Texas Widow Prevails In Death Claim Case By Showing Husband’s Drug Overdose Could Have Been Caused By Side Effects of Prescription Pain Medication

It is axiomatic in workers’ compensation law that a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, is compensable if it is the direct and natural result of a compensable primary injury [see Larson’s Workers’ Compensation Law, § 10.01 et seq]. The most basic application of this principle is the rule that all the medical consequences and sequel that flow from the primary injury are compensable. The cases illustrating this rule fall into two groups.

Range of Compensable Consequences

The first group, about which there is little legal controversy, comprises the cases in which an initial medical condition itself progresses into complications more serious than the original injury; the added complications are almost always compensable [see Larson, § 10.02]. The second group of medical-causation cases comprises the cases in which the existence of the primary compensable injury in some way exacerbates the effects of an independent medical weakness or disease. The causal sequence in these cases may be more indirect or complex, but as long as the causal connection is in fact present the compensability of the subsequent condition is beyond question.

Intervening Causes, Such as Medication Overdose

In some circumstances, for example, when pain medication is prescribed for an employee’s work-related injury and that employee later dies from an overdose of that medicine, the issue arises as to whether the causal connection with the original injury is still present in any significant way. Indeed, has there been a sufficient break in the chain of causation such that the death is not compensable? A Texas appellate court dealt with just that issue recently in Commerce & Industry Ins. Co. v. Ferguson-Stewart, Case Number 13-10-00554-CV ((Tex. App.—Corpus Christi-Edenberg [13th Dist.] May 10, 2012). The appellate court, affirming a decision by a state trial court, held that under the facts of the particular case, because evidence showed the employee became disoriented, forgetful, and confused as a side effect of taking the medication, his death could indeed be compensable.   Continue reading

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Oklahoma Opt Out Legislation Fails: A Post Mortem

By Thomas A. Robinson

Late last Wednesday evening (April 25th), supporters of a controversial bill that would have allowed some Oklahoma employers to “opt out” of the state’s traditional workers’ compensation system [see Oklahoma House Bill 2155] fell short of having sufficient votes to move the legislation through the Oklahoma House of Representatives and on to the state’s Governor. The measure would have allowed qualifying employers to establish written benefit plans pursuant to the Employment Retirement Income Security Act of 1974 (ERISA) in lieu of the existing state system. While the ERISA plans would have been required to provide benefits at the same or higher level as under current law, critics, pointing to somewhat similar plans established by opt out employers in nearby Texas, said the practical effect of House Bill 2155 would have been to diminish significantly the disability and medical benefits injured workers might receive in Oklahoma.

The vote–42 in favor and 50 against—surprised many since an earlier version, containing many of the same provisions, had passed in the House in mid-March by a margin of greater than 3 to 1. Following that favorable House vote, the bill eased its way through the Oklahoma Senate on April 18 by a 28-17 vote, although in a somewhat different form. I’ve held off writing the H.B. 2155 obituary—a last minute legislative maneuver as the bill was going down in defeat allowed for the possibility that the measure might be brought back up for a vote at any time through the close of yesterday’s House session. That deadline has now passed without a new vote; the bill has now officially succumbed.   Continue reading

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Oklahoma’s Controversial “Opt Out” Legislation Fails (At Least Temporarily)

Late Wednesday evening, supporters of a controversial bill that would allow some Oklahoma employers to “opt out” of the state’s traditional workers’ compensation system [see Oklahoma House Bill 2155] fell short of having sufficient votes to move the legislation through the Oklahoma House of Representatives. With 42 House members voting in favor of the bill and 50 members voting against, it appears unlikely that the measure will become law. On April 18, the Oklahoma Senate had passed the bill, by a 28-17 vote. Many were surprised by Wednesday’s negative vote since an earlier version of the bill, with many of the same provisions, had actually passed in the House in mid-March by a margin of greater than 3 to 1.

House Bill 2155 would allow qualifying employers to establish written benefit plans pursuant to the Employment Retirement Income Security Act of 1974 (ERISA). While the ERISA plans would be required to provide benefits at the same or higher level as under current law, some critics, pointing to somewhat similar plans established by opt out employers in Texas, say the practical effect of House Bill 2155 would be to diminish significantly the disability and medical benefits injured workers might receive in Oklahoma.

