Chapter 3 Accident

• Library: The Law of Workers’ Compensation Insurance in South Carolina (SCBar) (2019 Ed.)

Chapter 3 Accident

I. General

For an injury to be compensable in South Carolina, it must result from an "accident." This requirement is found in § 42-1-160, which interprets "injury" and "personal injury" to mean "only injury by accident . . . and shall not include a disease in any form, except when it results naturally and unavoidably from the accident and except such [occupational] diseases . . . ."

As discussed below, the definition of "accident" can become an issue where the resulting injury is accidental but the cause is not, such as intentional injury, repetitive trauma, and diseases. Also, special rules exist regarding heart attacks, strokes, hernias, and mental injuries. The causal relationship between the accident and injury is also frequently at issue.¹ Section 42-1-160 was amended in 1996 to provide that stress arising out of and in the course of employment, unaccompanied by physical injury, may be compensable under certain circumstances.

Whether an accident did or did not happen is a question of fact to be determined by the Workers' Compensation Commission.² If the facts are undisputed, "[t]he compensability of a particular event as an accident within the purview of the workers' compensation law is a question of law to be decided by the courts . . . ."³

II. Definition of "Accident"

Section 42-1-160 states that "injury" includes only "injury by accident." The term "accident" is not defined in the Code. However, "accident" as used in the Workers' Compensation Act has been defined synonymously with the terms "accident" and "accidental means" as used in insurance policies.⁴

In Sharpe v. Case Produce Company,⁵ the court of appeals summarized the analysis to be used when determining whether a worker has sustained an injury by accident. The analysis is as follows:

(1) In determining whether something constitutes an 'injury by accident,' the focus is on the injury itself, not on some specific event[;] (2) The word 'accident' . . . means an unlooked for and untoward event which is not expected or designed by the person who suffers the injury[;] (3) No slip, fall, or other fortuitous event or accident in the cause of the injury is required[;] (4) The unexpected result or industrial injury is itself considered the compensable injury[;]⁶ (5) "an accident is an event not within one's foresight and expectation and may be due to purely accidental causes or may be due to oversight and negligence, carelessness, fatigue, or miscalculation of the effects of voluntary action;" and (6) "proof of a causative event" is not required.⁷

III. Accidental Cause Versus Accidental Result

The issue of whether "accident" refers to the cause of the injury or merely to the result was addressed in the case of Layton v. Hammond-Brown-Jennings Company.⁸ Layton alleged he had sustained a hernia while moving laundry heaters. Though the statute was eventually amended to specifically address hernias and their compensability, the Supreme Court in Layton noted that Layton's injury occurred while he was lifting a heater off the pile or stack of heaters in the usual manner that he lifted the other heaters. Layton did not strike himself in any way, slip, lose his footing, stumble, or fall. Nothing untoward happened, and Layton was not conscious of any strain.⁹

The employer argued that there was no "accident" because the cause of the injury was not accidental. The court reviewed the accidental cause versus the accidental result argument as follows:

Appellants frankly concede that there is a conflict in the authorities, and that such conflict is irreconcilable. One line of cases holds that it is not necessary that there be some fortuitous or unusual and unlooked for mishap to establish an accident, if there has been an unexpected injury occurring while the employee is performing his usual duties in his customary manner. The other line holds that there must be some fortuitous or unusual and unlooked for mishap resulting in injury in order for it to be an accident.¹⁰

In finding the hernia compensable, the court sided with the accidental result faction and stated, "[o]ne of the purposes of the Workmen's Compensation Act is to protect and partially compensate employees who are injured while engaged in the regular course of their employment irrespective of mishap independent of the injury itself . . ."¹¹

In Green v. City of Bennettsville,¹² the issue before the court was whether Green's death was the result of an intentional act. In dicta, the court stated:

The event, to constitute an accident, must be one that is unforeseen; that is, unforeseen by the person injured by its occurrence . . . . The words 'undesigned' or 'unforeseen' [in the definition of 'accident'] refer to the result produced, and not to its cause. When a man lifts a heavy weight, he intends to do exactly what he does do; nevertheless, if he strains a muscle, or ruptures a blood vessel, the injury is due to an accident.¹³

