"First Do No Harm" – Missouri Employee's Injuries At Doctor's Office Not Compensable

The Supreme Court of Missouri, construing the state’s special causation rules for workers’ compensation claims, affirmed a decision by the state’s Labor and Industrial Relations Commission that denied an employee’s alleged consequential injuries that were sustained when a physician, to whom the employee had gone for treatment after an exposure to an insecticide, accidentally tripped her as the employee was being escorted for pulmonary function testing [Schoen v. Mid-Missouri Mental Health Ctr., 2020 Mo. LEXIS 127 (Apr. 14, 2020). Stressing that the employee’s risk of being tripped accidentally was a risk to which she was equally exposed outside of her employment, the Court found that the employee had failed to show her injuries were caused by the employment.

Background

The facts in the case followed a rather bizarre pattern. The employee was exposed to cypermethrin, an insecticide, while working as a charge nurse at a mental health center (“the employer”). The employer sent the employee to an ER, where she was prescribed medication and returned to work without any limitations. She continued to complain of breathing issues and the employer sent her to Dr. Runde, apparently a pulmonary specialist, for further evaluation.

While the employee was at Dr. Runde’s office, another patient had a dog in the office. As the employee was being escorted for pulmonary function testing, the dog got loose. Dr. Runde attempted to divert the dog from the employee’s path, but he accidentally tripped the employee instead. The employee fell and claimed she sustained permanent injuries to her knees, lower back, hip, and neck.

The employee amended her workers’ compensation claim, contending the injuries she sustained at Dr. Runde’s office were compensable. An ALJ awarded the employee benefits, finding that the employee’s trip and fall injuries were the “natural and probable consequence of” the cypermethrin exposure. The Commission reversed, finding that the employee failed to meet her burden of proving her cypermethrin exposure was the “prevailing or primary factor” in causing any injury from being tripped at the doctor’s office. The employee appealed.

Supreme Court Opinion

The Court initially noted that, within the context of this case, the Workers’ Compensation Act provided compensation for injuries by accident only if the accident was the “prevailing factor in causing both the medical condition and disability [§ 287.020 R.S.Mo.]. The Court also indicated an injury could not arise out of and in the course of the employment if it did not come from a hazard or risk to which the employee would have been equally exposed outside of and unrelated to the employment in normal nonemployment life.

Tripping Was Risk to Which Employee Was Equally Exposed Outside Her Employment.

The employee argued that her tripping injuries were the natural consequence of her cypermethrin exposure. The Court countered, however, that under § 287.020.2 R.S.Mo., an injury was not compensable merely because work was a “triggering or precipitating factor.” The Court stressed that the employee’s risk of being tripped accidently was a risk to which she was equally exposed to outside of her employment.

“But For” Relationship is Insufficient

The Court held the employee’s assertion of simple but-for causation was not sufficient to demonstrate a causal connection with her work. For the employee’s injury to arise out of and in the course of her employment, she was required to demonstrate that her accident (a) was a prevailing factor of the injury and (b) was not a risk that the claimant would have been exposed outside of and unrelated to the employment. It is not enough for an injury to occur while the employee was doing something related to or incidental to work.

Comment: Missouri’s Rule Here is an Outlier

As a quick aside, may I offer that Missouri’s holding is is an outlier. As discussed in Larson’s Workers’ Compensation Law, § 10.07, when an employee suffers additional injuries because of an accident in the course of a journey to a doctor’s office (or during the visit with the doctor) occasioned by a compensable injury, the additional injuries are generally also held compensable.