An Oklahoma colleague told me earlier today that “the bill is in its coffin, but the lid isn’t nailed down quite yet.” Using a legislative maneuver that’s a bit over my apolitical head, the Speaker of the Oklahoma House can apparently bring the matter back up for a vote within three legislative days of Wednesday’s unsuccessful balloting. It was not brought up yesterday (Thursday). The House is recessed today, so it would appear that supporters have until COB Tuesday to garner the votes necessary to favorably pass on the matter. I’ll keep you posted.

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The Fight Against Workers’ Compensation Fraud Takes Many Forms–Florida Goes After Unscrupulous Check Cashing Firms

In August 2007, the Supreme Court of Florida ordered the empanelment of a statewide grand jury to investigate various criminal offenses, including activities related to check cashers. In 2008, the grand jury issued its report and the state legislature enacted major reforms recommended in the report to provide greater regulatory and enforcement tools of the Office of Financial Regulations (“OFR”), which is responsible for licensing money service businesses (“MSBs”). In 2011, Florida commissioned the Money Service Business Facilitated – Workers’ Compensation Work Group (the “work group”) to study the issue of workers’ compensation premium fraud, as facilitated by check cashers. The work group determined that the problem is most prevalent within Florida’s construction industry. On May 6, Governor Rick Scott signed House Bill 1277 into law to assist in the fight against premium fraud. The bill earlier had passed both houses by unanimous votes.   Continue reading

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Virginia Court Affirms Denial of Benefits Related to Unexplained Fall In Spite of Evidence That Claimant’s Step From Truck Was Larger Than Normal Staircase Distance

In yesterday’s post, I pointed out the difficulty courts (and not a few practitioners) have had with a specific form of neutral risk–those in which an employee falls while walking across a level floor on the employer’s premises for no discoverable reason. In that blog post I referred to a statement by my mentor, Dr. Arthur Larson, who wrote that there is no way in which an award on those facts can be justified except upon a positional risk theory–that the particular injury would not have happened if the employee had not been engaged upon an employment errand at the time [see Larson’s Workers’ Compensation Law, § 4.01 et seq.].

These cases are problematic because, out of necessity, either the employer or the employee must bear the loss. In these close cases it seems possible to show some connection with the employment; there is at least the fact that the injury occurred while the employee was working. On the other hand, to show connection with the employee personally, there is nothing. The protective philosophy of most workers’ compensation acts would seem to support a notion, therefore, that while the work connection is slender, it is at least stronger than any connection with the claimant’s personal life [see Larson, § 4.03, as well as the minority opinion in Byrom v. Randstad N. Am., L.P., 2012 Tenn. LEXIS 152 (Mar. 8, 2012), discussed in yesterday’s blog]. In spite of these policy considerations, a majority of jurisdictions have failed to adopt the positional risk doctrine for neutral risk injuries.

Let’s change the facts slightly. What if instead of a level, unimpeded floor, we have a staircase with no obstructions? Should an unexplained fall under such conditions produce a compensable injury? What if the step is from a piece of employment equipment and not a staircase? What if the step is somewhat greater, in terms of distance, than an ordinary step on a staircase? These issues were discussed recently by the Court of Appeals of Virginia, in May v. Town of Bridgewater, 2012 Va. App. LEXIS 106 (Apr. 10, 2012). In that decision, the court affirmed a denial of benefits to a claimant who injured his knee when he stepped from the back of a trash truck. That the distance of the “step” was 22-1/4 inches, higher than a “normal” eight inch step, was insufficient to allow for a recovery in the absence of medical evidence that a condition of employment had caused the claimant’s injury. Observing that the medical evidence in the case did not establish anything more than a speculative link between the injury and the height of the step, the court found that claimant had failed to establish his claim.   Continue reading

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North Dakota Supreme Court Refuses to Adopt Positional Risk Doctrine in Unexplained Fall Cases

There’s nothing like an employee’s unexplained fall while walking on a level, unobstructed floor to test one’s position on the positional risk doctrine in workers’ compensation claims. As was noted in my post on March 16, 2012 related to Byrom v. Randstad N. Am., L.P., 2012 Tenn. LEXIS 152 (Mar. 8, 2012), if an employee falls while walking across a level floor on the employer’s premises for no discoverable reason, there is no way in which an award can be justified except upon a positional risk theory–that the particular injury would not have happened if the employee had not been engaged upon an employment errand at the time [see Larson’s Workers’ Compensation Law, § 4.01 et seq.]. While some courts have been happy to apply the positional risk rule in these “neutral” risk cases, most have not.

