Arising out of employment (causal relationship)

• Author: David L. Pollak/Roger A. Tolman, Jr./Monika R. Reyes
• Pages: 295-348

ARISING OUT OF

EMPLOYMENT

6-1

CHAPTER 6

ARISING OUT OF EMPLOYMENT

(CAUSAL RELATIONSHIP)

I. GENERAL DISCUSSION

§6:01 Proximate Cause

§6:02 Unrelated Harm

§6:03 Normal Bodily Movement

§6:04 Post Notice of Termination Claims

II. BURDEN OF PROOF

§6:10 Applicant’s Burden

§6:11 Scientif‌ic Evidence Required

III. SUFFICIENCY OF MEDICAL EVIDENCE

§6:20 Single Opinion Suff‌icient

§6:21 Opinion Must Be Supported

§6:22 Fallacious Reasons: Surmise, Speculation, Conjecture or Guess

§6:23 Groundless Conclusions

§6:24 Scientif‌ic Certainty, Mathematical Precision Not Required

§6:25 Necessity of Precise Diagnosis

§6:26 Possibility vs. Probability — McAllister

§6:27 Statutory and Regulatory Suff‌iciency

IV. CONDITIONS: STRESSRELATED AILMENTS

A. Psychiatric Injury: Background

§6:40 No Need for Physical Impact

§6:41 Subjective Test — Albertson’s

§6:42 Real or Imagined Stress?

§6:43 What’s Left of Albertson’s?

B. Legislative Restrictions on Compensability of Psyche Claims

§6:50 General Points

§6:51 Minimum 10% Causation: Injuries 1/1/90 - 7/16/93

§6:52 Minimum Six-Month Period of Employment: Injuries 7/16/91 - Present

§6:52.1 Exception to Six-Month Rule — Sudden and Extraordinary Employment Condition

§6:53 Predominant Cause/Substantial Cause Post-7/16/93 — McCullough and Hunton

§6:53.1 No Permanent Disability for Psychiatric Compensable Consequence Injuries After

1/1/13 Except in Catastrophic Cases

§6:54 Defenses Against Psychiatric Claims Including Post Termination Defense, Good Faith Personnel

Action Defense (for Injuries 7/16/93 - Present)

§6:55 Must Be Compensable Mental Disorder Per DSM-III-R and IMC Rules

ARISING OUT OF

EMPLOYMENT

California Workers’ Compensation 6-2

C. Suff‌iciency of Evidence in Stress Cases

§6:60 Psychiatric Cases

§6:61 Medical Evidence

§6:62 Uncorroborated Psychologist’s Opinion

§6:63 “Triangular” Stress

V. STRESS FROM ALLEGED WRONGDOING ON THE JOB

§6:70 Investigation of Criminal Activity — Blackburn

§6:71 Good Faith Personnel Action Defense

§6:72 Other Bizarre Wrongful Activity

§6:73 Compare Non-Employment Related Investigation

VI. OTHER AILMENTS, CONDITIONS

§6:90 Circulatory Ailments — Cacozza and Calabresi

§6:91 Lung Cancer, Emphysema and Other Respiratory Ailments

§6:92 Tobacco Smoking

§6:93 Alcoholism

§6:94 Drug Addiction From Prescribed Medication — Ballard

§6:95 Hepatitis, AIDS and Other Contagious Diseases

§6:96 Traumatic Epilepsy

§6:97 Required Treatment for Pre-Existing Disease or Prophylaxis

VII. MYSTERIOUS INJURY OR DEATH

§6:110 The Clemmens Case

§6:111 “Industrial, Personal and Neutral” Risks

VIII. ASSAULTS (TORTIOUS ACTS)

§6:120 General Rules

§6:121 Work-Connected Assaults

§6:122 Vulnerable Isolated Employment Position

§6:123 Stray Bullet Cases — The Ephraim Case and the “Neutral Risk”

§6:124 Employment as Means of Assault

§6:125 Act or Omission of Employer Contributing to Assault

§6:126 Strictly Personal Assaults

§6:127 Injunctive Relief Against Potential Assailants

IX. ALTERCATIONS

§6:140 Initial Physical Aggressor Defense

§6:141 Narrow Construction; Burden of Proof

§6:142 Horseplay or Skylarking Not Suff‌icient

§6:143 Real, Present and Apparent Danger of Bodily Harm

§6:144 Inconsequential or Justif‌ied “First Swing”

§6:145 Unjustif‌ied Retaliation

§6:146 “He Started It”

§6:147 Non-Aggressor Recovery

X. HORSEPLAY AND SKYLARKING

§6:160 Background

§6:161 Non-Initiator Recovery — Carmel

§6:162 Non-Condoned Horseplay

§6:163 Initiator Recover y?

§6:164 Narrow Rule: Instigator or Willing Participant Barred, But Note Distinctions

ARISING OUT OF

EMPLOYMENT

6-3 Arising Out of Employment (Causal Relationship)

XI. SELFINFLICTED INJURIES

§6:170 No Compensation for Intentionally Self-Inf‌licted Injury

§6:171 For Purpose of Monetary Gain?

§6:172 Compare Irresistible Impulse

§6:173 Burden of Proof/Non-Industrial Genesis

XII. SUICIDE

§6:180 No Compensation for Willful and Deliberate Suicide

§6:181 Compare Irresistible Impulse — Burnight and Beauchamp

§6:182 Burden of Proof

XIII. INTOXICATION

§6:190 Burden of Proof

§6:191 Proximate But Not Sole Cause — Summerville and Smith

§6:192 Blood Test Evidence

§6:193 Estoppel

§6:194 Employee Intoxication and “Scope of Employment”

XIV. COMPENSABLE CONSEQUENCE INJURIES

§6:200 Subsequent Incident Caused by Initial Disabilit y — Wallin

§6:200.1 No Additional Permanent Disability for Compensable Consequence Injuries to the

Psyche, Sexual Dysfunction or Sleep Dysfunction for Injuries After 1/1/13

§6:201 En Route to or From Medical Treatment or Evaluation — Laines

§6:202 Time Limits — Compensation Rate

§6:203 Injuries Occurring in the Course of Rehabilitation Programs

§6:204 Aggravation of Injury by Medical Treatment

§6:205 Aggravation of Injury by Overzealous Investigation

§6:206 Litigation Neurosis

§6:207 Conditions Caused by Employment Termination

§6:208 Incidents Occurring Subsequent to Termination of Active Employment — Soby