Court Sides with Employer in Workers’ Comp Case

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CalChamberInCourtA state appeals court has ruled that a worker’s claim of a psychiatric injury did not meet the tests to qualify for workers’ compensation coverage.

The California Chamber of Commerce filed a friend-of-the-court brief in the case of Travelers Casualty & Surety Company et al. v. Workers’ Compensation Appeals Board and Mark Dreher.

Central to the case was what constitutes a “sudden and extraordinary” employment condition. State law provides an exception to allow a workers’ compensation claim for psychiatric injury to be covered within the first six months an employee is on the job if the injury is the result of a sudden and extraordinary employment condition.

The First District Court of Appeal agreed with the CalChamber argument that the psychiatric injury did not qualify for workers’ compensation coverage because the worker had been on the job for less than six months and the injury did not result from a “sudden and extraordinary” employment condition.

Background

As outlined in the court decision, the facts are not in dispute. Mark Dreher was working as a live-in maintenance supervisor for an apartment complex when he slipped and fell on a concrete walkway on October 19, 2009 while walking in the rain to another building in the complex. He had worked for the company that owned the complex for 74 days before the accident.

Dreher suffered numerous injuries, including a fractured pelvis and injuries to his neck, right shoulder, right leg and knee. He also suffered gait derangement, a sleep disorder and headaches. He underwent surgery to repair pelvic fractures, a second surgery to repair a torn meniscus, and additional surgery to address issues with his right foot and ankle.

He sought compensation for a psychiatric injury arising from the accident and was evaluated in June 2011. The workers’ compensation administrative law judge found that Dreher sustained an injury arising out of and in the course of his employment, but denied the claim for psychiatric injury, finding that it was barred because Dreher had been employed for less than six months and his psychiatric injury did not result from a sudden and extraordinary employment condition.

Dreher petitioned the Workers’ Compensation Appeals Board (WCAB) to reconsider his case. The board decided in Dreher’s favor that the injury was caused by an extraordinary employment condition and therefore was not barred from coverage. Travelers Casualty & Surety Company asked the court to review the case.

Court Ruling

The appeals court found that Dreher did not meet the burden of proving “by a preponderance of the evidence, that a sudden and extraordinary condition caused the injury.”

Although Dreher’s injury was “more serious than might be expected,” the court said, “it did not constitute, nor was it caused by, a sudden and extraordinary employment event” within the meaning of the law (Section 3208.3(d)).

“The evidence showed that Dreher routinely walked between buildings on concrete walkways at the work site and that he slipped and fell while walking on rain-slicked pavement,” the court stated. Like accidents in other workers’ compensation cases, “Dreher’s slip and fall was the kind of incident that could reasonably be expected to occur.”

Dreher’s testimony that he was surprised by the slick surface of the walkway because the other walkways had a rough surface and that the walkway where he slipped was later resurfaced “did not demonstrate that his injury was caused by an uncommon, unusual or totally unexpected event,” the court wrote.

The court found Dreher’s claim for psychiatric injury was barred from coverage because it was not the result of a “sudden and extraordinary event” and returned the case to the WCAB with instructions to deny the claim for psychiatric injury.

Staff Contact: Heather Wallace

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Heather Wallace
About Heather Wallace
Heather Wallace has been CalChamber associate general counsel since November 2011. She is a seasoned litigator with experience on employment law, health care, intellectual property and more. She came to the CalChamber from the Managed Risk Medical Insurance Board (MRMIB), where she was senior staff counsel, providing legal advice on the Healthy Families Program, the Pre-Existing Condition Insurance Plan and the Major Risk Medical Insurance Program. She holds a B.A. in history from the University of New Orleans and earned her J.D. with honors from Santa Clara University School of Law, where she was technical editor of the Computer and High Technology Law Journal.