PA Court: Carefully Planned Suicide Still Compensable

Decision is Consistent with Majority Rule

In a holding that is consistent with the dominant rule among American jurisdictions, a Pennsylvania appellate court recently affirmed a Board decision that awarded death benefits to the surviving spouse (and a dependent child) of an injured employee who committed suicide under circumstances that suggested a significant measure of planning and forethought [SEPTA v. Workers’ Comp. Appeal Bd. (Hansell), 2021 Pa. Commw. LEXIS 471 (May 24, 2021)]. Acknowledging that the employee’s surviving spouse had removed OxyContin tablets from their home when she discovered that her husband had performed an Internet search to determine how many pills it would take to be fatal, and acknowledging further that, shortly before his death, the decedent had purchased the rope that he used to hang himself from a local building supply company, the Court nevertheless stressed that the issue of independent intervening cause did not so much turn on the employee’s knowledge that he was committing suicide, but rather on the existence of an unbroken chain of causation from the injury to the suicide [see Larson’s Workers’ Compensation Law, § 38.03].

Background

On June 17, 2016, Decedent suffered a work-related lower back sprain, for which Employer issued a Notice of Compensation Payable (NCP). Following the injury, Decedent attempted light-duty work but was unable to do it. On March 19, 2017, Decedent committed suicide. Thereafter, Claimant filed a fatal claim petition, listing herself and their son as dependents, and alleging Decedent’s work injury caused mental stress/illness that led to his suicide. Employer denied the allegations, and the matter progressed to proceedings before a WCJ.

Claimant’s Testimony Regarding Husband

At a hearing, Claimant testified that Decedent had worked at Employer since 1984. She testified that before his injury, Decedent was “fun-loving, caring, a wonderful father, good husband, and loved sports,” but that after the work injury, she noticed a gradual change in Decedent’s personality beginning in September 2016. Claimant described Decedent’s condition after that date as “depressed, obsessed, paranoid, delusional, illogical, [and] irrational.” Claimant explained that Decedent focused on losing his job and his low back pain; worried about getting fired; thought they would lose their home, which was paid off before Decedent’s suicide; believed that their son would not be able to attend private school; worried he was being followed; paced and looked out windows; and had trouble concentrating. Claimant described Decedent as being “consumed” with the back injury.

Prior Psychological Issues

Claimant acknowledged that in 2007, some nine years before his work-related injury, Decedent treated with a psychiatrist for general anxiety and experienced a panic attack. He was prescribed 0.5 milligrams of Xanax. Decedent treated at a psychological center from 2007 to 2015.

Signs of Potential Suicide

Claimant testified that on Valentine’s Day 2017, Claimant caught Decedent writing a suicide note. She also removed OxyContin from their house after she found Decedent researching medication as to how many pills he might take to kill himself. On February 27, 2017, Claimant called 9-1-1, because Decedent’s behavior was erratic and worrisome. Decedent was admitted to the hospital where he stayed until his discharge on March 10, 2017. Upon discharge, Decedent was advised to follow-up with a physician, which he did on March 16, 2017. Claimant testified that Decedent also attended an independent medical examination on March 17, 2017. Claimant drove Decedent to the IME and described him as being “a mess” and unable to write his name, think, or concentrate to the point he had difficulty answering simple questions about his pain.

Suicide Rope Purchased at The Home Depot

Claimant testified they had dinner together as a family on March 18, 2017. She stated there were no signs that she should be concerned. On March 19, 2017, Claimant left the house for approximately three hours to run some errands. Upon her return, Claimant could not find Decedent. Claimant ultimately found Decedent hanging in a shed and called 9-1-1. After Decedent’s death, Claimant found a receipt for rope purchased at The Home Depot.

Medical Testimony

Claimant presented the deposition testimony of Gladys Fenichel, M.D., who is certified by the American Board of Psychiatry and Neurology. Dr. Fenichel testified that Decedent had been diagnosed with “major depressive disorder, single episode moderate and panic disorder,” and that the primary stressor identified in the records was the fact that Decedent was out of work. Dr. Fenichel testified that his findings were confirmed by other medical reports in the record. In Dr. Fenichel’s professional medical opinion, the work-related back injury was the identified stressor that preceded the condition of major depression and suicide, and the work injury was a substantial contributing factor to Decedent’s suicide.

Employer’s Evidence

Employer presented the testimony of Ira Sachs, D.O., a board-certified orthopedic surgeon who performed an IME on Decedent two days before his suicide. Dr. Sachs admitted he did not assess Decedent’s mental stability or suicidal ideation, as it was not part of the IME. Nor did Dr. Sachs review Decedent’s mental health records. He was also unaware that Decedent had just been hospitalized for his suicidal thoughts. However, Dr. Sachs did confirm that the work injury significantly interfered with Decedent’s enjoyment of life and relationships with other people. Dr. Sachs opined Decedent had fully recovered from his work injury at the time of the IME.

