Note to Employers and Carriers: Don’t Give Up Too Early in Cases Involving Preexisting Disease or Condition

Eggshell Skulls

There’s a rule most of us learned early on in the first semester of Torts in law school: that there is ordinarily no allowance for an already weakened state of the injured party. If a defendant negligently injures another, the defendant is responsible for all the consequences, whether they were foreseeable or not. Generally referred to as “the Eggshell Skull Rule,” the concept bleeds over into workers’ compensation law [see Larson’s Workers’ Compensation Law, § 9.02].

Thus, in one case from a few years ago, a morbidly obese long-term employee, who weighed some 360 pounds, suffered from diabetes, and walked with a cane because of issues with her knees, was awarded disability and medical benefits when she suffered a cracked femur as she tried to extricate herself from a booth in a university cafeteria where an employee appreciation dinner had been given [see Waters v. Indiana State Univ., 953 N.E.2d 1108 (Ind. Ct. App. 2011). The employer contended–and the Full Board agreed–that the risk of injury was personal to the claimant, that at the time of her injury, she was engaged in an “activity of daily living”–ordinary movement. The appellate court disagreed, observing that while the employee’s pre-existing physical condition may have contributed to her injuries and undoubtedly hampered her recovery, her injuries were at least partially attributable to her exit from the cafeteria booth.

Two recent decisions show an important point that should not be lost by employers and carriers: that in spite of the Eggshell Skull rule, the burden is, nevertheless, on the claimant to show a causal connection between the workplace and the injury. A preexisting disease or infirmity may yet disqualify a claim where the employment does not aggravate, accelerate, or combine with the disease or infirmity to produce the death or disability for which compensation is sought. That is to say that if the injury is caused by the natural progression of claimant’s preexisting condition and not by a risk created by the workplace, no compensation should be due the claimant.

Nebraska Decision Affirms Denial of Shoulder Injury Claim

The first case, Gills v. Nebraska Machine Prods., Inc., 2013 Neb. App. LEXIS 122 (July 9, 2013), involved a claim filed by an employee who contended he sustained a compensable shoulder injury while moving a 300-pound tub containing machine parts. The tub was placed on a cart with wheels and the employee moved similar tubs numerous times each day. Construing Neb. Rev. Stat. § 48–151(4), the Nebraska Court of Appeals recently affirmed the compensation court’s dismissal of a claim for workers’ compensation benefits. The appellate court noted that the claimant had complained of shoulder pain for as many as eight years prior to being hired by the employer. Indeed, the employee had been diagnosed with a torn rotator cuff more than two years before he began his work. Quoting Larson, § 9.02, the Court observed that the claimant could point to no intervening event causing his current condition. Following the diagnosis of the torn rotator cuff, which pre-dated his claim, employee continued to have the same pain and limitations. There was no error in the compensation court’s conclusion that the claimant’s symptoms were a natural of his original pre-employment injury.

Delaware Court: Coronary Artery Disease Claim Not Causally Related to Police Officer’s Response to “Burglary in Process” Call

In another case involving the issue of preexisting conditions, Sommers v. New Castle County, 2013 Del. LEXIS 339 (July 9, 2013), the Supreme Court of Delaware recently affirmed a Superior Court order that had affirmed a denial by the state’s Industrial Accident Board of a police officer’s petition for compensation. The officer experienced chest pains as he sped to the scene of a reported burglary. The pain subsided later that day but reappeared three days later when the officer lifted a laundry basket at his home. Based upon medical testimony offered at trial, the IAB and Superior Court found that the officer’s cardiac injuries were caused by his preexisting severe coronary artery disease, and not by the burglary investigation he had conducted in the scope of his employment.


In both cases noted above, it would have been easy for the carrier or adjuster to give up on the claim. After all, in Gills, the employee claimed injury following his attempts to move a 300 pound container. In Sommers, one could sense the tension and anxiety as the officer responded to the burglary call. “Is the burglar armed? Is he holding a hostage? Is this a violent home invasion? Will I need to use my gun?”

Digging into the claim and the issue of preexisting conditions uncovered the fact that Gills already had a rotator cuff tear. Careful questioning of the cardiac specialists revealed that Sommers’ heart-related issues were long-standing. The eggshell skull doctrine only works against the interests of the employer/carrier where the employment aggravates, accelerates or at least combines with the condition or infirmity to cause disability or death. Where the current disability is the result of natural progression of a preexisting condition, the claim should fail.

This entry was posted in Issue commentary and tagged , , , . Bookmark the permalink.