New Hampshire High Court Adopts “Chain-of-Causation Test” for Suicides

In a case of first impression, the Supreme Court of New Hampshire, adopted the “chain-of-causation test” for suicides and affirmed a decision by the state’s Compensation Appeals Board (CAB) that awarded death benefits to the wife of a deceased worker who committed suicide several months after sustaining serious injuries in a work-related vehicle accident [Appeal of Pelmac Indus., 2021 N.H. LEXIS 154 (Oct. 13, 2021)]. The Court noted the decedent’s worsening depression following the accident and said that the CAB had appropriately found as a fact the news that decedent’s shoulder surgery would be delayed further was the “last straw.” The decedent’s suicide resulted from a disturbance of mind of such severity as to override normal rational judgment, and, under the chain-of-causation test, meant the death benefits claim was compensable.

Background

The decedent lived in Manchester, New Hampshire, and worked for the employer as an alarm installer and technician. He did not usually commute to and from the employer’s office location, but rather traveled to various work sites throughout New Hampshire and Massachusetts using a company van. Although he worked a regular schedule of four, 10-hour days, he was subject to call and could be sent to problem situations before or after hours.

On June 4 and 5, 2018, the decedent had an assignment at a work site in the Berlin area, about a two-and-a-half-hour drive from Manchester. After the first day of work in Berlin, he drove the company van to his home as usual and he drove back to Berlin the next morning for the second day of the assignment. While driving home on June 5, at approximately 4:45 p.m., the decedent was involved in a single-vehicle accident when the company van crossed the road, went into the median, and flipped over.

The decedent sustained serious injuries in the accident, including multiple lacerations to his head, a fractured neck, a concussion, a serious tear to his left rotator cuff, and multiple fractured ribs. He was taken to the hospital for emergency care, where he remained for five days. One of the decedent’s physicians, a neurologist, noted that the “accident might have been related to” the decedent’s sleep apnea, which was being managed and treated with a “CPAP” machine. The decedent’s rotator cuff injury required surgery on his shoulder that could not be performed until his neck fracture healed and his neck brace, which he needed to wear at virtually all times, could be safely removed.

According to the decedent’s wife, the decedent became anxious and upset that his healing was not progressing at a satisfactory rate. He began keeping a diary that documented his dissatisfaction with his doctors, his efforts to expedite and understand his recovery, his panic about his injuries not healing, and his fear of not being able to regain his pre-accident quality of life.

For more than two months the decedent lived with and tried to manage his injuries, including wearing his neck brace almost “24/7.” On August 29, he met with a neurosurgeon, expecting to hear that the neck brace could be removed and to have his shoulder surgery scheduled. However, the decedent was informed that his neck fracture required at least another month to properly heal and at that time the neurosurgeon would re-evaluate whether the decedent’s shoulder surgery could be scheduled. Four days later, the decedent died by suicide at his home. He left a note thanking his wife, but expressing deep dissatisfaction with his present and future situation.

After the suicide, the employer’s carrier terminated payment of the claim on the basis that the decedent’s death did not arise out of and in the course of the employment.

Workers’ Compensation Proceeding

Following a hearing, the DOL hearing officer found that the decedent’s June 5 injury arose out of and in the course of employment, but that the suicide was not causally related to the June 5 work injury which foreclosed death benefits. The CAB found that “there was an obvious cause and effect” between the work accident and injuries and the subsequent suicide, and awarded death benefits. In its decision, the CAB relied upon an expert medical opinion that a causal relationship between the original injury and the suicide existed.

Appellate Decision: Going and Coming Rule

On appeal, the carrier argued that the decedent’s June 5 injury was not work-related, and, in the alternative, that his subsequent death by suicide did not result from the original injury. Finding that the decedent was a traveling employee, the Court had little difficulty dispatching with the carrier’s going and coming argument. The decedent’s employment involved extensive travel. Such travel was integral to his job as an installer/technician. The Court added that although there was some testimony that the decedent’s accident “might have been related to sleep apnea,” that same neurologist expressly noted that the cause of the accident was “unknown.” The court declined, therefore, to say that the decedent’s sleep apnea was a personal risk that caused the accident.

Was the Suicide “Direct and Natural Result” of Accident?

Acknowledging that death benefits could not be awarded if the decedent’s suicide and resulted from his “willful intention to injure himself” [RSA 281-A:2.XI], the Court also noted that an employer remains liable for subsequent injuries that are the “direct and natural result” of a prior, work-related injury. The issue here was whether the decedent’s death was the direct and natural result of the June 5 injury or whether it resulted from an independent, intervening cause. The Court added:

We have not had occasion to consider whether and under what circumstances suicides can be deemed to result from a prior, work-related injury and deemed not to be the product of the employee’s “willful” intent or conduct, as relevant to awards of death benefits [Opinion, p. 9].

After surveying decisions from a number of other jurisdictions, the Court continued:

Accordingly, we join the majority of jurisdictions that apply the chain-of-causation test and adopt the following test in New Hampshire: An employee’s death by suicide is compensable under RSA 281-A:26 if the claimant proves by a preponderance of the evidence that the suicide resulted from a disturbance of mind of such severity as to override normal, rational judgment, and that such disturbance of mind resulted from the employee’s work-related injury and its consequences [Opinion, p. 25-26].

Applying the rule to the instant case, the Court held that the CAB did not err in awarding death benefits to the decedent’s wife. The CAB determined, and the Court affirmed, that the decedent’s injuries resulting from the June 5 accident constituted a work-related injury. The CAB found that these injuries—a neck fracture, a concussion, fractured ribs, head lacerations, and a serious rotator cuff tear—were significant and prevented the decedent from fully caring for himself and being his usual “cheerful,” “confident,” and “active” self. It found that over the course of the summer the decedent’s mental well-being deteriorated, he became “increasing[ly] discontent,” and he was desperate to have his surgery and “be the person he once was.”

The CAB also found that his family knew the decedent’s mental well-being was getting worse, but that they did not fully recognize the degree of his depression-like mental state. The CAB discussed how, after more than two months of living with his injuries, the decedent learned that he would have to wait at least another month before his shoulder surgery could be scheduled, news that the CAB found was “the last straw.” Further, the CAB credited the medical expert’s opinion that the June 5 injury “was a substantial proximate cause” of the September 2 suicide.

Deferring to the CAB’s factual findings supporting its award of death benefits, the Court affirmed the CAB’s determination that the decedent’s death by suicide was compensable under RSA 281-A:26.