Workers’ Compensation Benefits for “Unexplained” Work Injuries

In order to prove that an injury is compensable under workers’ compensation law, courts have typically held that you must prove that the condition occurred by accident “arising out of and in the course of the employment.”
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In many cases, this means that you have to show that but-for the conditions and obligations of employment, the worker would not have been in a position to sustain the injury.

In North Carolina, the section of the law addressing the “arising out of and in the course of” is found in G.S.97.2-6 of the state’s Workers’ Compensation Act. Winston-Salem workers’ compensation attorneys recognize that in cases where the injury may have happened at work but is unexplained, benefits may be tougher to secure – though certainly not impossible.

One such claim was recently fought in the case of City of Brighton v. Rodriguez, reviewed by the Colorado Supreme Court.

The facts of the case are this:

The plaintiff worked as a special events coordinator for a small city government office. One January morning, while walking to her office, she stopped atop a flight of concrete stairs and briefly talked with two co-workers who were at the bottom of the stairs. She then began to descend the stairs, which were observed to be unobstructed and dry.

Suddenly, the other workers would later testify, the woman pitched forward, stumbled and fell down the stairs, striking her head and losing consciousness. She could not remember whether she had tripped or slipped or lost her balance or whether there was some other factor at play. Prior to the fall, she had no indication of vision problems or dizziness or neck pain.

She was transported by ambulance to a nearby hospital, where a brain scan revealed four unruptured aneurysms. Several weeks later, she underwent surgery for this condition.

The fall itself resulted in head, neck and back injuries.

The city at first conceded general liability for the fall, but later sought to withdraw this claim after learning of her aneurysms, claiming that that the fall was caused by this, and not a result of any work-related condition. Alternatively, the city argued, the fall was simply “unexplained.” Either way, the city contended it was not responsible to pay workers’ compensation benefits.

One doctor would later offer the opinion that the fall was likely caused by a dizziness or fainting episode caused by the aneurysms. However, another doctor countered that the aneurysms were likely not the cause of the fall, as she had been asymptomatic prior to the incident.

The administrative law judge found that the fall was unexplained, and that the worker had failed to show that her injury “arose out of” her employment. She appealed.

The appellate court set aside the administrative law judge order, finding that because the city had initially admitted liability, it was up to the city to prove that her injuries did not “arise out of” employment. The appellate court found the city had not met this burden, and therefore granted the worker’s claim.

Upon review, the Colorado Supreme Court pointed out the city’s concession that the activity that caused her injuries – walking down the stairs to her office – was sufficiently work-related to be considered part of her employment. However, the city further argued that he did not provide sufficient causal connection between the work and her injuries.

The state supreme court disagreed. All injuries that cause risk fall into three categories: employment risks, personal risks and neutral risks. That last category involves risks that are not associated with either the employment itself or the employee. An unexplained fall, the court reasoned, constituted a neutral risk, not stemming from an occupational hazard or a personal risk.

The court determined that these kinds of injuries are considered to “arise out of” employment because they would not have occurred but-for employment. The employment causally contributed to the injury because it obligated the worker to be engaged in employment-related functions, duties or errands at the time of injury.

However, the “but-for” test does not relieve the worker of having to prove causation, and neither does it suggest that all injuries sustained at work are covered under workers’ compensation law.

In this case, though, the burden of proof was met by the employee and her benefits claim was approved.

If you have been injured at work in Winston-Salem, contact the Lee Law Offices at 800-887-1965.

Additional Resources:
City of Brighton v. Rodriguez, Feb. 3, 2014, Colorado Suprem Court

More Blog Entries
Third Party Liability Cases in Aftermath of Employee Injuries, Feb. 8, 2014, Winston-Salem Workers’ Compensation Lawyer Blog

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