An Analysis of Post-2005 Work Injuries Involving Idiopathic Conditions MSIA ANNUAL CONFERENCE PRESENTED BY: ROSS C. BALL DATE: SEPTEMBER 22, 2014 St. Louis Chicago Kansas City 8000 Maryland Ave Suite 550 Clayton, MO 63105 314-721-3400 One North Franklin 11460 Tomahawk Creek Pkwy. Suite 1900 Suite 310 Chicago, Illinois 60606 Leawood, Kansas 66211 312-855-1105 816-761-3915
287.020.3(1) RSMo Definition of Injury: 1) Arises out of and in the course of employment; and 2) Is the prevailing factor in causing both the resulting medical condition and disability.
287.020.3(2) RSMo An injury arises out of and in the course of employment only if: (a) It is reasonably apparent, upon consideration of all the circumstances, that the accident is the prevailing factor in causing the injury; and (b) It does not come from a hazard or risk unrelated to the employment to which workers would have been equally exposed outside of and unrelated to the employment in normal nonemployment life.
287.020.3(3) and (4) RSMo (3) An injury resulting directly or indirectly from idiopathic causes is not compensable. (added in 2005 Amendments) (4) A cardiovascular, pulmonary, respiratory, or other disease, or cerebrovascular accident or myocardial infarction suffered by a worker is an injury only if the accident is the prevailing factor in causing the resulting medical condition.
What is an Idiopathic Condition? Dictionary/Medical Definition vs. Legal Definition Dictionary/Medical Definition: a disease or condition of unknown cause. Legal Definition: an event that is self-originating. The cause is personal to the claimant and unrelated to the claimant s job. It is peculiar to the individual, innate. Alexander v. D.L. Sitton Motor Lines, 851 S.W.2d 525 (Mo. banc 1993).
Pre-2005 Analysis: Increased Risk Alexander v. D.L. Sitton Motor Lines, 851 S.W.2d 525 (Mo. banc 1993) - MO Supreme Court held that a causal connection is established if the conditions of the workplace contributed to cause the accident, even if the precipitating cause was idiopathic. - The Court specifically stated that even though a heart attack, itself, is not compensable, injuries sustained in a fall as a result of the heart attack would be compensable, assuming there is a causal connection between the fall and the workplace.
Alexander Superseded and Overruled Ahern v. P&H, LLC, 254 S.W.3d 129 (Mo. App. 2008) - The Eastern District held that in light of the addition of 287.020.3(3) the increased risk analysis can no longer be applied to idiopathic injury cases. - However, the Court held in favor of Alexander s definition of idiopathic as referring to an event peculiar to the individual but not necessarily an in-born condition or one that is the result of multiple causes.
More from Ahern - The Eastern District held that Alexander s definition of idiopathic is still applicable because 287.020.10, which rejects and abrogates earlier case law interpretations of "accident", "occupational disease", "arising out of", and "in the course of the employment", is silent regarding the definition of idiopathic. - Unless a statute clearly abrogates common law by express statement or by implication, the common law stands. Mikah v. Central Bank of Kansas City, 112 S.W.3d 82, 90 (Mo. App. 2003).
Distinguishing Peculiar to the Individual Taylor v. Contract Freighters, Inc., 315 S.W.3d 379 (Mo. App. 2010) - An over-the-road truck driver s smoker s cough was not proven to be an idiopathic condition because it was not a diagnosed medical condition that was peculiar to him. - The court felt that to find otherwise would unfairly require any claimant whose injury might be associated with a cough or sneeze to prove what caused that particular cough or sneeze and that this is an unreasonable burden.
Taylor s Step-by-Step Analysis - Did employee sustain an accident arising out of and in the course of employment? - If so, did the accident result in personal injuries? - If so, did employer prove the injuries resulted directly or indirectly from idiopathic causes? - If so, the injuries are not compensable under Chapter 287.
Other Case Law
Crumpler v. Wal-Mart Assocs., 286 S.W.3d 270 (Mo. App. 2009) - Insulin-dependent diabetic worker requested a lunch break from supervisor. The lunch break was denied and worker passed out soon thereafter due to low blood sugar. - The ALJ, Commission, and Southern District all concluded claimant collapsed due to an idiopathic condition peculiar to herself: her diabetic condition.
Crumpler Cont d - The Southern District held that Since [claimant] had passed out numerous times away from work, and recalled no warning symptoms on this occasion, her work-relatedness claim must be proven by medical testimony, without which a finding for claimant would be based on mere conjecture and speculation and not on substantial evidence.
Stricker v. Children s Mercy Hosp., 304 S.W.3d 189 (Mo. App. 2009) - A nurse fell and injured her ankle in employer s parking garage. She attributed the fall to the heel of her work shoes Dansko clogs that she was wearing at the time. - Employer asserted on appeal that the injury was caused by an idiopathic condition her decision to wear the Dansko clogs and not a work condition, rendering the injury noncompensable.
