The Workers' Compensation Board (the board) concluded that claimant failed to establish that her fall was unexplained. The Court of Appeals held that the board applied the wrong standard, vacated the board's decision, and remanded the case to the board to apply the standard in the manner directed by that court. Sheldon v. US Bank ,
Some legal background is useful before describing the facts and procedural history in this case. A claimant bears the burden of proving that his or her injury is compensable. ORS 656.266(1). "A 'compensable injury' is an accidental injury *** arising
Under the unitary test for work-connectedness, a claimant cannot establish a compensable injury unless both the "arising out of" employment prong and the "in the course of" employment prong are satisfied to at least "some degree." Redman Industries ,
To establish that an injury arose out of employment, a claimant must establish that the injury "had its origin in a risk connected with the employment or rationally and naturally incidental thereto." Phil A. Livesley Co. v. Russ ,
An injury arising out of employment is not confined to injuries that result from employment risks. Instead, an injury arises out of employment if either (1) the injury results from an employment risk or (2) the injury results from a neutral risk where " 'the conditions of employment put [a] claimant in a position to be injured.' " Panpat v. Owens-Brockway Glass Container, Inc. ,
The distinction between an unexplained fall and an idiopathic fall frames the parties' dispute in this case. Claimant fell on her way to work while walking through the lobby of an office building where employer leased office space. As a result of the fall, claimant fractured a bone in her shoulder. Paramedics responded, and claimant told them that she had been "walking and then her foot got caught and she tripped and fell." Claimant was transported by ambulance to a hospital, and she told an emergency room nurse that "her foot rolled and she tripped and fell."
Employer contended that claimant's injuries were not compensable because her fall could have been caused by idiopathic factors, specifically, claimant's diabetes and obesity. In support of its contention, employer submitted a letter opinion by a physician, Dr. Bell. Bell had reviewed claimant's medical records but had never examined claimant personally. Based on her review of claimant's records, Bell opined that claimant's diabetes was a "potential contributing cause" in her fall because diabetes"is known to cause peripheral neuropathy" and "[p]eripheral neuropathy in the lower extremities *** affects sensation and reflexes." Bell also opined that claimant's obesity was "a potential contributing factor" in her fall because it "most likely affected her balance and mobility." Bell concluded that "symptomatic manifestations of diabetes and obesity could have caused [claimant] to fall." She further concluded that it was "at least equally possible [claimant's] fall *** was caused by idiopathic problems associated with diabetes and/or obesity as it was due to risks associated with employment."
Claimant testified that she had never been diagnosed with peripheral neuropathy. She admitted that she had experienced "some tingling" in her feet in the past, but she denied that that tingling had ever caused her to fall. Claimant testified that she had never experienced balance
Claimant submitted a letter opinion and testimony from her primary care physician, Dr. Kelly. Kelly had been claimant's primary care physician for 10 years before her fall. He stated that claimant had no history of problems with balance or mobility and that he had observed her walking without any impaired balance or mobility on numerous occasions. Kelly also stated that, although claimant was taking medication for hypertension
After the hearing, the ALJ issued a written opinion and order, noting that Bell had "only suggested that it was 'possible' for claimant's medical conditions to have contributed to her fall," and that Kelly "had no information from which to conclude" that claimant's medical conditions were "more than potential causes" of her fall. Given that evidence, the ALJ concluded that the possibility that claimant's medical conditions caused her fall was "speculative" and, therefore, claimant had "eliminated idiopathic causes" of her fall. Specifically, the ALJ concluded:
"Since the alleged personal/idiopathic risks offered are speculative, they are less than equally likely to have caused the fall as Claimant's explanation of a tripping incident. I find therefore that Claimant has eliminated idiopathic causes for her fall."
The ALJ then turned to the question of whether claimant had established that her injury occurred "in the course of"
The board also affirmed employer's denial of the claim, but on a different ground. As an initial matter, the board noted that the fall was not the result of an employment risk both because claimant did not argue that an employment risk contributed to her injury and because the board "found no such employment contribution," thus rejecting any suggestion that the 1/16th-inch lip on the lobby tile caused the fall. Catherine A. Sheldon , 66 Van Natta 275, 278 n. 1 (2014).
The board then considered whether claimant's fall was the result of an unexplained accident. The board stated that, to establish that a fall is unexplained, a claimant must " 'persuasively eliminate[ ] all idiopathic factors of causation.' " Id. at 277 (quoting Blank v. US Bank of Oregon ,
Applying that standard, the board concluded that claimant failed to establish that her fall was unexplained. The board stated that medical evidence in the record "raised the possibility" that claimant's medical conditions-namely, her obesity, diabetes, ankle weakness, and antihypertensive medication-"caused, or contributed to, claimant's fall."
