Workers' Compensation

In Workers’ Compensation System, Industrial Injury Need Only Be Contributing Cause to Disability

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In South Coast Framing v. Work. Comp. App. Bd. (2015) 61 C.4th 291, 188 C.R.3d 46, 349 P.3d 141, an employee died from a combination of drugs prescribed after a fall at work. The employee’s workers’ compensation doctor had prescribed various drugs to treat his injuries, including Elavil (an antidepressant), and two pain relievers, Neurontin and Vicodin. The employee’s personal doctor had prescribed Xanax (an anti-anxiety medicine), and Ambien (a sleep aid). The employee’s family sought death benefits, arguing that the medications prescribed for the employee’s industrial injury caused his death. In his report, the qualified medical examiner concluded that the employee’s drug overdose was caused solely by medications prescribed by his personal doctor. However, in his subsequent deposition, he testified that he could not say that Elavil had no effect. The workers’ compensation judge (WCJ) awarded death benefits, finding that the employee’s death resulted from the medications taken for the industrial injury. The WCJ explained that Elavil as well as Vicodin acted as concurring causes such that the employee’s death was a result of the original industrial injury. The Board adopted the WCJ’s report and denied reconsideration. The Court of Appeal reversed, concluding that if Elavil played a role, it was not significant, such that it constituted a material factor contributing to the employee’s death. Held, reversed.

(a) Under Lab.C. 3600(a), workers’ compensation liability exists for an injury “arising out of and in the course of the employment and for the death of any employee if the injury proximately causes death.” For an injury to “arise out of” the employment, “the employment and the injury must be linked in some causal fashion.” (61 C.4th 297.) The applicant has the burden of establishing the reasonable probability of industrial causation. (61 C.4th 297.)

(b) Here, the question is the required nature and strength of the causal link between the industrial injury and death. The statutory proximate cause language of Lab.C. 3600 “has been held to be less restrictive than that used in tort law, because of the statutory policy set forth in the Labor Code favoring awards of employee benefits. In general, for the purposes of the causation requirement in workers' compensation, it is sufficient if the connection between work and the injury be a contributing cause of the injury.” (61 C.4th 298, quoting Nash v. Work. Comp. App. Bd. (1994) 24 C.A.4th 1793, 30 C.R.2d 454.) “Tort liability only attaches if the defendant's negligence was a significant or substantial factor in causing injury. In the workers' compensation system, the industrial injury need only be a contributing cause to the disability.” (61 C.4th 299.) Thus, the Court of Appeal’s analysis that Elavil’s role in the employee’s death was insufficient to prove proximate causation because it was not sufficiently significant or a material factor, fails to honor the difference between principles of tort law and the application of the workers’ compensation scheme. (61 C.4th 299.)

(c) The court has recognized the contributing cause standard since the beginning of the workers’ compensation scheme. Under the long-established contributing cause test adopted in Kimbol v. Industrial Acc. Com. (1916) 173 C. 351, 160 P. 150, “if the injury can be seen to have followed as a natural incident of the work and to have been contemplated by a reasonable person familiar with the whole situation as a result of the exposure occasioned by the nature of the employment, then it arises ‘out of’ the employment. But it excludes an injury which cannot fairly be traced to the employment as a contributing proximate cause and which comes from a hazard to which the workman would have been equally exposed apart from the employment.” (61 C.4th 299.) In its reasoning that Elavil was not significant such that it constituted a material factor contributing to the employee’s death, the Court of Appeal “appeared to use the term ‘material’ as a further substantive hurdle in determining whether a work injury was a contributing cause of death. No authority supports such use.” (61 C.4th 305.)

(d) Substantial evidence supported the WCJ’s finding that Elavil and Vicodin contributed to the employee’s death. Although the level of Elavil could not have been independently fatal, the qualified medical examiner testified that it had a contributory effect. Even if it was possible that the employee might have died from an overdose of Xanax and Ambien alone, there was a reasonable possibility that Elavil made death more likely. (61 C.4th 303.) With respect to Vicodin, another doctor reported that the specific combination of medicines, including Vicodin, “all separately and in combination had the capacity to induce respiratory depression, and even respiratory arrest.” (61 C.4th 303.) He further reasoned that the employee’s reports of blacking out showed that these drugs caused “untoward synergistic respiratory depression and/or central nervous system depression prior to the date of death.” (61 C.4th 303.) Thus, the doctor not only concluded that the drugs could have caused the employee’s death, “but contributed to a respiratory or nervous system condition that ultimately led to his demise.” (61 C.4th 303.) The qualified medical examiner testified that Vicodin was “potentially a cause.” (61 C.4th 303.) “In light of the evidence, the WCJ could reasonably find that Elavil and Vicodin increased the likelihood of death by drug overdose.” (61 C.4th 303.) Under these circumstances, those two drugs could be found to have contributed to the employee’s death within the meaning of Lab.C. 3600. (61 C.4th 304.)

(e) The Court of Appeal emphasized the qualified medical examiner’s inability to offer a precise percentage for Elavil’s contribution to the employee’s death. McAllister v. Work. Comp. App. Bd. (1968) 69 C.2d 408, 71 C.R. 697, 445 P.2d 313 rejected a similar argument, reasoning that an applicant is required “to establish no more than that industrial causation is reasonably probable.” (61 C.4th 306.) Here, that standard was met. (61 C.4th 306.)

(f) The WCJ alternatively found industrial causation because the employee’s personal doctor prescribed Ambien to address his inability to sleep due to pain from the work injury. Substantial evidence also supported this finding. On the record, the WCJ could reasonably conclude that the employee could not sleep because the injury caused discomfort. Thus, the prescription for Ambien, and the employee’s later drug overdose, were causally related to the work injury. (61 C.4th 306.)

Witkin References

On injury arising out of employment generally, see 2 Summary (10th), Workers’ Compensation, §230 et seq.

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Last updated
Friday, September 04, 2015