Stricker Cont d - The Western District summarily dismissed employer s assertion that this injury resulted from an idiopathic cause holding the record supported the Commission s finding that the Dansko clogs were work shoes, based on claimant s testimony and her supervisor s testimony. - Interestingly, the court did not even discuss whether the condition was peculiar to the claimant.
Recent Commission Decisions
Wright v. Sitton Motor Lines; SIF, 2013 MOWCLR LEXIS 56 (March 26, 2013) - A truck driver who suffered from preexisting Meniere s disease fell when her foot caught and twisted on a concrete offset. She sustained a right wrist fracture. - Employer/Insurer settled and claimant proceeded to trial against the SIF. The SIF argued claimant did not sustain a compensable primary injury because the fall was a result of an idiopathic condition: her Meniere s disease.
Wright Cont d - The Commission held that it was the SIF s burden to prove that the claimant fell as a result of her Meniere s disease and it failed to meet this burden because: (1) Claimant provided the only firsthand account of the fall and specifically testified that she was not suffering from Meniere srelated symptoms at the time of the fall; (2) The SIF s vocational expert did not identify any source for his believe that Meniere s-related dizziness played a role in causing claimant to fall; and (3) Even if the SIF s vocational expert did identify a source for this belief, he is not a medical expert and not qualified to opine regarding the effects of Meniere s disease.
No Memory of the Accident
Maderazo v. Dillard s, Inc., 2011 MOWCLR LEXIS 256 (December 8, 2011) - Claimant was from the Philippines and spoke very poor English. She had advanced arthritis in both knees. - She fell and broke her hip at work. At first, she could not remember how she fell, but later testified that her fall was caused by a swinging door striking and catching her foot. - The Commission majority affirmed the ALJ s decision that the injury was not the result of an idiopathic condition.
Maderazo Cont d - The ALJ placed a great amount of emphasis on claimant s poor English skills and also found it understandable that she initially stated she just fell considering the extreme pain she was experiencing when that first account was given.
Burt v. Reckitt Benckiser, 2012 MOWCLR LEXIS 118 (June 20, 2012) - Claimant fell down stairs in a factory. He was diagnosed with syncope and collapse. He had no memory of the fall. He testified as to two instances of passing out when he was approximately 10 years of age and a family history of seizures. - The ALJ found that claimant suffered a syncopal episode that caused him to fall. The ALJ stated that claimant failed to prove that his fall was related to the fact that he was on stairs and there was evidentiary support demonstrating that he fell due to an idiopathic condition.
Burt Cont d - Applying the Step-by-Step analysis from Taylor, the Commission held that claimant failed to prove that his injury arose out of and in the course of his employment. - Therefore, the Commission held that there was no need to even analyze whether claimant s injuries resulted directly or indirectly from an idiopathic cause.
Green v. MO Dept. of Corrections, 2013 MOWCLR LEXIS 178 (September 19, 2013) - The claimant was a truck driver with well documented COPD, a heart condition, and throat cancer. All of these conditions caused him to be easily fatigued. - He woke up from an auto accident with no memory of how the accident occurred. He simply recalled looking in the rearview mirror and then waking up in a ditch. - Claimant alleged that a can of ether had leaked into the cab and caused him to pass out. Employer asserted that he passed out due to an idiopathic condition.
Green Cont d - The Commission affirmed the ALJ s determination that claimant suffered a transient cardiac arrhythmia event due to his underlying coronary artery disease, an idiopathic condition, while driving employer s vehicle. - The ALJ found that claimant failed to prove that the ether caused him to pass out and it was more likely true than not true that he passed out due to an idiopathic cause, a cardiovascular event.
Byrd v. Hussmann Refrigeration; SIF, 2014 MOWCLR LEXIS 82 (June 17, 2014) - Claimant was driving a hyster (forklift) when it locked up and threw him off. Claimant first reported he remembered falling, but later said he did not remember anything that happened. - He reported feeling dizzy when he showed up at work that day. The hospital records also indicated he reported feeling dizzy most of the day. He had started a new blood pressure medication the week before. At the ER he was diagnosed with syncope and collapse, and renal insufficiency. - Claimant alleged that the hyster locked up and threw him because it ran out of power. Employer alleged that he passed out due to an idiopathic condition.
Byrd Cont d - The ALJ found that claimant fainted, which caused him to fall off the hyster. Claimant failed to meet his burden. - The ALJ found it persuasive that even claimant s medical expert testified that claimant s renal insufficiency was probably the reason for the syncopal episode. - The Commission supplemented the award by stating it was at least equally likely claimant s fall from the hyster was the result of an idiopathic syncopal event unrelated to his employment and, therefore, affirmed the ALJ s decision that claimant did not carry his burden of proof.
Practice Points - Follow the Step-by-Step Analysis provided in Taylor. - Claimant s contemporaneous statements are extremely important. - Establishing a preexisting idiopathic condition is usually going to require a prior medical diagnosis of the condition (i.e., a generalized smoker s cough was insufficient).
Questions???