)). Notice what the Court did not take away: her 20% permanent loss of use of the right leg from the first knee injury stayed in place.
The same rule applies to mental health. When a wrist injury caused depression, and the depression was said to cause a brain injury, the brain injury was not covered (Paul Johnson Plastering v. Johnson, 265 Va. 237 (2003)).
For an ankle, knee, and hip chain, this is where claims are won or lost. If your doctor writes that your hip hurts “because of your knee,” the insurance company will say the hip is a consequence of a consequence. If the doctor writes that your hip is the result of the altered gait from your ankle injury, the link runs straight back to the work accident. Same hip, different result. Which is accurate is a medical question, and the doctor’s exact words matter.
What Proof Does Virginia Require?
You need medical evidence that the work injury more likely than not caused the second problem. A doctor’s note that the limp “may” have caused your knee pain is not enough. The Court of Appeals has held that an opinion based on a possibility does not prove causation (Farmington Country Club, Inc. v. Marshall).
Medical opinions are not the only evidence. Your own testimony about how the fall happened can help, and the Commission weighs all of it (same case). But in a gradual case, the treating doctor’s written opinion usually decides it.
What Should You Do When a Second Body Part Starts Hurting?
- Tell your treating doctor right away. Say which body part hurts, when it started, and that you have been limping or favoring the injury. If it isn’t in the records, the insurance company will say it didn’t happen.
- Ask the doctor to write whether the new problem comes from the work injury. The useful opinion says it is more likely than not caused or made worse by the original injury, or by the limp or treatment it required.
- If you fell, report the fall to your employer in writing within 30 days. A fall caused by your injury is treated as a new accident for notice and filing purposes, even though it is covered through your original injury (Leonard v. Arnold; Va. Code § 65.2-600).
- Tell the insurance company in writing, and file with the Commission. Telling the adjuster is not the same as a claim. File a claim with the Virginia Workers’ Compensation Commission listing the new body part and the benefits you want. Always file, even if the adjuster says the insurance company will take care of it.
How Long Do You Have?
If the second injury came from a new fall or accident, the two-year filing deadline runs from the date of that new accident, not the original one. In the crutches case, the worker lost his claim for his neck injuries because he did not file in time after the fall, even though everyone agreed the injuries were covered (Leonard v. Arnold; Bartholow Drywall Co. v. Hill; Va. Code § 65.2-601).
When the second problem builds up slowly from the limp, with no new fall, Virginia treats it as a change in condition of the original injury, not a new accident (Bartholow Drywall Co. v. Hill). If you already have an award, a request for more wage benefits generally has to be filed within 24 months of the last day for which wage benefits were paid under that award, or 36 months for a permanent disability rating (Va. Code § 65.2-708). That deadline does not apply to medical treatment (Prophet v. Bullock Corp., 59 Va. App. 313 (2011)). If no award has been entered yet, the timing depends on the facts. Don’t wait to find out which clock is running. File as soon as a doctor connects the new problem to your injury.
How Does the Insurance Company Fight These Claims?
Here are a few of many defenses insurance companies raise against a compensable consequence:
- “It’s arthritis, or just your age.” In the Amoco Foam case, the insurance company’s doctor called the knee problem a “degenerative process” unrelated to the ankle. Expect an X-ray or MRI showing wear to be used this way. A work injury that materially aggravates or speeds up an existing condition can still be covered (Farmington Country Club, Inc. v. Marshall), but your doctor has to say so.
- “It came from something else.” Yard work, a weekend fall, an old sports injury.
- “Too much time passed.” The longer the gap between the limp and the first mention of knee pain in your records, the easier this argument becomes.
- “It’s a consequence of a consequence.” As explained above, this can defeat a hip claim built on a knee claim.
- “Your doctor only said it’s possible.” A “may” or “could” opinion invites a denial.
The insurance company is required to provide necessary medical treatment for a covered injury, as long as necessary (Va. Code § 65.2-603). That doesn’t mean it will. If it denies the knee or hip, you can ask the Commission for a hearing.
What Does a Compensable Consequence Do to Your Claim’s Value?
A covered second injury brings its own medical care, wage benefits, and permanent disability rating. If your ankle injury leads to a damaged knee on the other leg, that knee can be rated separately as a loss of use of that leg, which Virginia pays at up to 175 weeks for a total loss (Va. Code § 65.2-503). Here’s more on how impairment ratings work in Virginia.
The law changed in 2022 for the most serious cases. Virginia pays lifetime benefits for losing the use of two members, such as both legs. Before 2022, the Supreme Court of Virginia held that this applied only if both were lost in the same accident, so a second leg lost through a compensable consequence did not count (Merck & Co. v. Vincent (Va. 2021)). The General Assembly then amended the statute. It now covers the loss of two members “either from the same accident or a compensable consequence of an injury sustained in the original accident” (Va. Code § 65.2-503(C)(1)). The amendment does not say whether it applies to accidents that happened before it took effect, and we found no appellate decision on that question.
Why Settlement Timing Matters
A settlement is optional, and the Commission must approve it (Va. Code § 65.2-701). A full and final settlement can end your right to future benefits for the accident, and depending on its terms, that can include a knee or hip problem you haven’t claimed yet. If your other knee is starting to ache, the time to sort that out is before you settle, not after.
Pathfinder obtained a $1,200,000 settlement in a heavily contested ankle injury case with bodywide CRPS involvement and multiple compensable consequences. Every case is different, and past results don’t predict the result in yours. For more on the original injuries, see our guides to ankle injuries at work, knee injuries at work, and hip injuries at work.
Compensable Consequence Questions
Can I add a body part to my workers’ comp claim in Virginia?
Yes, if a doctor connects it to your work accident. If the body part was hurt in the original accident, it should be claimed as part of that accident. If it was hurt later because of the original injury, it is claimed as a compensable consequence. Either way, file a claim with the Commission that names the body part. Don’t rely on the insurance company to add it.
What if the second injury is worse than the first?
That happens. A limp after an Achilles tendon rupture can lead to a knee or hip that needs more treatment than the ankle did. The second injury is judged on its own medical evidence, and it can carry its own rating and wage benefits.
Talk to Pathfinder Injury Law About Your Second Injury
Pathfinder Injury Law handles only Virginia workers’ compensation claims. Call 804-505-0633 or use our online contact form.