In Fetzer v. North Dakota Workforce Safety and Ins., 2012 ND 73, 2012 N.D. LEXIS 70 (Apr. 10, 2012), the Supreme Court of North Dakota was recently called upon to determine the compensability of such an unexplained, level fall sort of case. In well-reasoned fashion, the majority and dissenting opinions both carefully articulated the issues. The majority of the court concluded that the “but-for” reasoning of the positional risk doctrine is incompatible with the North Dakota Workforce Safety and Insurance Act. Moreover, because the positional risk doctrine requires a claimant only to show that an injury was sustained while at work, the majority indicated the doctrine directly contravened both the language of N.D.C.C. § 65-01-02(10) and the Legislature’s stated intent in adding the “arising out of” element in a 1977 amendment.  Continue reading

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Divided Sixth Circuit Court Delivers Body Blow to Michigan’s Continuing Battle Regarding RICO Claims and Comp Exclusivity

by Thomas A. Robinson

A divided Sixth Circuit Court of Appeals, in Brown v. Cassens Transp. Co., 2012 U.S. App. LEXIS 6929 (6th Cir. Apr. 6, 2012), has again reversed the dismissal of plaintiff employees’ RICO action and remanded it to the United States District Court for the Eastern District of Michigan. The case, which has see-sawed between District Court Judge Paul D. Borman and the Sixth Circuit for the past seven years, involves the issue of whether Michigan’s Workers’ Disability Compensation Act [Mich. Comp. Laws § 418.301] (“WDCA”), through its exclusive remedy clause, bars plaintiffs’ recovery under the federal RICO statute. On multiple occasions, Judge Borman has ruled that the cause of action is barred. The recent decision of the majority of the Sixth Circuit panel, unless taken up by the Supreme Court, appears to settle the issue in favor of the plaintiffs.  Continue reading

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Ohio: Employer’s Failure to Call Employee Back to Work Was Due to Poor Economy, Not Retaliatory Motive for the Filing of a Comp Claim

An Ohio appellate court, in Lebron v. A&A Safety, Inc., 2012 Ohio 1637, 2012 Ohio App. LEXIS 1435 (Apr. 12, 2012), recently affirmed a trial court’s summary judgment order favoring a former employer in a civil action filed by a former employee who claimed he had not been called back for work because he filed workers’ compensation claims against the employer. Finding the defendant employer’s reason for not recalling the employee was not pretextual–it contended that due to the weak economy, its business revenue had fallen by 44 percent–the appellate court agreed that the former employee had failed to show that the employer had retaliatory motives when it did not recall plaintiff for work.   Continue reading

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Spouse’s “Aggressive Surveillance” Cause of Action May Proceed Against Third-Party Administrator

Generally speaking, the insurance carrier (and any third-party administrator representing the carrier), while performing its proper role in the workers compensation claims process, shares the employer’s immunity to suit by an injured employee [see Larson’s Workers’ Compensation Law, § 104.05[2]]. Ah, but what is, and what is not, “proper?”

In a recent decision, a federal district court judge in Connecticut denied the summary judgment motion filed by a third-party administrator representing the Connecticut Department of Corrections in an action filed by the spouse of an injured worker who claimed the TPA “aggressively” surveilled the worker’s family in connection with its investigation of her husband’s workers’ workers’ compensation claim [see Nordstrom v. GAB Robins North America, Inc., 2012 U.S. Dist. LEXIS 46148 (W.D. Ct., Mar. 31, 2012)].

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Ohio: Trauma Induced Stroke Sustained In Fall From Wheelchair Is Not Compensable Aggravation of Original Injury

A worker, who lost the use of his legs in 1965 in a work-related accident, and who was thereafter confined to a wheelchair, is not entitled to additional workers compensation benefits related to a trauma induced stroke that he sustained when, as he was being moved from his wheelchair by a home health aide, he fell, struck his head on a table, and sustained a right parietal bleed or hemorrhagic stroke, held a divided Ohio appellate court recently in Toth v. United States Steel Corp., 2012 Ohio 1390, 2012 Ohio App. LEXIS 1198 (Mar. 30, 2012). The majority held that the worker failed to show anything other than that his stroke was caused by the intervening act of being mishandled by the aide.   Continue reading

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