“But for” Causation Analysis

Under theory set forth by City of Brighton, work injuries may be compensable if caused by either: 1) a risk inherent to duties and scope of employment or 2) a neutral circumstance that would not have occurred but for work obligations. To find compensability under this theory, an Administrative Law Judge (ALJ) must find that “but for” a specific risk or circumstance, the employee would not have been injured. In Tiner v. PeopleCare LLC, the ALJ found that Claimant failed to establish her injury took place at work. The ALJ concluded by substantial evidence that the injury could not have been resultant of a risk or circumstance related to her employment, and therefore was not compensable.

In Tiner, Claimant was working as a Certified Nursing Assistant, providing in-home services and care to patients. In August 2019, Claimant tripped over a patient’s kitten and rolled her right ankle. Claimant cited pain and swelling in her ankle when she reported the injury to her employer. When examined by a doctor, Claimant admitted she had suffered previous injuries to this right ankle in both 2018 and 2019. Claimant was referred to an orthopedist who found joint disease, tendinopathy, and a torn tendon. The orthopedist suggested treatment which included a boot, physical therapy, and a surgical flat foot reconstruction. Further review by a nurse practitioner resulted in the opinion that in tripping over the cat, the incident at work did not represent an aggravation of a preexisting injury, but rather a continuation of a preexisting unstable ankle condition which may have dated back to 2018. The ALJ determined that Claimant did not demonstrate that but for tripping over the kitten at work, she would not have suffered injury to her right ankle. As a result, the ALJ denied the claim for benefits and Claimant appealed.

The City of Brighton test does require that a claimant be injured by the work-related event in question for that injury to be found compensable. Here, there was substantial evidence that the Claimant’s injury had been established well before she had tripped over the kitten at work. Specifically, the findings by the nurse practitioner provided the ALJ with convincing evidence that Claimant’s ankle injury did not take place at work in August 2019. The Industrial Claims Appeals Office (“Panel”) discussed that the determination of whether an employee’s injuries arose out of employment is a question of fact for resolution by the ALJ. Additionally, the Panel may not disturb such determinations unless the evidence relied upon by the ALJ may be rebutted by hard, certain evidence to the contrary. There was no such rebutting evidence provided. For those reasons, the Panel affirmed the ALJ’s determination that Claimant’s injury did not occur but for her work duties and was therefore not compensable.

Tiner v. PeopleCare LLC, No. 5-115-369 (ICAO, August 7, 2020)

Want to know more? Contact Eric Pollart at epollart@pollartmiller.com or 877-259-5693.

August 2020 Newsletter