U. S. INDUSTRIES/FEDERAL SHEET METAL, INC., ET AL., v. DIRECTOR, OFFICE OF WORKERS’ COMPENSATION PROGRAMS, UNITED STATES DEPARTMENT OF LABOR, ET AL.
No. 80-518
Supreme Court of the United States
Argued October 6, 1981—Decided March 23, 1982
455 U.S. 608
Richard W. Galiher, Jr., argued the cause for petitioners. With him on the briefs were Richard W. Galiher, William H. Clarke, and Frank J. Martell.
James F. Green argued the cause for respondents. With him on the brief for respondent Riley were Karl N. Marshall, Martin E. Gerel, James A. Mannino, Mark L. Schaffer, and Wayne M. Mansulla.*
JUSTICE STEVENS delivered the opinion of the Court.
In the early morning of November 20, 1975, respondent Ralph Riley awoke with severe pains in his neck, shoulders, and arms, which later were attributed by physiсians to an exacerbation of an arthritic condition. The United States Court of Appeals for the District of Columbia Circuit held that this “injury” was sufficient to invoke the “statutory presumption of compensability,”1 § 20(a) of the Longshoremen‘s and Harbor Workers’ Compensation Act, 44 Stat. (part 2) 1436,
An evidentiary hearing was convened before an Administrative Law Judge. After construing the evidence in a light most favorable to Riley and resolving all doubts in his favor, the Administrative Law Judge found “that Claimant sustained no injury within the meaning of Sec. 2(2) of the Act on November 19, 1975, as alleged, and that Claimant and Sutherland [Riley‘s co-worker] gave false testimony as to the happening of the accident.” App. to Pet. for Cert. 24A.
A divided panеl of the Benefits Review Board affirmed the denial of disability benefits, holding that the Administrative Law Judge‘s findings were supported by substantial evidence. In dissent, Member Miller stated:
“The Act does not require that claimant prove an accident in order to establish a claim. To the contrary, compensation is payable under the Act if claimant is disabled because of injury which is causally related to his employment.
33 U. S. C. §§ 902(10) ,902(2) .” 9 BRBS 936, 940 (1979) (emphasis in original).
On Riley‘s petition for review, the Court of Appeals vacated the decision of the Benefits Review Board, agreeing with Member Miller‘s position. Riley v. U. S. Industries/Federal Sheet Metal, Inc., 200 U. S. App. D. C. 402, 627 F. 2d 455 (1980). The court stated that “it can hardly be disputed that petitioner suffered an ‘injury’ when he awakened in pain on November 20, 1975.” Id., at 405, 627 F. 2d, at 458. The court then turned its “attention to the statutory presumption and the range of situations to which this Court has applied it.” Ibid. It construed its earlier cases as holding “that an injury need not have occurred during working hours” and “need not be traceable to any particular work-related incident to be compensable.” Id., at 405-406, 627 F. 2d, at 458-459.4
“The foregoing cases make clear the pervasive scope of the statutory presumption of compensability. Indeed, no decision of this Court has ever failed to apply the pre-
sumptiоn to any facet of any claim before it. We now hold expressly that where a claimant has been injured, the Act requires that, in the absence of substantial evidence to the contrary, a claimant be given the benefit of a rebuttable presumption that the injury arose out of and in the course of the claimant‘s employment.” Id., at 406, 627 F. 2d, at 459.
The question for remand was not whether Riley‘s “injury” stemmed from a “work-related incident,” but whether it was “‘employment-bred.‘” Ibid.
The Court of Appeals erred because it overlooked (1) the statutory language that relates the § 20(a) presumption to the employeе‘s claim, and (2) the statutory definition of the term “injury.”
I
The Court of Appeals’ first error was its invocation of the § 20(a) presumption in support of a claim that was not made by Riley. Riley claimed that he suffered an injury at work on November 19 when he was lifting duct work and felt a sharp pain in his neck. The Administrative Law Judge found as a matter of fact that the accident had not occurred; this finding is no longer challenged. The Court of Appeals’ theory of recovery was that Riley suffered an injury at home in bed on November 20 and that Riley was entitled to a presumption that this injury was “employment-bred.”
Section 20(a), 44 Stat. (pаrt 2) 1436, provides that “[i]n any proceeding for the enforcement of a claim for compensation under this Act it shall be presumed, in the absence of substantial evidence to the contrary . . . [t]hat the claim comes within the provisions of this Act.” The coverage of the presumption is debatable,5 but one thing is clear: the pre-
Section 13 of the Act,
II
The Court of Appeals’ second error was its incorrect use of the term “injury.” The court stated that Riley‘s attack of pain in the early morning of November 20 was an “injury” compensable under the Act if the employer did not disprove by substantial evidence that the “injury” was “employment-bred.” The fact that “something unexpectedly goes wrong with the human frame,” 200 U. S. App. D. C., at 405, 627 F. 2d, at 458 (quoting Wheatley v. Adler, 132 U. S. App. D. C. 177, 183, 407 F. 2d 307, 313 (1968)), however, does not establish an “injury” within the meaning of the Act. The mere existence of a physical impairment is plainly insufficient to shift the burden of proof to the employer.
