Under the Virginia Worker's Compensation Act, workers can only receive compensation from an injury if it was the result of an accident. The Virginia Court of Appeals set forth four elements that workers must prove to show that an injury was the result of an accident: (1) there must have been an identifiable incident; (2) the incident must have occurred at a “reasonably definite time,” not gradually over time; (3) there must be some “obvious sudden mechanical or structural change” that constitutes the injury; and (4), there must be a causal connection between the incident and the bodily change.
The burden of proof is on the injured worker to prove each element in order to be compensated for their injury. Each of the four above elements is discussed in this post, along with examples of cases that failed to meet the burden of proof.
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Was There an Identifiable Incident?
Injured workers cannot prevail if they cannot identify some specific incident. Just claiming a gradual onset of back pain while on the job is not enough. The Virginia Supreme Court has held that the injured worker must be able to attribute the injury to an identifiable movement, incident, or event on a particular day.
One injured worker was denied benefits even though she suffered from back pain over several days of work while lifting weights of at least 40 pounds and pushing or pulling heavy cans. She was examined by a physician, and a herniated disc was removed. But because the worker could not identify a specific incident that caused her injury, she was denied compensation.
Did the Incident Occur at a Reasonably Definite Time?
In order to receive compensation for an injury by accident, the injured worker must be able to prove that the incident occurred at some reasonably definite time. Not only must the injured worker prove that an incident occurred, but she must be able to prove that the incident was tied to a movement made or action was taken at a particular time, not just the result of difficult or stressful employment over a period of time.
One operations clerk who suffered a lumbar sprain because of long periods of sitting and occasionally bending forward in a hardback chair was denied benefits. The Court pointed out that her injury developed slowly over time, and not as the result of a sudden incident or event. Because she could not prove that an incident occurred at a particular time, she was denied compensation.
Was There Some Obvious Sudden Mechanical or Structural Change in the Body?
Virginia courts have consistently held that there must be some “braking, herniating, or letting go” as the result of usual exertion in order to prove an obvious sudden mechanical or structural change. Like the previous two requirements, it is not enough to claim that the injury resulted from a long period of difficult or stressful work. This requirement must involve the worker engaging in an activity that results in an unusual or unexpected injury.
In both of the cases above, the injury caused would not be enough to meet this requirement. A gradual increase in pain over time is not enough, even if the eventual result is a sprain or herniated disc. By comparison, one Virginia worker who suffered a ruptured disc in his back after helping to lift a coil of wire onto a truck bed was awarded compensation. He claimed that he immediately felt “something pop or make a definite snap in my back,” and that was enough to prove that there was some obvious sudden mechanical or structural change in his body.
Is There a Causal Connection Between the Incident and the Bodily Change?
Finally, in order to receive compensation from an injury, the injured worker must be able to prove a causal connection between the injury and his employment. Just because the injury occurred while she was at work does not mean that her claim will be approved. This causation requirement can be met in several ways, but it is most often proven by medical evidence. A physician's diagnosis, along with the accounts of witnesses to the incident, will normally be sufficient to prove causation.
Even in cases where there is no specific diagnosis from a physician, the element of causation can sometimes be proved by the injured worker's testimony and her medical history. In one case, a groundskeeper was injured when a tree fell on his foot. The injured worker did not seek medical treatment until a year after the accident, but the injury was still compensable. The Court ruled that because the injury was not particularly complex, a specific diagnosis was not necessary. A diagnosis would certainly make the case stronger for the injured worker, but the worker can sometimes be compensated without one.
A few key things to remember
- Evidence consisting of vague recollections or general overexertion will almost never be enough to meet the burden of proof for the injured worker. A winning case needs specific evidence, including a particular time and an identified incident.
- It is not necessary to have felt immediate pain during the incident in order to prove that the incident caused an obvious sudden mechanical or structural change in the body. The level of pain experienced is less important to a winning case than the fact that an obvious sudden change occurred.
- The incident must immediately cause an injury; gradual injuries are not compensable. Although pain that increases over time is a serious concern, it is not covered by Virginia's Workers Compensation Act.
- The incident must be work-related, not just an incident that occurred while in the workplace. If the injured worker was not injured while they were performing work responsibilities, the injury will not be compensable.
There are many types of injuries that workers can experience, but unfortunately, not all of them are covered by Virginia's Workers Compensation Act. If you have a question about whether an injury is considered an injury by accident, please call our office to set up an appointment to discuss your case with an attorney.
Why wait? Click to schedule a free workers compensation consultation with Attorney B. Patrick Agnew.
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