Written by Jessica Gorman, Esq.
Edited by Rachel Riordan, Esq.
What additional injuries an employer and carrier may be responsible for under the compensable consequence doctrine or chain of causation rule
You have an accepted accident for which an injured worker has injured his left ankle. While recuperating from surgery on his left ankle, his ankle gave way causing a right knee injury. Are you responsible for the right knee injury? The answer is yes. Subsequently, that right knee injury causes the injured worker to fall causing a new injury to the right knee. Are you responsible for that new knee injury? The answer may be no as a consequence of a compensable consequence, which is not covered under the Virginia Workers’ Compensation Act.
In Virginia, the doctrine of compensable consequence “is well established and has been in existence for many years.” Williams Indus., v. Wagoner, 24 Va. App. 181, 186, 480 S.E.2d 788, 790 (1997). This doctrine provides the standard that “when a primary injury under the Workers’ Compensation Act is shown to have arisen out of the course of employment, every natural consequence that flows from the injury is compensable if it is a direct and natural result of a primary injury.” Leonard v. Arnold, 218 Va. 210, 237 S.E.2d 97 (1977). Specifically, any such secondary injury is related as it if occurred in the course of and arising out of the injured workers’ employment. Bartholow Drywall Co. v. Hill, 12 Va. App. 790, 794, 407 S.E.2d 1, 3 (1991).
This doctrine is also known as the chain of causation rule and provides and states somewhat differently “where the chain of causation from the original industrial injury to the condition for which compensation is sought is direct, and not interrupted by any intervening cause attributable to the employee’s own intentional conduct, then the subsequent condition should be compensable.” Food Distribs. v. Estate of Ball, 24 Va. App. 692, 697, 485 S.E.2d 155, 158 (1997) (quoting Leadbetter, Inc. v. Penkalski, 21 Va. App. 427, 432, 464 S.E.2d 554,556 (1995).
“The simplest application of this principle is the rule that all the medical consequences and sequelae that flow from the primary injury are compensable. American Filtronea Co. v. Hanford, 16 Va. App. 159, 163, 428 S.E.2d 511, 513 (1993).” As such, in evaluating a subsequent medical condition or claim for additional injuries or benefits, you will need to look to see if there is medical evidence to support the connection between the initial injury and the later asserted condition. To prove a compensable consequence, an injured worker must meet the evidentiary standard which is “a reasonable medical probability” rather than a reasonable degree of medical certainty. Eilliott v. Blue Ridge Stone Corp., 71 O.W.C. 138, 139 (1992).
Compensable consequences include injuries sustained not as an immediate result of the original injury but as a result of some intermediate event which was itself a result of the original injury. Specifically, injuries sustained in a car accident while traveling to treatment for an original injury have been held compensable. See, Immer & Co. v. Brosnahan, 207 Va. 720, 152 S.E.2d 254 (1967). Suicide can also be compensable if the work related injury produces mental derangement and the mental condition then results in suicide. See, Food Distribs., supra, 24 Va. App. at 699-700, 485 S.E.2d at 159. Death has also been held as a compensable consequence where an injured worker “died as a result of a cardiac arrest caused by work related heatstroke.” Imperial Trash Serv. v. Dotson, 18 Va. App. 600, 602, 445 S.E.2d 716, 718 (1994). Additionally, the Act does not require a compensable consequence to meet the definition of an injury by accident in order to be compensable. Where there is a direct causal connection to the original accidental injury, a subsequent problem caused by repetitive trauma may be a compensable consequence. Frazier v. Infineon Technologies, VWC File No. 218-88-98 (Feb 6, 2006).
As it is reflected above, this doctrine applies to both new injuries resulting from new and separate accidents, as well as aggravations of prior compensable injuries. Leonard v. Arnold, 218 Va. 210, 237 S.E.2d 97 (1977); Bartholow Drywall Co. v. Hill, 12 Va. App. 790, 794, 407 S.E.2d 1, 3 (1991). However, three exceptions exist which eliminate the employer and carrier’s responsibility for a compensable consequence: (1) an aggravation of an earlier occupational injury if the new injury results from an accident that is independently compensable under the Virginia Worker’s Compensation Act, First Federal Savings & Loan v. Gryder, 9 Va. App. 60, 383 S.E.2d 755 (1989); (2) a consequence resulting from an intervening cause attributable to a claimant’s intentional conduct, Morris v. Badger Powhatan/Figgie International, Inc., 3 Va. App. 276, 348 S.E.2d 876 (1986); and (3) a compensable consequence of a compensable consequence, Amoco Foam Products Co. v. Johnson, 257 Va. 29, 33, 510 S.E.2d 443, 445 (1999).
The scenario referenced at the outset is from Amoco Foam Products Co. v. Johnson which ultimately held that there was no direct causal relationship between the injured workers’ employment and the second knee injury. As such, that second injury was therefore not compensable. This case along with Paul Johnson Plastering v. Johnson, 265 Va. 237, 576 S.E.2d 447 (2003) and Farmington Country Club, Inc. v. Marshall, 47 Va. App. 15, 622 S.E.2d 233 (2005) are the leading cases dealing with non-compensable consequences of compensable consequences. In Johnson, the injured worker initially sustained a wrist injury. The injured worker asserted that, because of the injury, he developed depression, but as a result of the depression he developed structural changes in his brain. The court held there was no direct relationship between the brain injury and the initial wrist injury and therefore was not compensable. Likewise, in Marshall, the injured worker sustained an initial back injury. As a result of that injury he developed stress and depression and asserted as a result of the stress and depression developed gastro-esophageal reflux disease (“GERD”). The court followed the reasoning in Amoco and Johnson and held that the injured worker was not entitled to benefits.
As such, it is important to scrutinize any new conditions which develop or subsequent injuries asserted to determine whether they are truly consequences of the initial injury to be compensable as a compensable consequence or whether there are sufficient facts to argue one of the exceptions to the compensable consequence doctrine so as to limit the liability for the claim.
Please feel free to contact us at any time if you have any questions regarding compensable consequences or to discuss whether any of the exceptions may apply to your claims to be able to limit your ongoing exposure.