Court Discusses Important Distinction Between “Legal” and “Medical” Causation
Stepping lightly through the difficult mine field of “legal causation,” a Utah appellate court affirmed a decision by the state’s Labor Commission that denied workers’ compensation benefits for the last of four work-related lower back injuries sustained by a beer delivery driver over an eight-year period [Layton v. Labor Comm’n, 2019 UT App 59, 2019 Utah App. LEXIS 59 (Apr. 18, 2019)]. Applying the state’s so-called “Allen” rule, the court stressed that although a claimant generally need not show that his or her injury was caused by unusual or extraordinary exertion, such a showing is required where the claimant suffers from a preexisting condition which contributes to the injury. Accordingly, where the claimant’s fourth injury was not due to unusual exertion, it could not be the basis for a compensable claim.
Over a period of eight years, Layton worked for the employer as a beer delivery driver, a job that often required Layton to lift heavy kegs of beer. During this time span, Layton injured himself in four separate workplace incidents—each involving his lower back—while in the course of making beer deliveries.
As to the first three injuries, there was no significant dispute. As to the fourth, however, which occurred some three years after the third, the employer contended there was no causal connection between the injury and the workplace. That fourth injury occurred when Layton lifted an 18-pack case of beer, weighing approximately nineteen pounds, off a chest-height stack. After lifting the case with his arms outstretched in front of his torso, Layton began to pull the case toward his chest, at which point he felt “an immediate electrical sensation travel down his back” and into his legs, causing him to fall to the ground where he was immobilized for a number of minutes.
Degenerative Disc Disease
A medical panel comprised of two doctors—an occupational medicine specialist and a general surgeon— determined that Layton suffered from degenerative disc disease (“DDD”), a preexisting condition in which pain is caused by a spinal disc that loses integrity. They opined that the condition was not caused by the four back injuries, although those injuries may have temporarily aggravated the preexisting DDD.
Based on the panel report and other relevant medical evidence, the ALJ found that Layton’s preexisting DDD instead had contributed to at least his 2010, 2012, and 2015 industrial injuries, that under applicable Utah law, in order to receive compensation for those injuries, Layton was required to make a heightened showing in order to prove that his injuries were legally caused by the incidents (rather than by his preexisting condition), and that with regard to the first three incidents, Layton could make such a heightened showing, but not with regard to the fourth, the 2015 Incident. Accordingly, the ALJ awarded Layton compensation for injuries sustained in the first three incidents, but not for injuries sustained in the fourth (the injury which precipitated back surgery).
Court of Appeals Discussion
Upon appeal, the appellate court stressed that a claimant’s recovery for aggravation of a preexisting condition is limited to situations where the “lighting up” is clearly due to workplace demands rather than to day-to-day wear and tear. Under this framework [Allen v. Industrial Comm’n, 729 P.2d 15 (Utah 1986); Fred Meyer v. Industrial Comm’n, 800 P.2d 825, 829 (Utah Ct. App. 1990)], to meet the legal causation requirement, a claimant with a preexisting condition must show that the employment contributed something substantial to increase the risk he already faced in everyday life because of his condition. Generally speaking, where the claimant suffers from a preexisting condition that contributes to the injury, an unusual or extraordinary exertion is required to prove legal causation. Where there is no preexisting condition, a usual or ordinary exertion is sufficient.
The court acknowledged that since the evidence here was conflicting, the Commission could easily have reached a different result. It was the Commission’s job—and not the appellate court— to weigh that conflicting evidence and come to a factual determination. It had done so and the court would not overturn it. The court also noted that during the appeal, Layton had acknowledged that the fourth injury did not meet the heightened Allen/Meyer standard. His argument, of course, was that he didn’t actually suffer from a preexisting condition, but rather a condition that had been caused by the employment. The court stressed, however, that again, this was a factual determination for the Commission to weigh and determine.