Lead Opinion
Reynolds brought a claim for workers’ compensation benefits against his employer, Reynolds Construction Company, claiming that job-related mental worry and fatigue caused him to suffer a disabling stroke. The administrative law judge’s (ALJ) award of benefits to Reynolds was adopted and affirmed by the appellate division of the State Board of Workers’ Compensation, and the superior court entered an order affirming the appellate division. We granted the employer’s application for a discretionary appeal.
Reynolds, a 37-year-old man, worked for a construction business owned by his family. The symptoms of the stroke first becаme apparent one afternoon as he returned home from viewing a potential job site. Testimony received from Reynolds and his brother, who also worked for the family’s construction business, indicates that, for approximately three years prior to the stroke, Reynolds was subject to extreme fatigue and stress associated with running the business. Reynolds and his brother testified that this work-related fatigue and stress caused or contributed to Reynolds’ stroke. A review of the rec
No medical expert testified at the hearing about Reynolds’ stroke; however, certain medical records were introduced including a letter from Reynolds’ treating physician. As to the cause of the stroke, the physician’s letter merely stated: “The stroke Mr. Reynolds suffered is not directly related to any work related injury, but is simply the result of arteriosclerosis.” The physician’s letter does not address the role stress or fatigue may have played in causing Reynolds’ stroke or aggravating his condition. See Griggs v. Lumbermen’s Mut. Cas. Co.,
On appeal, the employer asserts that, in determining the cause of an injury attributed to work-related fatigue or stress, a factfinder cannot rely on inferences drawn from his own experience or on the observations of credible lay witnesses if there is conflicting expert medical evidence as to the injury’s cause.
While we agree with the employer’s position that injuries allegedly caused by work-related fatigue and stress should be closely scrutinized, the issue оf whether these injuries should be compensable is not before us. It has already been decided. Ga. Bureau of Investigation v. Worthington,
Georgia law recognizes three forms of competent evidence for establishing a causal connection between work activities and cardiovascular problems such as heart attack and stroke: (1) medical opinion, (2) lay observation and opinion and (3) the “natural inference through human experience.” Hiers and Potter, Ga. Workers’ Compensation — Law and Prаctice, § 6-2 citing Guye, supra, and Carter v. Kansas City Fire &c. Ins. Co.,
As Presiding Judge McMurray previously recognized: “Neither law nor medicine are exact sciences, and we have not reached that degree of certainty where a medical expert can state a definite and certain diagnosis that the claimant’s [injury that was allegedly stress-related] did not arise out of and in the course of his employment.” Zippy Mart v. Fender,
The present case aptly demonstrates the dangers in allowing such weight to be attributed to medical evidence. The medical records in question offered only a cursory one-sentence pronouncement as to causation and did not clearly address Reynolds’ claim that his job-related stress and fatigue caused, contributed to or aggravated his injury.
Longstanding Georgia law provides factfinders freedom to accept or reject evidence as they see fit, particularly expert opinion evidence. “ ‘[Expert] testimony is not conclusive or controlling and is submitted for whatever the [factfinder] considers it to be worth. The [factfinder] can consider such expert opinion testimony by reference to their own experience and may discard the opinion of experts entirely.’ [Cit.]” (Emphasis supplied.) Wilson v. Professional Ins. Corp.,
In light of the above, we hold that the ALJ’s “natural inference” did not disappear and the testimony of credible lay witnesses was not rendered meaningless simply because limited medical evidence was
Judgment affirmed.
Notes
Due to weather and economic problems, the construction company’s income fell dramatically, experiencing a 90 percent decrease in its gross sales. Creditors repossessed much of the company’s equipment, its insurance policies were cancelled due to lack of payment and the company was forced to fire 25 to 30 of its employees. Moreover, Reynolds had personally guaranteed many of the company’s debts and was being pursued individually by numerous creditors. When construction jobs were available, Reynolds would work seven days a week, often spending over fifteen hours a day at the job site.
Previous cases suggest that stress may be an aggravating factor in cardiovascular problems. See Zippy Mart v. Fender,
Concurrence Opinion
concurring specially.
