The Oregon Workers' Compensation Board upheld a hearing's decision finding that a worker who fell while on the job is not covered under workers compensation.
In this case, the worker fell while standing on the job. However, she had treated for other medical problems which had caused intermittent loss of balance. After the fall at work, the worker did not remember feeling dizzy are being unstable. The claim was denied, because the insurance company fell that "personal factors" had not been eliminated as a cause of the fall.
The Workers' Compensation Board agreed. It explained that in order to find that an on-the-job injury "arose out of" the claimant's employment, there must be some link between a risk connected with the nature of the work or a risk to which the work environment exposed the claimant. Where somebody suffers what is known as an "unexplained" fall at work, then the law requires that those injuries be covered. However, in order to prove that a fall should be covered, an injured worker must show that there are no other "idiopathic" factors of causation. In other words, the injured worker making the claim must show that there are no personal factors, like medical conditions or other reasons for the fall.
A medical opinion played a central role in this decision. A physician provided in opinion that the type of fall the injured worker suffered in this case was identical to an earlier fall that occurred at home. There were other medical opinions offered, but none of those rebutted the original opinion that the fall was probably due to some pre-existing medical condition.
This case shows the need to connect a risk associated with performing the work with the resulting injury. This is known as proving that the injury "arose out of" the work activity. These cases require careful review of the evidence, and in a lot of situations, a strong medical opinion.
If you have a denied Oregon Workers' Compensation claim involving a fall or other mishap at work, contact us at 503-325-8600, and we can review your case without charge to determine whether an appeal is appropriate. Even if we take the case, there is no fee unless we prevail at the hearing.
