Workers’ Compensation Case Review: Colorado Supreme Court clarifies work injures caused by “unexplained” falls.

On-the-job injuries caused by falls are typically covered for benefits, however when the injured worker cannot point to a specific cause of the fall – things recently have been complicated.  During the past three years insurance carriers have denied “mystery” claims as idiopathic or unexplained leading to conflicting, contradictory rulings for Administrative Law Judges (ALJ), the Industrial Claims Appeals Office (ICAO), and the Court of Appeals.

Now the Colorado Supreme Court weighed in.

Helen Rodriguez worked as a special events coordinator for the City of Brighton. On January 8, 2009, Rodriguez was walking to her office, which was located in the basement of the Brighton City Hall building (“City Hall”). She paused at the top of a flight of concrete stairs running along the outside of City Hall to greet two of her coworkers, Scott Miller and Dennis Williams, who were standing toward the bottom of the stairs. After a brief chat with Miller and Williams, she began to walk down the stairs, which were dry and unobstructed. All of a sudden, she tumbled forward. Rodriguez hit her head, lost consciousness, and did not remember precisely how she fell—for example, she did not know whether she tripped, slipped, lost her balance, or something else entirely. Prior to falling, Rodriguez was not experiencing a headache, neck pain, dizziness, or vision problems.

Although the insurance carrier originally admitted liability, it sought to withdraw its admission.  At the hearing the ALJ concluded that the fall was “unexplained” and therefore not compensable because the injury did not “arise out of” her employment.  The ICAO affirmed the decision, but the Court of Appeals set aside the ICAO order endorsing the argument that “uncertainty about the cause of an injury cannot properly bar a workers’ compensation claim if every one of the potential causes satisfies the conditions of recovery.”

The Supreme Court reiterated that three types of risks cause work place injuries:

(1)  employment risks, which are directly tied to the work itself (e.g. a gas explosion at work);

(2)  personal risks, which are inherently personal or private to the employee him- or herself (an employee’s preexisting idiopathic illness or medical condition that is completely unrelated to his or her employment, such as fainting spells, heart disease, or epilepsy; an assault at work arising solely from an employee’s private, and not professional, life.) ; and

(3)  neutral risks, which are neither employment related nor personal.

Examples of neutral risks include, (1) an employee was killed by car thieves on the way back from an employment errand, Indus. Comm’ n of Colo. v. Hunter, 73 Colo. 226, 227–30, 214 P. 393, 394 (1923); (2) a farm hand was killed by a lightning strike while tending to his employer’s horses, Aetna Life Ins. Co. v. Indus. Comm’n, 81 Colo. 233, 234, 254 P. 995, 995 (1927); (3) an employee was murdered by a random, insane man while on the job, London Guarantee & Accident Co. v. McCoy, 97 Colo. 13, 15–17, 45 P.2d 900, 901–02 (1935); and (4) an employee was injured after a co-employee accidentally discharged a hunting rifle in the employer’s parking lot, Kitchens v. Dep’t of Labor & Emp’t, 29 Colo.App. 374, 376, 379–80, 486 P.2d 474, 475–77 (1971).”

 

The Supreme Court held that an “unexplained” fall—i.e., a fall with a truly unknown cause or mechanism—falls into the “neutral risk” category and thus the “but-for” test applies to determine whether unexplained falls “arise out of” employment:

“Injuries stemming from neutral risks, whether such risks be an employer’s dry and unobstructed stairs or stray bullets, “arise out of” employment because they would not have occurred but for employment. That is, the employment causally contributed to the injury because it obligated the employee to engage in employment-related functions, errands, or duties at the time of injury.”

The Supreme Court, citing Horodyskyj v. Karanian, 32 P.3d 470, 475 (Colo. 2001), stated, “The “but-for” test provides that an injury from a neutral risk “arises out of” employment “if it would not have occurred but for the fact that the conditions and obligations of the employment placed [the] claimant in the position where he [or she] was injured.”

Further,

… the “but-for” test does not relieve the employee of the burden of proving causation, nor does it suggest that all injuries that occur at work are compensated under workers’ compensation law. Rather, it acknowledges that an employee meets his or her burden to prove that an injury “arose out of” employment when the employee proves that an injury (1) had its “origin in” his or her work-related functions and is “sufficiently related to” those functions so as to be considered part of employment, and (2) arose from a neutral risk, whether that neutral risk is an unexplained fall down an employer’s staircase or “an arrow out of nowhere.”

To demand more precision from injured workers, the Supreme Court wrote, would be “inconsistent with the spirit of a statute that is designed to compensate workers for workplace accidents regardless of fault.”

As always, how this or any other case we discuss in this blog would apply to your case depends on many more factors.  We urge you to call us to see if you are entitled to workers’ compensation benefits.  Workers’ Compensation is difficult, confusing, and very complex.  Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve.   Contact us here or call us at 303-780-7329 for your FREE CONSULTATION.

Cite:  City of Brighton v. Rodriguez, — P.3d —-, 2014 WL 351391 (Colo.), 2014 CO 7

Tags:  Compensability, Unexplained Falls, Neutral Risks