Friday, September 6, 2013

SC Case Highlights Culture Differences

South Carolina (where I'll be presenting in October at the state's educational conference in Myrtle Beach) takes a hard line on causation and a recent Court of Appeals ruling in that state provides a clear example just how strictly the "COE" part of the equation is construed there and highlights some important lessons.

Carolyn Nicholson worked for the South Carolina Department of Social Services as a supervisor in the investigations department. Part of her job responsibilities were to attend weekly audit meetings to review and update case files.

On Feb. 26, 2009, while heading to an audit meeting, Nicholson tripped and fell in the carpeted hallway of the DSS office. 

Nicholson had been carrying a stack of files with her, but she testified that the files did not cause her to trip. She also asserted that her leg did not give way, and she had no health problems that would cause her to fall.

There also was no defect in the carpet or floor of the hallway, as Nicholson recalled. It was a normal, level, carpeted hallway, and there was no debris on the floor either. 

She said that her shoe had scuffed against the carpet, and "the friction from the carpet just grabbed me" and that's what made her fall. 

Nicholson sustained injuries to her neck, back, and left shoulder that kept her out of work for two months. She sought temporary total disability benefits and payment for her medical treatments.

Her employer and its insurance carrier, the State Accident Fund, admitted that Nicholson fell at work but denied she sustained compensable injuries by an accident arising out of her employment.

The hearing officer agreed with State Accident Fund because "there was nothing peculiar about the floor at (the DSS) building that caused her to fall," and her fall "would have carried the same consequences had she fallen on a carpeted floor outside" the DSS building.

The hearing officer was overturned by the Workers' Compensation Commission because the conditions of her workplace had posed the risk that caused her injury.

The Court of Appeals reversed the WCC citing a 1955 Supreme Court case, Bagwell v. Ernest Burwell Inc., which requires that a worker must be able to show a causal connection between the conditions under which she performs her work and her injury to compensable.

Consequently the Court of Appeals reasoned that a level carpeted floor with no defect did not present any sort of unusual risk to Nicholson.

There was also nothing about the presence of the carpet that was "peculiar to the work" that Nicholson did, the court said. In fact, "the only fact connecting Nicholson's fall to her employment is that her injuries occurred while she was working in a carpeted area of DSS's building."

I'm not sure I like or dislike this ruling.

I like that South Carolina hasn't expanded workers' compensation into the realm of fuzzy injury claims. Here's a state with workers' compensation laws that are interpreted in light of a time when claims were real, physical, and indisputably part of the employment risk.

On the other hand the employment risk has changed since South Carolina adopted workers' compensation, and since 1955 - so this ruling shifts the cost of the employment risk over to the general health and public benefit systems which I don't think is right.

But what is most interesting about this ruling is that it highlights the disparity in how workers' compensation operates from one state to the next, and how complicated things can get for the injured and the providers trying to figure out what system to be in for services, benefits, and payments.

And also why certain measures of system performance comparing one state to another can't be reliable because they are not an apples to apples comparison - what would be an accepted injury in one state is denied in another, simply as a matter of application of law.

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