Next, in Strawhorn v. J.A. Chapman Construction Company,¹⁴ the Supreme Court stated that "the element of surprise or improbability necessary to constitute an accident in contemplation of the law need only be the result or effect of the happening."¹⁵

Similarly, in Hiers v. Brunson Construction Company,¹⁶ where an employee died of pneumonia as a result of being exposed to extreme weather conditions, the court stated that the adjective "accidental" may refer to the injury itself. No slip, fall or other fortuitous event or accident in the cause of the injury is required; the unexpected result or industrial injury is itself considered the compensable accident.¹⁷

In Stokes v. First National Bank,¹⁸ an award of benefits to a bank executive was affirmed. Stokes suffered a nervous breakdown due to an excessively increased work load, and there was no precipitating physical injury suffered by Stokes to cause his breakdown. The court of appeals considered the "accidental cause" versus "accidental result" argument at length. In the discussion which followed, the court of appeals stated:

The term [accident] relates not only to the dynamics of the occurrence causing the injury but also to the injury itself . . . . "The term 'injury' as used in the phrases 'personal injury or death accidentally sustained', 'injury by accident', 'injury proximately caused by accident', and similar expressions, has been construed to mean not only an injury the means or cause of which is an accident, but also an injury which is itself an accident; that is, an injury occurring unexpectedly from the operation of internal or subjective conditions, without the prior occurrence of any external event of an accidental character."¹⁹

Stokes was subsequently affirmed, with the Supreme Court simply stating that, "[i]n determining whether something constitutes an 'injury by accident' the focus is not on some specific event, but rather on the injury itself."²⁰

In contrast, the court of appeals in Capers v. Flautt²¹ denied an award of compensation for contact dermatitis to the claimant, a dishwasher, who had contracted the disease as a result of exposure to detergent and water. The claimant, Robert Capers, had previously contracted the same disease in an earlier dishwashing job. The court of appeals defined "accident" as "unlooked for or untoward event that the injured person did not expect, design or intentionally cause,"²² and held that Capers' injury was not accidental:

He [Capers] had been aware of the situation for several years and had previously left a job due to the same problem caused by exposure to detergents and water. Therefore, the outbreak of dermatitis was not an unlooked-for event which Capers did not expect. It was, in fact, an event which Capers could anticipate given his past experience.²³

IV. Heart Attack and Stroke

For a heart attack or stroke to constitute a compensable injury,²⁴ a claimant must establish two elements: (1) that the employee was subjected to either unusual or extraordinary physical exertion, violence or strain in the course of the employment, or to unusual and extraordinary conditions of his employment; and (2) that a causal connection existed between this exertion, violence, strain, or unusual conditions to the claimant's heart attack or stroke. The first element is commonly referred to as "legal causation," the second element as "medical causation."²⁵ The showing of this unusual exertion, strain, or condition is deemed to satisfy the "by accident" requirement of § 42-1-160.

Although not clearly set out in the early cases, South Carolina now subscribes to the "unusual exertion or strain" test of what constitutes a compensable "accident" in most heart attack and stroke cases.²⁶ Raley v. City of Camden²⁷ was the first South Carolina case to clearly enunciate this standard. In the next case to reach the Supreme Court, Price v. B.F. Shaw Company,²⁸ the decedent died of a coronary thrombosis while performing his usual duties. A compensation award was affirmed by the circuit court, only to be reversed by the Supreme Court on the grounds that in order to be compensable, the injury must be the result of some unusual exertion or strain from that normally encountered. The court also stated that a departure from the "unusual exertion" rule, which was based upon the judicial presumption that death or injury from heart disease is ordinarily the result of natural rather than traumatic causes,²⁹ would convert the Workers' Compensation Act into the protection afforded by a life insurance policy.³⁰ Since this case, the court has been "definitely committed to the unusual exertion or strain rule in heart attack cases," as pointed out by Chief Justice Stukes in Sims v. State Commission of Forestry,³¹ in which he cited the Price case as resolving the controversy.

Black v. Barnwell County³² was the first case to clearly set out the two distinct elements of a compensable heart attack. Undisputed medical testimony indicated Black's deadly heart attack occurred shortly after he climbed stairs at...