This case illustrates again the necessity to revamp the appellate procedure for workers’ compensation cases. Although the superior court heard the appeal from the appellate division within 60 days from the date the notice of appeal was filed, the court failed to file its order within 20 days of the date of the hearing, as required by OCGA § 34-9-105 (b). The record reflects that the judge signed the detailed order on the twentieth day after the hearing, but that the order was not filed with the clerk until the twenty-second day after the hearing. Because the superior court order was not timely entered pursuant to OCGA § 34-9-105 (b), the appellate division was affirmed by operation of law and the superior court order wаs a nullity. Buschel v. Kysor/Warren,
Even though the application for appeal pursuant to OCGA § 5-6-35 purported to be from the superior court order, it was sufficient to invoke this Court’s jurisdiction. Lanier v. Jim Brown Dev. Corp.,
This brings about the anomaly of an application for discretionary review of a void order, which we granted so as to review the much earlier award of an administrative tribunal. The law, of course, does not provide for an application to this court, under OCGA § 5-6-35 or any other statute, for review of the award of thе workers’ compensation board. Yet that is in effect what we have permitted, timing it from the date of the superior court order which is legally void.
This procedure puts the case into the same posture as one where appellant simply bypasses the superior court altogether and we ignore the procedural law. See Atlanta Family Restaurants v. Perry,
When judicial resources are strained and the cost of litigation is substantial and delay itself harms — conditions which all exist now and bear no hope of subsiding — the provision for two appellate reviews of a contested workers’ compensation case is wasteful and unnecessary. Besides, as shown by this case and Atlanta Family Restaurants, supra, and many others, the procedure provided by law is not always adhered to. This ongoing problem deserves legislative scrutiny.
Dissenting Opinion
dissenting.
Reynolds claims that job-related mental stress and worry caused him to suffer a stroke. Reynolds was an officer of Reynolds Construction Company, a family-operated business. He testified before the ALJ that, as he left a construction bid meeting at work, he became sick with a severe headache, sweating, and cold chills in part of his head. He went home early but became even sicker and eventually went to the hospital that night. Medical evidence presented by the employer showed that he was finally diagnosed as having suffered a cerebrovascular accident involving an occlusion of the right vertebral artery, commonly called a stroke.
Reynolds, who proceeded pro se at the hearing before the ALJ, testified that, becаuse of the company’s continuing financial problems, he had been working long hours and had been experiencing continuous job-related stress for about three years prior to the stroke. Reynolds did not claim that physical fatigue or exertion from working long hours caused or contributed to the stroke. Rather, he claimed that long hours of continuous mental stress and worry on the job caused or contributed to the stroke. Reynolds’ brother, also an officer of the company, also testified that Reynolds had been experiencing mental stress and pressure because of the company’s financial problems. He stated: “[W]е were all under duress, pressure, and strain and stress . . . [The claimant] had a lot of pressure on him. I can go get a fishing pole and leave mine alone, but he couldn’t do it.”
The only other evidence presented was the medical records of Reynolds’ physician. It was the physician’s opinion that Reynolds’ stroke was not job-related but was the result of his arteriosclerosis. Other medical evidence showed that the stroke was secondary to Reynolds’ existing diabetes, hypertension and hypertriglyceridemia.
In concluding that the stroke arose out of and in the course of Reynolds’ employment, the ALJ found that, “[f]rom the lay observations and opinions given by employer [sic] Reynolds and his brother and from the natural inferences and through human experience of this finder of fact, it is found that the employee’s stroke and the occlusion of the posterior inferior cerebellar artery was triggered by the extremely stressful conditions and long hours the employee was ex
The employer contends that the ALJ, as affirmed by the appellate division and the superior court, erred in using the “natural inference through human experience” as the basis for determining that the stroke was a compensable injury, wherе there was uncontradicted medical evidence showing that the stroke was not work-related. Although I agree that the ALJ and the appellate division erred by using the “natural inference through human experience” as the basis for finding that the stroke was a compensable injury, I do so for different reasons than those urged by the employer.
The employer’s contentions with respect to the application of the “natural inference” rule and OCGA § 34-9-1 (4) are misplaced.