Section 3(a) provides that “[c]ompensatiоn shall be payable under this Act in respect of disability . . . of an employee, but only if the disability . . . results from an injury.” 44 Stat. (part 2) 1426, as amended,
A prima facie “claim for compensation,” to which the statutory presumption refers, must аt least allege an injury that arose in the course of employment as well as out of employment.10 The “injury” noticed by the Court of Appeals, how-
III
Riley‘s claim stated a prima facie case of compensability; if the Administrative Law Judge had believed Riley‘s allegations, he would have found that Riley‘s attack of pain in the early morning of November 20 was caused by an injury suffered when Riley was lifting duct work on the job on November 19. The judge, however, disbelieved Riley‘s allegations and marshaled substantial evidence to support his findings. The statutory presumption did not require him to adjudicate any claim that was not made, and the Court of Appeals erred in remanding for that purpose. Nor could the statutory presumption have aided Riley had he made the clаim envisioned by the Court of Appeals—that he suffered an “injury” at home—for such a claim omits the requirement that a compensable injury arise in the course of employment.
The judgment of the Court of Appeals is reversed.
It is so ordered.
JUSTICE O‘CONNOR took no part in the consideration or decision of this case.
Workmen‘s compensation legislation has never been intended to provide life or disability insurance for covered employees. The required connection between the death or disability and employment distinguishes the workmen‘s compensation program from such an insurance program, and the separate requirements that the injury аrise out of and in the course of employment are the means for assuring, to the extent possible, that the work connection is proved. See W. Dodd, Administration of Workmen‘s Compensation 681 (1936); see generally Cudahy Packing Co. v. Parramore, 263 U. S. 418, 422-424 (1923).
I
Section 20(a) of the Longshoremen‘s and Harbor Workers’ Compensation Act (LHWCA),
By its terms, and quite in contrast to the practice in judicial proceedings, § 20(a) requires the employer to take the initial steps to disprove his liability. This preliminary shifting of the burden to the employer exemplifies the “humanitarian nature of the Act,” O‘Keeffe v. Smith Associates, 380 U. S. 359, 362 (1965) (per curiam), and the “strong legislative policy favoring awards in arguable cases,” Wheatley v. Adler, 132 U. S. App. D. C. 177, 183, 407 F. 2d 307, 313 (1968) (en banc). Section 20(a) is clearly broad enough to encompass the question of causation. “The statutory presumption applies as much to the nexus between an employee‘s malady and his employment activities as it does to any other aspect of a claim.” In re District of Columbia Workmen‘s Compensation Act, 180 U. S. App. D. C. 216, 223, 554 F. 2d 1075, 1082 (1976). To defeat a claim for compensation, the employer must rebut the presumption of compensability by offering substantial evidence that the claim is not one “arising out of and in the course of employment.”
The statutory presumption thus defines the basic agenda for the hearing before the Office of Workers’ Compensation Programs (OWCP), and the factfinding required before the OWCP may deny a compensation claim. In this case, there is no serious dispute that respondent Riley suffered some disabling injury.1 See Riley v. U. S. Industries/Federal Sheet Metal, Inc., 200 U. S. App. D. C. 402, 406, n. 3, 627 F. 2d 455, 459, n. 3 (1980). Riley has an arthritic neck condition, and “the pain [he] suffered . . . was due to an exacerbation of his arthritic neck condition.” Id., at 405, 627 F. 2d, at 458. Given the existence of this condition, and the statutory presumption, the relevant inquiry was whether the employer had shown that the condition was not sufficiently work-related to render the emplоyer accountable.2 No such finding was ever entered. Rather, the Administrative Law Judge and the Benefits Review Board focused exclusively on the testimony of Riley and his co-worker that something happened to Riley while lifting duct work on November 19, 1975, causing an immediate pain in his neck. The Administrative
Had the Administrative Law Judge credited the testimony of Riley with respect to the November 19 incident, it would surely have strengthened Riley‘s position that the exacerbation of his arthritic neck condition was work-related. But the finding that this incident did not occur hardly demonstrates that Riley‘s disability did not arise out of and in the course of employment. An injury need not be traceable to a single event at work in order to be compensable. “Even if the asserted work-related incident had never occurred, the injuries suffered by the claimant might nevertheless have been ‘employment bred.‘” Id., at 406, 627 F. 2d, at 459.3
II
Rather than allow a remand so that the normal process of administrative adjudication might run its course, the Court discerns a dispositive procedural requirement within the Act. The Court places its emphasis on the language of § 20(a):
“In any proceeding for the enforcement of a claim for compensation under this Act it shall be presumed, in the absence of substantial evidence to the contrary . . . [t]hat the claim comes within the provisions of this Act.” (Emphasis added.)
