PYA/MONARCH AND RELIANCE INSURANCE COMPANY v. THOMAS EDWARD HARRIS
Record No. 0454-95-3
COURT OF APPEALS OF VIRGINIA
APRIL 2, 1996
JUDGE JOHANNA L. FITZPATRICK
Present: Chief Judge Moon, Judges Coleman and Fitzpatrick. Argued at Salem, Virginia. FROM THE VIRGINIA WORKERS’ COMPENSATION COMMISSION.
Berrell F. Shrader (Attorneys and Counselors at Law of Virginia, P.C., on brief), for appellee.
In this workers’ compensation case, PYA/Monarch and its insurer, Reliance Insurance Company (collectively referred to as employer), appeal the commission‘s decision awarding benefits to Thomas Edward Harris (claimant). Employer argues that the commission erred in: (1) finding that claimant‘s injury arose out of his employment by improperly extending the increased effects analysis used in idiopathic fall cases to an unexplained accident, and (2) determining that claimant‘s injury caused his disability. We hold that claimant‘s injury was a noncompensable, unexplained accident and reverse the commission‘s decision.1
Claimant drove a truck for employer. On March 2, 1994, claimant encountered freezing rain and ice while making his
At the hearing on his application for benefits, claimant testified that the driver‘s seat in the truck‘s cab is located six-and-one-half to seven feet from the ground. To enter the cab, claimant had to go up “two rungs on the ladder and then one on the step there going through the door.” On the date of claimant‘s fall, the surface of the truck‘s cab was covered with ice.
After his fall, claimant went to the emergency room at Lewis-Gale Hospital. Dr. T. Gary Parrish examined claimant and
The commission was “persuaded that the fall was precipitated by the design or icy condition of the cab or both.” However, the commission made no specific finding regarding the cause of claimant‘s fall because it found that “the elevated height of the trailer cab constituted an added risk of the employment that caused or contributed to the claimant‘s injuries and loss of consciousness.” Additionally, the commission determined that the six-month restriction on claimant‘s driving was “a very real medical restriction that the claimant could not medically or legally ignore, and which was attributable to his work accident,” and that employer was liable for claimant‘s disability.
Employer argues that claimant‘s fall was a noncompensable,
“To qualify for workers’ compensation benefits, an employee‘s injuries must result from an event ‘arising out of’ and ‘in the course of’ the employment.” Pinkerton‘s, Inc. v. Helmes, 242 Va. 378, 380, 410 S.E.2d 646, 647 (1991). “The concepts ‘arising out of’ and ‘in the course of’ employment are not synonymous and both conditions must be proved before compensation will be awarded.” Marketing Profiles, Inc. v. Hill, 17 Va. App. 431, 433, 437 S.E.2d 727, 729 (1993) (en banc). The claimant must prove these elements by a preponderance of the evidence. Id.
In this case, employer does not dispute that claimant suffered an injury by accident occurring “in the course of” employment, but asserts that claimant failed to prove that his fall “arose out of” his employment. “The commission‘s decision that an accident arises out of the employment involves a mixed question of law and fact and is thus reviewable on appeal.” Southside Virginia Training Ctr./Commonwealth of Virginia v. Shell, 20 Va. App. 199, 202, 455 S.E.2d 761, 763 (1995).
“All risks causing injury to a claimant can be brought
In cases in which the claimant alleges an injury by accident resulting from an employment-related risk, “[a] ‘critical link’ must exist between the conditions of the workplace and the injury in order for the injury to qualify as ‘arising out of’ the employment.” Pinkerton‘s, 242 Va. at 380, 410 S.E.2d at 647. In proving the “arising out of” prong of the compensability test, a claimant has the burden of showing that “‘there is apparent to the rational mind upon consideration of all the circumstances, a causal connection between the conditions under which the work is required to be performed and the resulting injury.‘” Marketing Profiles, 17 Va. App. at 434, 437 S.E.2d at 729 (quoting Bradshaw v. Aronovitch, 170 Va. 329, 335, 196 S.E. 684, 686 (1938)).
“[I]f 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 [the arising out of test] 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 workmen would have been equally exposed apart from the employment.”
In a personal risk or idiopathic case, the claimant‘s injury is one “caused by a preexisting personal disease of the employee.” Southland Corp. v. Parson, 1 Va. App. 281, 283, 338 S.E.2d 162, 163 (1985). In Virginia, the general rule regarding idiopathic falls is that the claimant must prove that the injury was not caused by some idiopathic condition. See Winegar v. International Telephone & Telegraph, 1 Va. App. 260, 263, 337 S.E.2d 760, 761 (1985). “When an employee‘s injuries result from an idiopathic condition and no other factors intervene or operate to cause or contribute to the injuries sustained as a result of the idiopathic condition, no award shall be made.” Virginia Dep‘t of Transp. v. Mosebrook, 13 Va. App. 536, 538, 413 S.E.2d 350, 351-52 (1992). However, “‘the effects of [an idiopathic] fall are compensable if the employment places the employee in a position increasing the dangerous effects of such a fall, such as on a height, near machinery or sharp corners, or in a moving vehicle.‘” Southland Corp., 1 Va. App. at 284-85, 338 S.E.2d at 164 (citation omitted). Thus, in an idiopathic fall situation, the well-established increased risk doctrine applies, and no recovery is allowed unless the claimant proves that a condition of the employment increased the effects of his or her fall.
Finally, an unexplained fall or accident is encompassed in
In Pinkerton‘s, the Court explained:
Every unexplained accident, by definition, means that no one can relate how the accident happened. The reason for the inability to recall may be based on a preexisting or resulting, temporary or permanent, physical condition of the claimant, as well as mere inattention at the moment of the accident. If mere inability to recall the events is the rationale for application of the presumption, then it would also be logical that the claimant should be entitled to the benefit of the presumption in any of these circumstances, or whenever there is an unexplained accident.
Id. at 381, 410 S.E.2d at 648. The Supreme Court concluded that “[b]roadening the use of the [unexplained death] presumption to such an extent [would] significantly alter[] the jurisprudence of workers’ compensation law. This change . . . is more properly a
In the instant case, claimant‘s fall was an unexplained
Additionally, in analyzing whether claimant‘s fall arose out of his employment, the commission improperly extended the increased effects analysis properly used in idiopathic fall cases to an unexplained fall situation. We are bound by the rationale of Pinkerton‘s that an unexplained fall is not compensable “[i]n the absence of a showing that the [injury] ‘arose out of’ the employment.” 242 Va. at 381, 410 S.E.2d at 648. In Southland Corp., we recognized the distinction between unexplained falls and idiopathic falls, and did “not consider the consequences of an unexplained fall by an employee.” 1 Va. App. at 284, 338
No credible evidence established that claimant‘s fall was caused by an idiopathic condition. The medical evidence ruled out the possibility that a seizure caused claimant‘s fall. Although Dr. Waybright indicated several other idiopathic conditions as potential causes of claimant‘s fall, he also considered it equally possible that claimant slipped when climbing down from the driver‘s seat of the truck cab. Thus, the increased risk analysis used in idiopathic fall cases was inappropriate in the instant case because claimant‘s fall was clearly an unexplained accident controlled by the Supreme Court‘s rationale in Pinkerton‘s.
Because claimant is not entitled to a presumption that his fall arose out of his employment, and because claimant failed to prove the requisite causal connection between his employment and his accident, the commission erred in awarding claimant compensation. Accordingly, the decision of the commission is reversed.
Reversed.