Employer also presented the deposition testimony of Wolfram Rieger, M.D., a board-certified psychiatrist. Dr. Rieger reviewed Decedent’s medical records and testified that, in his opinion, Decedent’s suicide was not related to his work injury. The doctor testified that Decedent had ongoing psychiatric problems that predated his work injury. According to Dr. Rieger, Decedent’s back pain was one of many stressors.

WCJ’s Decision

Based upon the evidence presented, the WCJ granted the fatal claim petition. In so holding, the WCJ credited the testimony of Claimant, noting it was consistent with the available medical records and provided compelling, competent, and credible support for the opinion of Dr. Fenichel. While the WCJ found Dr. Fenichel’s testimony credible, the WCJ rejected Dr. Rieger’s testimony, finding it was not credible as it had no support in the medical records. The WCJ further rejected Dr. Sachs’ testimony to the extent Dr. Sachs opined that Decedent had fully recovered.

Board Affirmed, Using Chain-of-Causation Test

The Board affirmed, finding that there was substantial and competent evidence of record to support the WCJ’s finding that Decedent suffered a mental disturbance that was so severe it obscured his rational judgment.

The Board also rejected Employer’s argument that Decedent’s suicide was not compensable since it was planned and intentional. The Board concluded that Dr. Fenichel’s testimony, which was credited by the WCJ, satisfied the chain-of-causation test for suicides. The Board also rejected Employer’s argument that the WCJ should have analyzed the fatal claim petition using a physical-mental standard, noting that requiring “proof of psychological injury would be redundant” of the chain-of-causation test.

Appellate Court’s Decision

Initially, the appellate court observed that in McCoy v. Workmen’s Compensation Appeal Board (McCoy Catering Services, Inc.), 102 Pa. Commw. 436, 518 A.2d 883, 884-85 (Pa. Cmwlth. 1986), it had first enunciated the chain-of-causation test, which provides that a suicide is compensable if:

1. There was initially a work-related injury;
2. The “injury directly caused the employee to become dominated by a disturbance of the mind of such severity as to override normal rational judgment;” and
3. The “disturbance resulted in the employee’s suicide.”

If this standard was met, said the court, the death is considered not intentionally self-inflicted and is, therefore, compensable. Reviewing the record, the appellate court found no error in the WCJ’s Decision granting the fatal claim petition.

The court acknowledged that Decedent’s actions obviously showed some planning on his part, but it could not, as a matter of law, conclude that this made his suicide intentional and, thus, not compensable. The court added that Employer appeared to be trying to impose some sort of temporal proximity requirement when one did not exist. Rather, the court was required to consider whether the work injury directly caused Decedent “to become dominated by a disturbance of the mind of such severity as to override normal rational judgment … and this disturbance resulted in [Decedent’s] suicide,” quoting McCoy, 518 A.2d at 884-85.

The court stressed that the record evidence supported the WCJ’s finding that Decedent’s work injury in June 2016 directly caused Decedent “to become dominated by a disturbance of the mind of such severity as to override normal rational judgment,” which culminated in Decedent’s suicide in March 2017. Decedent’s downward spiral, or as Claimant described it, trip down the “rabbit hole,” following the work injury, was also well documented in Decedent’s medical records. The court concluded:

In summary, there is substantial evidence to conclude that Claimant satisfied the chain-of-causation test. There is no dispute that Claimant suffered a work-related injury. Second, as described above, there is ample evidence that this work injury “directly caused [Decedent] to become dominated by a disturbance of the mind of such severity as to override normal rational judgment.” McCoy, 518 A.2d at 884-85. Finally, there is also substantial evidence to support a finding that this “disturbance resulted in [Decedent’s] suicide.” Id. Accordingly, we will not reverse the Board’s Order on this basis.

Mental-Mental Standard

The appellate court also indicated the WCJ had not erred in applying the physical-mental standard instead of the mental-mental standard, which would have required a showing of abnormal working conditions. The court stressed that there was substantial evidence of record that Decedent’s mental health declined as a result of a physical work injury to his back. Therefore, the court held the mental-mental standard did not apply because the psychological injury was not the result of a psychological stimulus. Given the foregoing, the appellate court affirmed the Board’s Order, which had affirmed the WCJ’s Decision granting the fatal claim petition.