Unremarkably, the Court reads this language as applying the presumption to the “claim for compensation.” But quite remarkably, and without any support in precedent or the language of the Act, the Court construes the words “claim for compensation” to mean some sort of legal document, or at least some stated theory, setting forth a prima facie case for compеnsation, upon which all further proceedings must be based, and to which the presumption may attach.
The Court appears to glean its understanding of the word “claim” from the meaning assigned to the term “claim for relief” by Rule 8(a) of the Federal Rules of Civil Procedure. The Court concedes, as it must, that this understanding of the word “claim” finds no direct authority in the LHWCA itself. The Act does require the employee to file a timely “claim” with the Deputy Commissioner.
Moreover, the Court‘s reliance on a written pleading requirement is wholly out of step with the sensible informality with which the Act is administered.6 Under the present regime of administrative enforcement, issues are not narrowed through pleadings, but rather through a mixture of formal
Apparently the Court is of the view that its imported definition of “claim” is necessary to protect employers from being called into a compensation hearing without any warning of the basis upon which compensation is sought; on this argument, the employer would otherwise be forced to offer evidence refuting every conceivable basis upon which an employee‘s claim might be grounded. I do not share the Court‘s fear. The Act аlready contains sufficient accommodation to such legitimate employer concerns: in the form of a statutory notice requirement, in the practical manner in which the presumption of compensability has historically
III
As Justice Douglas once had occasion to remind us, “[t]he problems under this Act should rest mainly with the Courts of Appeals.” O‘Keeffe v. Smith Associates, 380 U. S., at 371 (dubitante). The Court‘s treatment of the relatively simple issues raised by the present case underscores the wisdom of that counsel of deference. The Court of Appeals concluded below that the relevant issues were never resolved by the Administrative Law Judge. I can hardly disagree. Therefore, I dissent.
Notes
There appears to be little in the abbreviated record before this Court directly supporting this broader theory of recovery. Although one physician testified that “[t]he man is certainly disabled from working,” App. 130, this statement was made in the course of questioning about the possible effects of the alleged November 19 incident. Another doctor, describing Riley‘s condition shortly after he entеred the hospital, noted: “[M]ost of his work is overhead type and involves quite a bit of hyperextension of the neck. That means that most of his work he will have to do with his neck bending upwards.” Id., at 158. That same doctor, however, referred repeatedly to Riley‘s assertion that he felt pain as a result of bending or twisting his neck while lifting duct work in November 1975, and rendered his diagnosis on that basis. See id., at 162-169. Although Riley hardly proved his theory by this medical evidence, given the nature of the injury and the nature of his work, Riley clearly made the “initial demonstration of employment-connection [that] will give the presumption a fоothold.” 1 A. Larson, supra, § 10.33, at 3-121 (1978).
“Thе adjective law of workmen‘s compensation, like the substantive, takes its tone from the beneficent and remedial character of the legislation. Procedure is generally summary and informal. . . . The whole idea is to get away from the cumbersome procedures and technicalities of pleading, and to reach a right decision by the shortest and quickest possible route. . . .
“On the other hand, as every lawyer knows, there is a point beyond which the sweeping-aside of ‘technicalities’ cannot go, since evidentiary and procedural rules usually have an irreducible hard core of necessary function that cannot be dispensed with in any orderly investigation of the
merits of a case.” 3 A. Larson, The Law of Workmen‘s Compensation § 78.10, p. 15-2 (1976).Professor Larson writes that an informal substitute for a claim may be acceptable if it “identif[ies] the claimant, indicate[s] that a compensable injury has occurred, and convey[s] the idea that compensation is expected,” id., § 78.11, p. 15-9; that “considerable liberality is usually shown in allowing amendment of pleadings to correct . . . defects,” unless the “effect is one of undue surprise or prejudice to the opposing party,” id., at 15-11; and that “wide latitude is allowed” as to variance between pleading and proof, “[b]ut if the variance is so great that the defendant is prejudiced by having to deal at the hearing with an injury entirely different from the one pleaded, the variance may be held fatal,” id., at 15-13—15-14. Riley had the benefit of these liberal pleading rules; nonetheless, the Court of Appeals applied the statutory presumption to a claim that was not fairly supported by the existing claim or by the evidentiary record. As Professor Larson warns, “[n]o amount of informality can alter the elementary requirement that the сlaimant allege and prove the substance of all essential elements in his case.” Id., at 15-12.
Although I do not profess expertise in the administration of the LHWCA, it does seem to me that this provision might have relevance in a case, such as the present one, where the administrative law judge intends to reject the claimant‘s principal theory of the case, but where a second theory should be more fully explored before the question of compensation is finally determined. Of course, I would leave questions regarding the application of this and all other regulations governing LHWCA proceedings for the Review Board to resolve on remand. See also 20 CFR § 702.336(a) (1981).