In, Ex parte Reed Contracting Servs., Inc., No. 2150230, 2016 WL 360725 (Ala. Civ. App. Jan. 29, 2016), the plaintiff, Henry Riley (“Riley”), injured both of his knees and wrists during the course of his employment with his employer, Reed Contracting Services (“Reed”) when he fell from a man lift in March 2012. Id. at *1. Riley was diagnosed with a torn medial collateral ligament in his right knee, and osteoarthritis in both knees in the months after the accident. Riley’s knee injuries were initially treated conservatively with physical therapy. In 2014 Riley continued to complain of bilateral knee pain; however, his authorized treating physician, Dr. Cantrell, found that Riley’s ongoing complaints were related to arthritis that pre-existed the work-related injury, placed Riley at maximum medical improvement (“MMI”), and returned him to work. Dr. Cantrell testified Riley would benefit from bilateral knee replacements, and trauma from the accident could have caused Riley’s knees to become symptomatic, but maintained the surgeries would treat arthritis and not injuries from the fall. Id. at *3. Riley then paneled to Dr. Davis, who found that Riley’s pre-existing arthritis was aggravated by the work-related fall, and such accelerated the timing for the knee replacement surgery. Reed did not authorize the knee replacement surgeries. 

The trial court conducted a hearing at which Riley testified that he had been able to perform his job before the accident, and that pain in his knees prevented him from returning to work. The trial court considered the doctors’ testimony and other evidence, and found that the accident resulted in a “permanent aggravation” of Riley’s arthritic knees, and ordered Reed to authorize the surgeries. Id. at *4. The trial court also rejected Dr. Cantrell’s MMI date and ordered Reed to pay accrued temporary total disability benefits. Reed petitioned the Court of Civil Appeals for a writ of mandamus to vacate the trial court’s order. 

On appeal, the Court of Civil Appeals found that there was substantial evidence to support the trial court’s conclusion that Riley’s fall aggravated his pre-existing condition (arthritis) such that the bilateral knee replacement surgeries were compensable under the Act. Id. at *7. The Court noted that the work-related injury was only required to be a “contributing cause” of the injury requiring surgery. Furthermore, because Riley’s knee pain began after the fall and persisted ever since, the evidence supported the trial court’s finding that the fall caused a permanent aggravation. The Court also found that Riley had not reached MMI based on the need for further surgery. Id. at *9. Based on this decision, employers must remain aware of the complexity of pre-existing injury cases and the impact the “contributing cause” standard can have on them.