How Do I Prove My Job Caused My Injury?

How Do I Prove My Job Caused My Injury?

Understanding Legal Causation, Medical Causation, and Proximate Cause in an Alabama Workers’ Compensation Claim

You were hurt at work.  Your doctor agrees that you have a real medical problem, but the workers’ compensation insurance company says: “That doesn’t mean your job caused it.”

This can be one of the most confusing parts of an Alabama workers’ compensation claim.

An MRI can prove that you have a herniated disc.

A nerve conduction study can demonstrate carpal tunnel syndrome.

But proving that you have a medical condition is not necessarily the same thing as proving that the condition is related to your work.

Under Alabama workers’ compensation law, questions of legal causation and medical causation are used to determine whether there is a sufficient connection between your employment and the injury for which you are seeking benefits.

And while people frequently use the term “proximate cause,” workers’ compensation causation is not always the same as the traditional proximate-cause analysis used in an ordinary personal injury lawsuit.

Understanding those differences can help explain why some workers’ compensation claims are accepted—and why others are denied.

Recommended Reading: Did My Work Accident Cause a New Injury, an Aggravation or Exacerbation of an earlier injury or Just a Recurrence?  Understanding Preexisting Conditions in Alabama Workers’ Compensation Cases.

First, What Does “Causation” Mean?

Strip away the legal terminology and causation asks a fairly simple question: What does your work have to do with your injury?

Sometimes the answer is obvious.

A roofer falls from a roof and fractures his leg.

A warehouse employee is struck by a forklift and injures his shoulder.

A nurse hurts her back while catching a falling patient.

Other cases are much more complicated.

A 58-year-old construction worker has degenerative disc disease and develops severe back problems after years of heavy lifting.

An assembly-line worker develops carpal tunnel syndrome after performing thousands of repetitive hand movements.

An employee suffers a heart attack after unusually strenuous work.

An employee with a previous knee injury experiences substantially increased symptoms after another accident at work.

In these cases, determining whether the condition is compensable requires a closer examination of causation.

What Is Legal Causation?

Legal causation asks whether there is a sufficient relationship between the employment and the accident or risk to bring the injury within Alabama’s Workers’ Compensation Act.  For an injury caused by a sudden job accident, the employee generally must establish that the accident arose out of and occurred in the course of the employment.

Those phrases mean different things.

“In the course of employment” generally concerns the time, place, and circumstances under which the accident occurred.

“Arising out of employment” concerns the causal relationship between the employment and the accident.

Suppose a warehouse employee is unloading merchandise and falls from a loading dock.  That presents a fairly straightforward connection between the employment and the accident.

But suppose an employee suffers an unexplained medical event while simply sitting at a desk.  The fact that something happened at work does not necessarily mean it happened because of work.

That distinction is at the heart of legal causation.

Recommended Reading: What does “Arising out of and Occur in the Course of Employment” Mean?

Legal Causation Can Be Different When There Is No Sudden Accident

Some injuries do not result from one identifiable accident.

An employee may suffer an injury from cumulative physical stress, repetitive motion, occupational exposure, or another condition that develops over time.

In appropriate nonaccidental-injury cases, Alabama courts have applied a legal-causation test asking whether the employee’s job exposed the employee to a danger or risk materially in excess of that to which people are ordinarily exposed in their everyday lives.

The Alabama Supreme Court discussed this distinction at length in Ex parte Trinity Industries, Inc., 680 So. 2d 262 (Ala. 1996).

This requirement helps distinguish an occupational injury from a medical condition that merely happened to become symptomatic while someone was employed.

What Is Medical Causation?

Once the necessary connection between the employment and the accident or occupational risk is established, there is another question:

Did that accident or work-related exposure actually contribute to the medical condition for which you are seeking benefits?

That is medical causation.

Suppose an employee falls from a ladder at work.  There may be little question that the fall arose out of and occurred in the course of employment.  But suppose the employee later claims that the fall caused the need for lumbar surgery.

The employer may respond: “The MRI shows severe degenerative disc disease that existed before the accident.”

Now the dispute is not necessarily whether the employee fell at work.  The dispute is whether that fall contributed to the back condition and need for treatment.

That is a medical-causation question.

Recommended Reading: What is “Medical Causation” and Why it Matters in an Alabama Workers’ Compensation Claim.

Your Job Does Not Necessarily Have to Be the Sole Cause

This is one of the most important principles in Alabama workers’ compensation law.

An employee does not necessarily have to prove that work was the sole cause of the medical condition.

In Ex parte Valdez, 636 So. 2d 401 (Ala. 1994), the Alabama Supreme Court explained that medical causation does not require the occupational hazard to be the sole cause of the employee’s condition. Rather, it can be sufficient for the occupational hazard to be a contributing cause.

Several things may therefore contribute to an injury.

Age may contribute.

Arthritis may contribute.

Degenerative disc disease may contribute.

A previous injury may contribute.

And the job accident may contribute.

The existence of the first four does not necessarily eliminate the fifth.

The question may instead be whether the work injury contributed to producing the disability or need for treatment.

What Does “Proximate Cause” Mean?

“Proximate cause” is a term most people encounter in personal injury cases.  In an ordinary negligence case, it generally refers to the legally sufficient causal connection between someone’s wrongful conduct and the resulting injury.

For example: A driver runs a red light.  The driver’s vehicle strikes another car.  The occupant suffers a broken leg.

The driver’s negligence is directly connected to the resulting injury.

