120-Pound Weight Gain Might (or Might Not) Sink Idaho Worker’s Aggravation Claim

In a meticulous and well-reasoned opinion weighing and discussing multiple issues, the Supreme Court of Idaho held that the state’s Industrial Commission committed error when it ruled that the claimant’s disability related to his aggravation claim be evaluated based on his condition at the point of maximum medical improvement and not at the time of the hearing [Sharp v. Thomas Bros. Plumbing, 2022 Ida. LEXIS 56 (May 18, 2022)].

The Court also found the Commission had utilized an incorrect standard when it held the claimant's post-accident weight gain—he weighed 250 pounds at the time of injury, but after surgery gained an additional 120 pounds—was a subsequent superseding event that relieved the employers of liability for the full extent of his disability. Relying upon Larson’s Workers’ Compensation Law, § 10.01, et seq., but adopting a somewhat different rule, the Court held that, on remand, if the Commission determined that the claimant’s conduct leading to his weight gain was undertaken with a “rash or deliberate disregard” of the risk that he would aggravate his back injury, the Commission must re-determine the extent of his disability for which the employer was liable [Opinion, p. 34].

Background

Claimant injured his back while working as a plumber in late August 2015. At the time of the accident, he was obese, standing five feet six inches tall and weighing 250 pounds. He underwent surgery and continued to have lower back pain. The surgeon discharged Claimant in January 2016, by which time Claimant had gained 30 pounds. Before the surgery, the surgeon told Claimant that he needed to lose weight to avoid complications, and he expressed disappointment that Claimant had gained weight in the intervening months instead.

Claimant began physical therapy and was subsequently examined and treated by several medical providers, all of whom advised Claimant to lose weight. Claimant was determined to have reached maximum medical improvement in 2016. At that time, the employer’s physician opined that Claimant had sustained disability as 21 percent, while Claimant’s expert calculated it at 43 percent.

Commission: Weight Gain Was Intervening Factor

In a December 2020 decision, the Commission determined that the employer was liable for certain unpaid medical expenses, though not for dietician services to help Claimant lose weight. It also found Claimant’s post-accident weight gain was “a change in Claimant’s condition not caused by his industrial accident.” Therefore, the Commission evaluated Claimant’s disability using the employer’s expert’s restrictions because it believed these reflected Claimant’s disability in 2016, when he reached MMI. The Commission also found the opinion of the employer’s vocational expert was more persuasive than the opinion of Claimant’s expert and, thus, concluded Claimant’s permanent disability was 21 percent.

Idaho Supreme Court: Commission Failed to Follow Brown Decision

On appeal, the Supreme Court observed that the Commission used the employer’s expert’s restrictions even though it observed that Claimant’s expert’s more recent restrictions might accurately reflect Claimant’s functional ability as of the date of the hearing. The Commission further acknowledged that Idaho Code § 72-425 provides that a disability evaluation is an assessment of a claimant’s “present” ability to obtain suitable employment. Furthermore, it acknowledged the Court’s holding in Brown v. Home Depot, 152 Idaho 605, 272 P.3d 577 (2012), that the statute’s use of the word “present” required a disability evaluation to take account of the claimant’s personal and economic circumstances at the time of the hearing, not at some earlier time.

Nevertheless, said the Court, the Commission declined to follow Brown. In short, the Commission found that Claimant’s 120-pound weight gain was a superseding event that relieved the employer of liability for any disability attributable to it. The Court agreed with Claimant that the Commission had erred in not evaluating his disability at the time of the hearing as required by § 72-425.

Workers’ Compensation is Not Synonymous With, Nor a Branch of, Tort Law

The Court said the Commission had also erred by applying an incorrect standard for determining when an employer is relieved of liability for the aggravation of a compensable injury or a secondary injury that flows from a compensable injury. The Court acknowledged that in tort law, whether a subsequent event terminates the legal responsibility of an otherwise liable party is evaluated under the doctrine of superseding causes. It added:

But this is not a tort case. We take this opportunity to emphasize a critical point: workers’ compensation law is not synonymous with, nor a branch of, tort law [Opinion, pp. 20-21, citation omitted].

In workers’ compensation law, an employer’s fault is not a precondition of liability. The Court stressed, however, that the Commission’s decision had been inappropriately concerned with the employer’s fault rather than a work connection as the basis of liability. At one point, the Commission had stated that without the superseding cause analysis, the employer would be “saddled” with unfair liability. The Commission’s decision was fundamentally inconsistent with the principles of workers’ compensation law, said the Court.

Rash or Deliberate Disregard of the Risk?

Reviewing extensively the treating of these issues in Larson, the Court held the correct standard for determining whether the employer was liable for the aggravation of Claimant’s injury was whether Claimant acted with rash or deliberate disregard of the risk that additional harm would flow from his compensable injury.

Heightened Negligence Standard

Relying upon Larson, but forging a slightly different path, the Court held that a heightened negligence standard must apply before an employer is relieved of liability for the consequences flowing from a compensable injury. It continued:

Occasional lapses in judgment are a fact of the human condition. If, by happenstance, a lapse worsens a compensable injury or combines with a compensable injury to bring about new harm, cutting off employer liability would fail to ensure the “sure and certain relief” that the workers’ compensation law is meant to provide. Therefore, we hold that the consequences flowing from a compensable injury are also compensable unless they result from an employee’s conduct that is undertaken with rash or deliberate disregard of a material risk that the harm will occur [Opinion p. 34].

On remand, the Commission was required to consider all the relevant facts when determining whether Claimant deliberately disregarded the risk that his weight gain would aggravate his compensable injury.