Commentary: Suicide Within the Workers’ Compensation Context

This decision is in line with the majority rule among American jurisdictions. As observed in Larson’s Workers’ Compensation Law, § 38.01 et seq., most suicide cases within the workers’ compensation realm present the same pattern of facts, i.e., the pattern found here: a severe, or extremely painful injury, followed by a deranged mental state ranging from depression to violent lunacy, followed in turn by suicide. The basic legal question in virtually all jurisdictions is the same: Was the act of suicide an intervening cause breaking the chain of causation between the initial injury and the death? The only controversy involves the kind or degree of mental disorder that will lead a court to say that the self-destruction was not an independent intervening cause.

Uncontrollable Impulse Test

The early, dominant workers’ compensation decision on the subject was Sponatski’s Case, 220 Mass. 526, 108 N.E. 466 (1915) [note that Massachusetts subsequently amended its statute—Mass. Gen. Laws ch. 152, § 26A—to provide for compensation when “due to the injury, the employee was of such unsoundness of mind as to make him irresponsible for his act of suicide”], in which the employee was splashed with molten lead, which caused the loss of his eye. The Board found the injury caused a nervous and mental derangement, and that while mentally deranged, the employee committed suicide. The Board awarded death benefits, concluding that the industrial accident was the sole, direct, and proximate cause of the suicide. The Supreme Judicial Court of Massachusetts (Suffolk) affirmed, stressing that:

where there follows as the direct result of a physical injury an insanity of such violence as to cause the victim to take his own life through an uncontrollable impulse or in a delirium of frenzy “without conscious volition to produce death, having a knowledge of the physical consequences of the act,” then there is a direct and unbroken causal connection between the physical injury and the death. But where the resulting insanity is such as to cause suicide through a voluntary wilful choice determined by a moderately intelligent mental power which knows the purpose and the physical effect of the suicidal act, even though choice is dominated and ruled by a disordered mind, then there is a new and independent agency which breaks the chain of causation arising from the injury [108 N.E. at 467-68].

In the years that followed Sponatski’s Case, courts tended to focus on two components described in the decision: the “uncontrollable impulse” factor, and the “knowledge of physical consequences” factor. Some courts treated the two as separate requirements. Others utilized a relative-weight analysis in considering the issues. Over time, however, almost all courts came to recognize the illogic of grafting the knowledge-of-physical-consequences component onto the causation rules governing the suicide defense. It was deemed sufficient to utilize the “uncontrollable impulse” factor —identified in some jurisdictions as the “voluntary wilful choice test [see Larson, § 38.02]—alone in determining whether the suicide was a break in the chain of causation.

Chain of Causation Test

In recent decades, however, the great majority of jurisdictions have abandoned the Sponatski’s uncontrollable impulse test, holding instead that the intervening cause issue turns not on the employee’s knowledge that he or she is committing suicide, but rather on the existence of an unbroken chain of causation from the injury to the suicide.

For example, in a New York case, Matter of the Claim of Smith v. Cornell University, 77 A.D.3d 1007, 908 N.Y.S.2d 472 (3rd Dept. 2010), the decedent, a painter, sustained work-related injuries in 2000 and 2001 and developed chronic pain as a result. His suicide in 2007 was found to be compensable. The decedent’s treating psychiatrist confirmed that the decedent’s disability and accompanying chronic pain led to his depression and eventual suicide; the independent medical examiner agreed that the decedent’s disability and pain contributed to his depression and suicide.

Returning to the facts of the instant case, there was little question that Decedent’s suicide was anything other than willful. As noted above, his wife initially found a suicide note that her husband had written. Later, she discovered his Internet research regarding the use of OxyContin as an agent. Indeed, in the days prior to his death, Decedent had been hospitalized because he appeared to be a suicide risk. He purchased the suicide rope from The Hope Depot. Under the Sponataki rule, it seems clear that the suicide would not have been compensable.

As explained, however, by the Pennsylvania Commonwealth Court, Decedent here had become dominated by a disturbance of the mind of such severity that it overrode his normal rational judgment. It was this disturbance that resulted in Decedent’s suicide. Since that disturbance had its origin in the work-related injury, Decedent’s suicide was not an intervening cause of death, and the spouse and child were to receive death benefits.

Contrast Suicide with Other Intentional Injuries

Attorneys and claims representatives should note the significant difference between an employee’s intentional injury—which is generally found not to be compensable—and a suicide under the circumstances presented here in the Hansell case [see Larson, § 38.06]. When an employee intentionally causes injury to himself, the injury is generally not compensable, either because it is deemed not to be “accidental,” at least in those jurisdictions still utilizing that original requirement for compensability, or the injury is found not to have been sustained in the course and scope of the employment; the intentional act is often deemed to be a significant deviation from the employment. With suicides, such as that by Decedent in Hansell, the majority of jurisdictions now employ a rule that is analogous with the “direct and natural consequence” doctrine: That a subsequent injury—here the suicide—is compensable if it is the direct and natural result of a compensable primary injury.