Based on that record, the board stated that "claimant did not persuasively eliminate the possible idiopathic reasons for her fall."
The Court of Appeals reviewed the board's factual findings for substantial evidence, ORS 183.482(8)(c), and its legal conclusions for errors of law, ORS 183.482(8)(a). The court first noted that "[a]n injury that is unexplained and occurs in the course of employment is presumed, as a matter of law, to arise out of the employment." Sheldon ,
The court attempted to provide that guidance, explaining that, to persuasively eliminate idiopathic factors of causation, "a claimant must establish that idiopathic factors are less than equally likely as work-related factors to have caused the injury."
In applying that standard, the Court of Appeals found fault with the board's reasoning:
"The standard applied by the board-reflected in the board's reliance on Kelly's statement that idiopathic factors 'could not be excluded'-effectively required claimant to conclusively rule out all possible idiopathic causes of her injury, no matter how remote, to prove that her injury is compensable. As explained above, such a standard is inconsistent with claimant's burden of persuasion, which requires only that claimant prove that idiopathic factors were less likely to have caused her fall than some other, unexplained factors."
Because the court concluded that the board applied the wrong legal standard for determining what it means to persuasively eliminate idiopathic factors, the court vacated the board's decision and remanded for reconsideration under the correct legal standard.
Both the board and the Court of Appeals attempted to apply a standard first used by this court in Livesley . That standard turns on whether the claimant has eliminated idiopathic causes. See Livesley ,
Before this court, the employer conceded that the claimant's fall was "not idiopathic in nature."
This court disagreed, holding that injuries resulting from unexplained falls may arise out of employment and be compensable. Livesley ,
The Livesley decision also clearly announced the standard for determining when an unexplained fall is compensable, which is separate from the standard for determining when a fall is unexplained. As noted above, the parties in Livesley agreed that the claimant's fall was unexplained and that he had eliminated idiopathic causes of the fall.
As to that question, the court referred back to the unitary work-connectedness test, noting that a claimant must prove that the "in the course of" employment prong and the "arising out of" employment prong have a sufficient combined weight to justify compensation.
The court then reasoned that because an unexplained fall only minimally satisfies the "arising out of employment" prong, a claimant attempting to establish the compensability of an unexplained fall must more substantially satisfy the "course of employment" prong. And the court determined that the claimant in that case had met that burden. According to the court, the " 'course of employment' elements [were] strong," Livesley ,
On the other hand, the Livesley decision appears to reason that unexplained falls may be deemed to arise out of employment because, when the cause of the fall is unknown, the fall might have been caused by an employment risk, rather than a neutral risk. The court described employment risks as the "ordinary risk[s] of employment," and stated that "where idiopathic causes for an unexplained fall have been eliminated, the inference arises that the fall was traceable to some ordinary risk, albeit unidentified, to which the employment premises exposed the employee."
At any given time, an employment environment might expose an employee to both employment risks and neutral risks. But if "ordinary risk" refers to employment risk, rather than neutral risk, then that sentence in Livesley could be read as suggesting that injuries resulting from unexplained falls arise out of employment based on an inference
Any confusion within Livesley has been resolved by later decisions. Those decisions uniformly cite Livesley for its endorsement of the positional-risk doctrine and not for its suggestion that injuries resulting from neutral risks can be deemed to arise out of employment based on an inference that those injuries actually result from an employment risk. See Panpat ,
In this case, however, the parties disagree about a threshold question that was not disputed in Livesley -namely, whether claimant's fall is unexplained and whether claimant has eliminated the idiopathic causes of her fall. And much of the parties' disagreement turns on attempting to understand what the Livesley court meant by the phrase "eliminate idiopathic causes." Id. at 30,
The parties' arguments on this point are difficult to decipher. It appears as though employer agrees with the version of the standard that the board applied, while claimant agrees with the version of the standard that the Court of Appeals applied. For the purpose of assessing standards, there are two separate issues: (1) which idiopathic causes does a claimant need to eliminate; and (2) what does it mean to eliminate those idiopathic causes.
As to the first issue, the phrase "eliminate idiopathic causes" raises the question of whether a claimant must eliminate all theoretically possible idiopathic causes or some smaller subset of idiopathic causes. In this case, the Court of Appeals was concerned that the board required claimant to eliminate all theoretically possible idiopathic causes. Sheldon ,
We agree with the Court of Appeals that a claimant need not eliminate all theoretically possible idiopathic causes. There is almost always going to be some theoretically possible explanation that cannot be disproven. So, if a factfinder were required to consider all theoretically possible explanations for an injury, then a factfinder would likely never conclude that an accident is unexplained. If a factfinder would likely never conclude that an accident is unexplained, then unexplained accidents would be, in effect, non-compensable. Such an approach is at odds with this court's decision in Livesley , which recognized the compensability of unexplained accidents.
