An analysis of major contributing cause and its application.

• Author: Perez, Mario L.
• Position: Florida workers' compensation and tort law

Before a claimant may receive compensation or benefits under the workers' compensation system, he or she must prove the occurrence of an accidental injury or death arising out of work performed in the course and scope of employment. In 1993, the Florida Legislature amended F.S. [sections]440.02(32), and thereby created a new evidentiary burden for claimants to meet before being able to receive workers' compensation benefits. Effective January 1, 1994, an accident does not arise out of the course and scope of employment unless the work performed in the course and scope of employment is the "major contributing cause" (MCC) of the injury or death. In many instances, practitioners and judges in the workers' compensation system will have no problems interpreting and applying this statutory scheme, because if a claimant lacking preexisting conditions is injured while working in the course and scope of the employment, liability will attach. Unfortunately, it is not always so simple.

In the absence of a statutory definition, the birth of MCC created many questions that remain unanswered. This article seeks to explore three distinct areas so one may obtain a better understanding regarding interpretive issues involved in the applicability of MCC. First, the article concentrates on the qualitative analysis--in other words, how MCC applies when a claimant attempts to prove entitlement to temporary or permanent benefits. The article next focuses on the quantitative analysis, or the quantity of evidence required to meet this new burden. Finally, the article discusses the possible effect MCC has on other legal principles that employers/carriers utilize in attempting to avoid liability.

Initially, it is worth noting, this article focuses on the applicability of MCC to those claimants who suffer from preexisting conditions. For instance, what happens when a claimant who has a preexisting condition is injured in the course and scope of employment, and the industrial accident hastens the necessity for treatment or creates a temporary disability? F.S. [sections]440.09(1)(b) provides "[i]f an injury arising out of and in the course and scope of employment combines with a preexisting disease or condition to cause or prolong disability or need for treatment, the employer [is responsible] to the extent that the injury arising out of and in the course and scope of employment is and remains the major contributing cause of the disability or need for treatment." The latter part of this statute provides for a disjunctive test. An employer is responsible for compensation or benefits if the industrial accident is and remains the MCC of the disability or need for treatment. One must then wonder what happens if the MCC of a claimant's injury is the preexisting condition, but the industrial accident hastens the necessity for treatment. Or, what happens if the MCC of a claimant's injury is the preexisting condition, but the industrial accident causes a temporary disabling aggravation of the preexisting condition? Further, one wonders how the MCC analysis applies to a resulting disability created by the combination of the industrial accident and a preexisting condition. These questions raise an important overall question: Does MCC focus on the claimant's condition or on the existence of a temporary disabling aggravation?

Clearly, a claimant may suffer a temporary disabling aggravation of a preexisting condition as a result of an industrial accident. After the industrial accident, a claimant will inevitably reach the point of maximum medical improvement, which is the point when lasting improvement is no longer reasonably anticipated. At maximum medical improvement, the permanency of the claimant's condition or the resulting disability can be determined. City of Pensacola v. Oswald, 710 So. 2d 95 (Fla. 1st DCA 1999). Is it possible that F.S. [sections]440.09(1)(b) requires claimants to prove that the industrial accident is the MCC of a temporary disabling aggravation, and then once again prove that the industrial accident is the MCC of the resulting disability in order to receive permanent benefits?

The case law below shows the MCC analysis may mark a change in contemporary thinking. Some practitioners may have incorrectly assumed that so long as the industrial accident is the MCC of the initial disability or need for treatment, the employer also would be liable for the resulting disability. However, this reasoning is flawed. The cases below demonstrate that an additional hurdle must be overcome to determine the compensability of the claimant's resulting disability. If the industrial accident is the MCC of the initial disability or need for treatment, it is not necessarily the MCC of the resulting disability. The employer is not responsible for the resulting disability unless the accident is also the MCC of the permanent condition or resulting disability. As we shall see, the MCC analysis focuses on two distinct aspects of a claimant's condition at separate, but crucial, stages of a claim.

The analysis then shifts focus to the required quantity of proof needed to establish the necessary causal relationship between the accident and the injury. Unfortunately, neither the legislature nor case law has provided a concise...