First, the Supreme Court has determined that, where the “natural inference” utilized by the ALJ in this case is available, it is competent and credible evidence of causation in cases where there is no medical evidence of causation, and that, even where medical evidence as to causation is presented, the “natural inference” does not disappear. Guye v. Home Indem. Co.,
Secondly, as to the employer’s argument that the evidence failed to satisfy the preponderance of the evidence requirement of OCGA § 34-9-1 (4), this argument is addressed to the trier of fact, not this Court, which is bound by the “any evidence” rule applicable to appellate review. Guye, supra at 215. Moreover, the preponderance of the evidence requirement of OCGA § 34-9-1 (4) applies to cases involving “heart disease, heart attack, the failure or occlusion of any of the coronary blood vessels, or thrombosis.” It does not apply when the injury at issue is a stroke involving a cerebrovascular occlusion. It may be argued that because the statutory list of medical conditions concludes with the general term “thrombosis,” the statute embraces conditions unrelated to the prior enumerated coronary problems and could be construed to include a thrombosis or occlusion of a cerebral vessel. However, I find no evidence that the Legislature intended this broad construction. “It is a well-recognized rule of construction that when a statute or document enumerates by name several particular things, and concludes with a general term of enlargement, this latter term is to be construed as being ejusdem generis with the things specifically named, unless, of course, there is something to show that a wider sense was intended.” (Citations and punctuation omitted.) Wester v. State,
Nevertheless, I conclude the ALJ and the appellate division erro
I agree with the general statements in the majority opinion that the factfinder is entitled to rely on the “natural inference through human experience” to establish causation and that the factfinder may reject the opinions of medical experts. The Supreme Court has clearly held that, where the “natural inference” is available, it is competent evidence of causation sufficient to satisfy the “any evidence” rule and that the “natural inference” does not disappear when expert medical evidence as to causation is presented. Gaye, supra at 215.-217; Southwire Co., supra at 897-898. Nevertheless, the issue which the majority does not address is whether there are necessarily certain types of cases where the “natural inference” should not be considered competent evidence of causation and whether this is such a case. This Court and the Supreme Court have found the “natural inference” available in numerous cases involving simple medical causation issues where a cause and effеct relationship between the work and the injury may be inferred based on common sense and human experience. However, it follows that the “natural inference” should not be available to the factfinder in cases where the issue of a causal relationship between the work and the injury involves more complicated medical questions beyond the ken of laypersons and which require expert medical testimony to establish causation. Placing limits on the availability of the “natural inference” in cases involving complex medical causation issues is the issue of first impression on which this case turns.
Reynolds had the burden of shоwing by competent evidence that his stroke arose out of and in the course of his employment. The disputed issue in this case is not whether the stroke occurred in the course of employment, but whether it arose out of employment. “The words ‘arising out of’ mean that there must be some causal connection between the conditions under which the employee worked and the injury which he received. The causative danger must be incidental to the character of the employment, and not independent of the relation of master and servant.” Thornton v. Hartford Accident &c. Co.,
It has been recognized that the burden of proving causation under these standards may be difficult to carry in cases of this nature. For example, in heart attack cases “it is often difficult for the trier of fact to find the line between a noncompensable heart injury that is a symptom of an existing disease merely manifested during job exertion, and a compensable heart injury to which the job exertion was a contributing precipitating factor. [Cits.] The generalized and complex nature of a heart injury may prevent causation from being conclusively attributed to the work performed. In determining whether claimant’s job activities caused or contributed to his heart injury, it has been said that the factfinder may rely on different forms of evidence, including medical opinion or ‘the natural inference through human experience.’ Carter v. Kansas City Fire &c. Ins. Co., [
In concluding that Reynolds’ job-related mental stress caused or contributed to his stroke, the ALJ relied on two types of evidence: (1) the lay observаtions and opinions of Reynolds and his brother, and (2) the natural inference through human experience. The award must
First, I address the ALJ’s use of the “natural inference” in this case to establish a causal connection between continuous job-related mental stress and worry and the stroke. Although the majority characterizes this as a case involving employment-related “stress and fatigue,” the record shows that Reynolds did not claim the stroke was caused by any type of physical exertion on the job. Rather, he claimed that the stroke was caused by three years of job-related mental stress and worry.
