What Constitutes a Personal Injury?
By Thomas H. Cypher and James 1. Helminski
MI Supreme Court Publishes
Much-Anticipated Opinion in Controversial Case
What constitutes a "personal injury" under the Workers' Disability Compensation Act? Does mere symptom aggravation, without a change in pathology, constitute a "personal injury"?
The difficulty in determining if a personal in-jury has occurred often arises when the employee suffers from a preexisting condition. It becomes an arduous task to distinguish whether the symptoms complained of are attributable to the progression of the preexisting condition or a work-related injury.
On July 30, 2003, the Michigan Supreme Court published its much-anticipated opinion in the controversial Rakestraw case (Rakestraw v General Dynamics Land Systems, decision No. 120996). As the dissenting opinion suggests, the decision in this case may "shake the foundations of established workers' compensation jurisprudence."
Facts
Plaintiff Wayne Rakestraw had a preexisting cervical condition. He suffered a herniated cervical disk that necessitated two surgeries, the first in December of 1991 and a second in April of 1992. When he was hired by the defendant employer in August of 1996, his preexisting neck condition was asymptomatic. Ultimately, the plaintiff was taken off work in September of 1999 because his strenuous duties as a manager of systems engineering, including extensive travel, reportedly brought on increasing, disabling pain.
The Magistrate awarded benefits, and concluded that the plaintiff's preexisting cervical condition was symptomatically worsened by his work activities. Additionally, the Magistrate found that the plaintiff's problem was not pathologically altered by his subsequent work activities. The Workers' Compensation Appellate Commission affirmed the decision, reluctantly based on prior Court of Appeals case precedent, in particular Mattison v Pontiac Osteopathic Hosp, 242 Mich
App 664 (2000).
The Court of Appeals in Mattison stated:
Awarding benefits on the basis of the aggravation of symptoms alone accords with the policy underlying the [Workers' Disability Compensation Act]. The objective of the WDCA is to compensate a claimant for the loss of an earning capacity caused by a work-related in-jury.... Even when a preexisting condition was not caused or aggravated by employment, if an employee is unable to work because work-related events have aggravated the symptoms of the condition to the point of disability, the employer should be liable for wage-loss benefits until the symptoms subside to their preexisting level. (Id. at 642.)
Supreme Court holding in Rakestraw
The Supreme Court held that a plaintiff, in order to prove that he or she suffered a work-related injury pursuant to §301(1), must prove that the injury is medically distinguishable from a 'preexisting, network-related condition. The Supreme Court further explained that "[a] symptom such as pain is evidence of injury, but does not, standing alone, conclusively establish the statutorily required causal connection to the workplace." In a nutshell, evidence of a symptom is not enough to establish a personal injury.
Note that this was a close, hotly contested decision amongst the seven justices of the Supreme Court. The majority ruled by a vote of 4-3, with a lengthy, biting dissent. Accordingly, when the makeup of the Michigan Supreme Court changes in the future, this issue may be reconsidered.
The Supreme Court overruled the Court of Appeals decision in Mattison and other Court of Appeals decisions.
Practical implications
The true meaning and full impact of this decision will only emerge as the case law unfolds in the coming years. However, the release of this decision will impact Michigan workers' compensation in a number ways. First, the plaintiff's burden of proof has become more difficult to meet. In a case where the plaintiff has a preexisting condition, he or she will have to demonstrate that there has been a distinct, actual in-jury, not just an increase in symptoms. The key phrase in the court's holding is medically distinguishable. This phrase presumably refers to distinguishing a new injury from the preexisting condition. What constitutes a medical distinction will be determined by lower courts. Until this case is tested, the full meaning of this decision will not be known.
Second, completely and accurately developing a plaintiff's (employee's) medical history will be crucial. Specifically, it will be necessary to deter-mine a plaintiff's preexisting level of pathology and exactly how the symptoms manifested them-selves. Independent medical evaluations and the careful review of diagnostic studies will become more significant to defending cases. This will assist employers/defendants in assessing whether there has been any quantifiable ("medically distinguishable") change in the plaintiff's condition.
At this point, we suggest that any case where an injured worker suffered from a preexisting condition should be scrutinized. If the only proven change in a preexisting condition is an in-crease in symptoms, the compensability of that claim should be considered. This includes cases that are currently being voluntarily paid.
Implications of the Court's Decision
• The true meaning and full impact of this decision will only emerge as the case law unfolds in the coming years.
• The release of this decision will impact Michigan workers' compensation in a number of ways.
- First, the plaintiff's burden of proof has become more difficult to meet. In a case where the plaintiff has a preexisting condition, he or she will have to demonstrate that there has been a distinct, actual injury, not just an increase in symptoms.
- Second, completely and accurately developing a plaintiffs (employee's) medical history will be crucial. Specifically, it will be necessary to determine a plaintiff's preexisting level of pathology and exactly how the symptoms manifested themselves.
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