Workers’ compensation is different because it generally does not depend upon proving that the employer was negligent.

That is why trying to import ordinary personal-injury concepts of fault and proximate causation into every workers’ compensation case can create confusion.  The Alabama Workers’ Compensation Act instead focuses on whether the injury arose out of and in the course of employment and whether the employment or work-related accident caused or contributed to the injury for which benefits are sought.

“A” Cause Can Be Enough

Consider an employee with significant arthritis in his knee.

Before the accident, he is working full duty.

He climbs ladders.

He kneels.

He carries equipment.

Then he twists the knee while carrying something at work.

Afterward, his symptoms become dramatically worse.

He cannot return to his regular job.  His doctor recommends knee replacement surgery.

The insurance company might argue: “The arthritis caused the need for surgery,” but that doesn’t necessarily answer the workers’ compensation question.

The employee may respond: “The arthritis was there before, but I was working. The job injury contributed to making the condition disabling and accelerated my need for surgery.”

Both statements could potentially contain some truth.

Workers’ compensation causation does not necessarily require the work injury to be the only explanation.

What If the Condition Would Have Eventually Become Worse Anyway?

This is another important causation question.

People age.

Arthritis progresses.

Degenerative disc disease may become worse.

An underlying condition may eventually require surgery regardless of employment.

If a condition becomes worse solely through its natural progression, without any contribution from employment, workers’ compensation generally does not become responsible merely because the employee happened to have a job.

But the result may be different when the employment aggravates, accelerates, or combines with the underlying condition.

Alabama cases have recognized that employment may satisfy medical causation when work acts upon a latent pre-existing condition to hasten symptoms or accelerate its harmful consequences.

The question therefore becomes: Did work contribute to what happened when it happened?

That can be very different from asking whether work originally created every part of the underlying disease.

Do I Need a Doctor to Say My Injury Was Caused by Work?

Medical testimony can be extremely important, but Alabama law does not necessarily require a doctor to use particular “magic words.”

The Alabama Supreme Court explained in Ex parte Price, 555 So. 2d 1060 (Ala. 1989) that medical causation is determined from the overall substance and effect of the evidence when considered in its full context.

That may include both medical and lay evidence.

For example:

An employee worked without restrictions before the accident.

The accident occurred.

Symptoms appeared immediately afterward.

The employee reported those symptoms.

Treatment began.

The employee could no longer perform the same work.

Diagnostic testing revealed the condition.

The physician’s testimony is considered together with those facts.

The absence of a sentence in the medical records saying “the accident proximately caused this condition” does not necessarily end the inquiry.

What About Psychological Injuries?

The contributing-cause principle can also arise in claims involving psychological injuries.

Under § 25-5-1(9), Ala. Code 1975, Alabama’s definition of “injury” does not generally include a mental disorder or mental injury that was neither produced nor proximately caused by a physical injury to the body.  However, Alabama appellate decisions have recognized that the physical injury need not necessarily be the sole cause of the psychological condition.

In Ex parte Vongsouvanh, 795 So. 2d 625 (Ala. 2000) and USX Corp. v. Bradley, 881 So. 2d 421 (Ala. Civ. App. 2003), Alabama courts addressed the contributing-cause principle in the context of psychological injuries associated with physical injuries.

Again, the recurring concept is contribution rather than exclusivity of cause.

Causation Also Matters When Someone Else Caused Your Job Injury

There is another reason understanding causation matters.

Suppose you are driving for work when another driver runs a red light and hits you.

For workers’ compensation purposes, the question is whether you suffered a compensable job-related injury.

For the separate personal injury case, you must establish the other driver’s legal responsibility for causing the collision and your resulting damages.

The same accident can therefore involve different causation analyses under two different bodies of law.

Recommended Reading: I Was Hit by Another Driver While Working—Do I Have a Workers’ Compensation Claim and a Car Accident Claim?  Can I Have an Alabama Workers’ Compensation Claim and a Personal Injury Claim?

The Law

Alabama workers’ compensation law generally requires proof of both legal causation and medical causation.

As explained in Ex parte Trinity Industries, Inc., 680 So. 2d 262 (Ala. 1996), the analysis differs depending upon whether the employee alleges an injury resulting from an accidental event or a nonaccidental injury.

Medical causation asks whether the work-related accident or exposure contributed to the injury for which compensation is sought.

Ex parte Valdez, 636 So. 2d 401 (Ala. 1994) makes clear that the employment need not necessarily be the sole cause of the condition; it may be sufficient that it was a contributing cause.

The Bottom Line

When an insurance company says: “Your job didn’t cause this,” that statement may be the beginning of the analysis—not the end of it.

The important questions include:

Was there a sufficient connection between your employment and the accident or occupational risk?

Did that accident, exposure, or work activity contribute to the medical condition, need for treatment, or disability?

And:

Did work aggravate, accelerate, or combine with an underlying condition rather than the condition simply worsening through its natural progression?

Alabama workers’ compensation law does not necessarily require your employment to be the sole cause of your injury.

In many cases, what matters is whether your work was a contributing cause.

Experience Matters When Causation Is Disputed

At Powell & Denny, P.C., we have extensive experience handling Alabama workers’ compensation claims involving disputed medical and legal causation, pre-existing conditions, repetitive injuries, and claims in which an insurance company contends that an employee’s condition was not caused by work. These cases often require careful consideration of the medical records, the employee’s work history, expert opinions, and Alabama workers’ compensation law to determine whether the evidence establishes the necessary connection between the job and the injury.