The primary use of the “natural inference” has been in cases where the claimant alleged that a heart attack was caused by job-related physical exertion. In Guye, supra, the Supreme Court determined that the “natural inference” was available as competent evidence that a heart attack was caused by strenuous manual labor at work. See also Carter, supra (natural inference available when heart attack followed physical exertion at work). In other heart attack cases, it has been determined that the “natural inference” was not available, either because the physical exertion was not sufficient to support the inference (see Hoffman, supra), or because facts otherwise failed to show a sufficient connection between the physical exertion at work and the onset of the attack. See Southwire Co., supra at 898 (natural inference not available where the symptoms of thе heart attack did not occur until the claimant had been home for several hours); see also Travelers Ins. Co. v. Maddox,
Although the “natural inferenсe” has been applied in cases where mental stress, worry, or excitement has been claimed as contributing factors in a heart attack, in these cases there has also been evidence that physical exertion caused or contributed to the heart attack. See Southwire Co. v. Eason,
In cases where the claim was that mental or emotional stress alone caused a heart attack or heart disease, awards for the claimant have been affirmed based on expert medical testimony in support of causation without reliance on the “natural inference.” City Council of Augusta v. Williams,
As the above analysis demonstrates, the cases in which the “natural inference” has been relied upon to establish a causal connection between a condition of employment and an injury, including those where mental or emotional stress was a factor, have all involved evidence that some type of physical exertion caused or contributed to the injury. These are the type of cases where a cause and effect relationship between the strenuous work conditions and the injury can be inferred based on common sense and human experience. See OCGA §§ 24-1-1 (6); 24-4-9. Awards based solely on claims that job-related mental or emotional stress caused an injury have relied on expert medical evidence rather than the “natural inference” to establish causation.
Two underlying reasons have been associated with application of the “natural inference through human experience” as competent evidence of сausation in some cases, while in other cases expert medical evidence should be required to supply competent evidence of causation. Larson, 2B, The Law of Workmen’s Compensation, § 79.53. First, in. some cases lay testimony, including testimony from the claimant, has probative value in establishing simple matters such as the fact and location of pain, the nature of the events surrounding the injury, and the fact and extent of the claimant’s ability or inability to work. See Thomas v. United States Cas. Co.,
Whether a causal connection exists between the continuous job-related mental stress experienced by Reynolds over a pеriod of three years and his stroke involving a cerebrovascular occlusion is not a simple medical question about which a cause and effect relationship may be inferred by laymen based on common sense or human experience. It is a medical question of the sort that requires expert medical testimony. See Nat. Dairy Products Corp. v. Durham,
It follows from these conclusions that the second form of evidence relied upon by the ALJ, lay observations and opinions given by Reynolds and his brother, was not sufficient to establish causation in this case. The three forms of evidence which may be used by the factfinder to establish a causal connection between the job conditions and a resulting heart attack or similar type injury were identified in Carter, supra at 604, as follows: “medical opinion, lay observations and opinion, and ‘the natural inference through human experience.’ See McDaniel v. Employers Mut. Liab. Ins. Co.,
Since neither the “natural inference through human experience” nor the lay opinions and observations presented by Reynolds were competent evidence of causation, and Reynolds produced no medical evidence in support of causation, there was no competent evidence of causation necessary to support the award, which must be reversed. This is not to say that the factfinder was required to accept the expert medical testimony presented by the employer. It is to say that Reynolds had the burden tb produce some competent evidence in support of causation and he produced none. Nevertheless, I would hold that, since the unavailability of the “natural inference” in this case was “an issue of first impression whose resolution was not clearly foreshadowed,” Reynolds should be given an opportunity to furnish additional competent evidence of causation to avoid imposing any “injustice or hardship.” Flewellen v. Atlanta Cas. Co.,
This “natural inference” rule is not the same as the natural presumption applicable in unexplained death cases. See Southwire Co., supra at 896-897; LaVista Equip., supra at 587; Odom v. Transamerica Ins. Group,
I do not conclude whether or not the “natural inference” may be available in other types of mental or emotional stress cases. For example, this case does not deal with a claim that a sudden, brief excitement or stimulus caused or precipitated an attack of some nature