That standard appears to be based on this court's statement in Livesley that injuries resulting from a fall are not compensable "where it is equally possible that its cause was idiopathic or work-related."
But determining whether an event is explained or unexplained presents a different calculus. The very idea of proving that an event is unexplained is an awkward one. When an event is unexplained, it is because there is an absence of evidence supporting any explanation. Thus, because an unexplained fall is supported by an absence of evidence, there is no evidence to weigh against the evidence supporting an idiopathic explanation for a fall. In other words, determining the likelihood that a particular risk caused a particular event requires knowing something about the likelihood that the event could have been caused by some other risk. But when those other risks are unknown, there is no way to measure the likelihood of those risks exactly.
Within that framework, the phrase "eliminate idiopathic causes" has a more concrete meaning that is consistent with its use in Livesley . Ultimately, to establish an unexplained fall, a claimant must prove that there are no nonspeculative explanations for a fall. Eliminating idiopathic causes is an intermediate step that arises only when the record reveals facially nonspeculative idiopathic explanations for a fall. If there are no facially nonspeculative idiopathic causes for explaining a fall, then there are no idiopathic causes for a claimant to eliminate. But if there are some facially nonspeculative idiopathic causes for explaining a fall, then the claimant must offer countering evidence sufficient to convince the board that the proposed idiopathic cause is, in fact, speculative.
Thus, to address the two issues identified above, a claimant is required to eliminate facially nonspeculative idiopathic explanations for a fall. And a claimant eliminates those idiopathic explanations by providing sufficient countering evidence to demonstrate that those idiopathic explanations are speculative in light of all admissible evidence.
The decision of the Court of Appeals is affirmed. The decision of the board is vacated, and the case is remanded to the board for reconsideration.
Notes
In this context, the word "idiopathic" "refers to an employee's preexisting physical weakness or disease which contributes to the accident." Phil A. Livesley Co. v. Russ ,
This court has not had the opportunity to consider the extent to which an injury may be compensable if it results from a combination of those risks-i.e. , a mixed-risk case. See Hamilton v. SAIF ,
This court has said that other examples of neutral risks "include an employee being hit by a stray bullet, bitten by a dog, struck by lightning, or injured by debris from a distant explosion." Redman Industries,
See also 1 Larson's Workers' Compensation Law § 7.04[1][a] at 7-25 ("[I]t is significant to note that most courts confronted with the unexplained-fall problem have seen fit to award compensation.").
It is unclear both what "risks associated with employment" Bell was considering and what her qualifications were to assess the likelihood that those employment risks might have caused claimant's fall. Determining that medical conditions pose a risk of falling is not the same as determining what caused a particular claimant to fall at a particular time.
As a general rule, injuries sustained when a worker is traveling to or from do not occur "in the course of" employment. Fred Meyer ,
As a result, under Livesley , a claimant cannot prove that an injury is compensable merely by disproving other possible explanations. We therefore reject employer's argument that the legislature overturned Livesley when, in 1987, it enacted the statute providing a claimant's burden of proof, which states, in part, that "[t]he worker cannot carry the burden of proving that an injury or occupational disease is compensable merely by disproving other possible explanations of how the injury or disease occurred." ORS 656.266(1). See also Tape Recording, Senate Labor Committee, HB 2271, April 23, 1987, Tape 120, Side A (testimony of Rep Bob Shiprack) ("Section 2 of the bill is not intended to overturn any cases. What we're doing here is codifying what is actually the current practice in workers' compensation.").
The current version of that treatise describes the positional-risk doctrine at 1 Larson's Workers' Compensation Law § 3.05 at 3-7.
"[A] lot of confusion, circumlocutions, and fictions could be avoided in the unexplained-fall cases by merely accepting the proposition that what is unexplained is neutral." 1 Larson's Workers' Compensation Law § 7.04[1][c] at 7-34.
In practice, that frequently means that the employer must offer some evidence establishing that there is a nonspeculative idiopathic explanation for a fall. That does not conflict with ORS 656.266(1), which imposes on the claimant the burden of establishing compensability of an injury. The employer is not required to prove that the idiopathic factor caused the fall. At most, the employer is required to establish that the idiopathic explanation being offered is nonspeculative.
We offer that example only to demonstrate the mechanics of proving that a fall is unexplained and to provide context understanding what it means to eliminate idiopathic causes of a fall. As noted, this court was not asked to review the factual determinations in Livesley , because the employer conceded that the claimant's fall was not caused by idiopathic factors.
