A MTA WORKER IS BOTH A HERO….AND AN INJURED WORKER: INJURED WORKER IN THE NEWS, #55

Mr. Anthony Wilson, an MTA Worker, is both a hero and an Injured Worker.   It was reported that “[l]ast week, Nelson was cleaning the Pelham Bay subway station in the Bronx when police allege 49-year-old Alexander Wright began to harass customers. Nelson stepped in to protect them, but the suspect quickly turned his rage toward Nelson, breaking his collarbone and nose.”  KESQ.COM

This fact pattern may involve many unique issues. This article will discuss two important issues that come up with these type of events;  the injury investigation and the Injured Worker’s high profile work injury celebrity status.

Why Would High Profile Claim Like This Be Investigated?

In California, any assault claim has the possibility of an insurance company defense of initial physical aggressor.  The initial physical aggressor rule could bar an Injured Worker’s claim.  Therefore, it is worthy of inquiry by the insurance company.  In other words, there will be an investigation as to whether the Injured Worker made the first physical contact.

Labor Code Section 5402, allows insurance companies 90 days to investigate claims.  “If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division.”  Thus, the Insurance Company will got out and get witness statements and see if the incident was caught on tape before accepting the claim.

Why Is The Injured Worker’s Celebrity Status A Problem?

An Injured Worker who becomes a celebrity as a result of their injury creates a problem.

When an Injured Worker is in a high profile worker’ compensation case, they may be on television or interviewed for news articles. These television reports or interviews may reveal information concerning the Injured Worker’s injuries and their physical activity level.   Additionally, in interviews, Injured Workers may try to make a positive and uplifting impression rather than be accurate concerning their complaints.  This information can be used to impeach the Injured Worker.  Also, it could be sent to examining or evaluating physicians.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

DID HOSPITAL WORKER’S GROIN INJURY RESULT IN AN INDUSTRIAL DEATH CLAIM? INJURED WORKER IN THE NEWS, #52

A Hospital Worker tragically died.   Law enforcement considers the death to be a homicide.  The alleged cause for the homicide was a kick in the groin.   Do the facts give rise to legitimate workers’ compensation  work-related death claim?

It is reported as follows:  a Hospital Worker had an altercation with a patient.   A mental health evaluation patient was trying to leave the hospital when the staff tried to prevent her from leaving.  The incident got physical.   The patient began to “swing her arms and pull away from security when (an employee) attempted to grab her arms. The Mental Health Unit eventually had to step in.” The patient allegedly started to kick and then struck a Hospital Worker with her knee in the groin.  The Hospital Worker, after the injury, was in the ICU for three days. Tragically, he died. katv.com

The article reporting on the matter indicated that “[a]uthorities say after a review of medical records and investigation, the cause of death is physiological stress associated with a physical altercation in the setting of cardiomegaly and obesity.”  katv.com

The coroner commented that “[t]here’s a lot of people walking around with the same medical conditions he had, that might live for another 15-20 or 25 years, had it not been for the kick to the groin.”  katv.com

This article will discuss the hurdles required to prove a death claim in this matter.  This article will discuss issues of causation and medical legal reporting.

Is The Coroner’s Opinion Enough to Prove the Death Is Work-Related?

The answer is “no.”  In California, Workers’ Compensation Law has standards of causation.  The doctors must express their opinion within the workers’ compensation framework.  With respect to a death claim, the medical evaluator should express their opinion within reasonable medical probability.  Further, with respect to a death case, the issue is whether the industrial injury was a “contributing” cause.  The South Coast Framing case  established the “contributing cause” standard for death cases.  (South Coast Framing, Inc. v. Workers’ Comp. Appeals Bd. (2015) 61 Cal.4th 291 [188 Cal.Rptr.3d 46, 349 P.3d 141].)  As we don’t know whether the Coroner’s opinion was within reasonable medical probability or whether it addressed causation as a contributing cause, on it’s face, it could not be used as evidence.

Thus, a medical opinion must have the correct language.   It should also be noted that criminal law has a different burden of proof.  Therefore, clarification is needed within a workers’ compensation framework.  It is possible that what might not be considered criminal causation can still be valid for the purposes of industrial causation.

What Medical Evidence  Is Needed To Proof the Death Was Work-Related?

In this matter, either the treating physician or a medical evaluator, QME or AME,  should be employed to render an opinion on industrial causation of the death.   The question would be whether the attack “contributed” to the injured worker’s death.  The worker’s involvement, i.e. physical activities, in the altercation can be viewed as a whole as opposed to the mere kick.  In other words, the stress, mental or physical, from the incident can be considered with respect to industrial causation for the death.  As noted, workers’ compensation should look at the totality of the incident and not the mere kick to the groin to make the assessment.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

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