California Supreme Court Lowers The AOE/COE Hurdle In Workers’ Compensation

In South Coast Framing, Inc. v. WCAB, Jovelyn Clark, S215637, May 28, 2015, the California Supreme Court clarified a claimant’s burden of proof in obtaining workers’ compensation benefits. In brief, a claimant meets the burden of proving that an injury arises out of and occurs in the course of employment by providing evidence that is “reasonable in nature, credible, and of solid value such that a reasonable mind might accept it as adequate to support its conclusion.”

Mr. Clark suffered neck, back and head injuries from a fall he suffered while working as a carpenter for South Coast Framing, Inc. From his “workers’ compensation doctor” he received epidural injections for back pain and medication for the injuries, including Elavil, Neurontin, and Vicodin. He also received medication from his “personal doctor,” including Xanax and Ambien. Approximately four months from his injury, Mr. Clark died as a consequence of the combined toxic effects of the drugs prescribed by his “workers’ compensation physician” and those prescribed by his “personal physician.”

Mr. Clark’s family filed for workers’ compensation death benefits asserting that all the drugs were the cause of death, and that the need for the drugs was, in part, the industrial injury. Defendant asserted that the death was caused by the combined effects of the Xanax and Ambien, and that the Elavil, Neurontin and Vicodin did not play a role in the death. The parties agreed upon Dr. Bruff, to be utilized for an opinion on the role of each medication in causing Mr. Clark’s death. In his report Dr. Bruff concluded that the Ambien and Xanax were the sole cause of the overdose. However, in subequent deposition testimony, the doctor explained that he could not “absolutely slam the door” on Elavil having some small role in causing death. Specifically, he testified “it would be ‘really speculative’ to place a percentage [of contribution] on it.”

The workers’ compensation trial judge awarded death benefits and explained that death resulted from a combination of all the drugs, including Vicodin and Elavil, and that the Ambien and Xanax were prescribed in part for pain and its effect on Mr. Clark’s insomnia. The WCAB denied the employer’s petition for reconsideration, but the Court of Appeal reversed the Board and denied benefits in response to the employer’s petition for writ of review. The Supreme Court granted a hearing on the family’s request to review the appeals court determination that there was no proximate cause between the industrial injury and Mr. Clark’s death.

In workers’ compensation, an employee or the family of the employee must prove that an injury or death arises out of and occurs in the course of the employment (commonly abbreviated “AOE/COE”). This obligation also requires that there be a proximate cause between the employment and the injury. Proximate cause is a legal hurdle present in both negligence suits and workers’ compensation. However, in Clark the California Supreme Court makes clear that the height of that hurdle is far greater outside of workers’ compensation. The court writes that “[I]n the workers’ compensation system, the industrial injury need only be a contributing cause to the disability.” Further, the burden of proving proximate cause of death is no different from the obligation imposed on the injured worker who seeks disability benefits.

The decision in Clark may be read as a retreat from the workers’ compensation model envisioned by the legislature in SB 863 and earlier changes imposing a higher standard in proving industrial injury, e.g. Labor Code Section 3208.3 among others. With these changes the legislature has moved the system towards “evidence based medicine” and toward “predominant cause” in psychiatric injury claims, as part of its efforts to constrain costs in a system subject to excess in many areas. However, the Clark court emphasizes that the purposes of workers’ compensation are best served if the concept of proximate cause is liberally interpreted to extend the right to benefits while the system limits what benefits are provided. The opinion adds to the perennial debate of whether the system has achieved the proper balance among the competing purposes it serves.

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June 3, 2015