With the sweeping changes in the Missouri Workers’ Compensation law since 2005, proof of the compensability of an accident itself has gotten much more difficult. Possibly the biggest challenge is the change from “liberal construction” (which gave the benefit of the doubt to employees) to “strict construction” (which does not). Administrative law judges, the Labor Commission, and the Division “shall weigh the evidence impartially without giving the benefit of the doubt to any party when weighing evidence and resolving factual conflicts.” § 287.800 R.S.Mo.
The actual compensability of an accident is governed by Section 287.120.1, which states that "[e]very employer subject to the provisions of this chapter shall be liable, irrespective of negligence, to furnish compensation under the provisions of this chapter for personal injury or death of the employee by accident or occupational disease arising out of and in the course of employee's employment."
There are several elements of Section 287.120.1 that must be proven in every case in order for the case to be found compensable. First, you must prove that the injury or death was by an accident or occupational disease. This article deals only with an "accident" case. Section 287.020 defines an "accident" as "an unexpected traumatic event or unusual strain identifiable by time and place of occurrence and producing at the time objective symptoms of an injury caused by a specific event during a single work shift."
Second, you must prove that the accident arose “out of and in the course of employee’s employment.” Section 287.020(2) tells us how to prove or disprove this fact:
"(2) An injury shall be deemed to arise out of and in the course of the employment only if:
(a) It is reasonably apparent, upon consideration of all the circumstances, that the accident is the prevailing factor in causing the injury; and
(b) It does not come from a hazard or risk unrelated to the employment to which workers would have been equally exposed outside of and unrelated to the employment in normal nonemployment life." § 287.020 R.S.Mo.
An injury arises “out of” employment if it is “a natural and reasonable incident thereof and is the rational consequence of some hazard connected with the employment." On the other hand, an injury arises “in the course of employment” only if it “occurs within the period of employment, at a place where the employee may reasonably be and while he is reasonably fulfilling the duties of his employment." Anderson v. Veracity Research Co., 299 S.W.3d 720, 729 (Mo. Ct. App. 2009). An important case to read on this element of proof is Johme v. St. John's Mercy Healthcare, 366 S.W.3d 504, 511, 2012 (Mo. 2012).
The next question you need to answer is whether the accident was the “prevailing factor in causing both the resulting medical condition and disability.” §287.020.2 RSMo. Section 287.020.3 states that “‘The prevailing factor’ is defined to be the primary factor, causing both the resulting medical condition and disability.” A recent must-read case on the subject is Tillotson v. St. Joseph Med. Ctr., 347 S.W.3d 511, 517 (Mo. App. 2011).
Section 287.020 goes on further to state that:
"(3) An injury resulting directly or indirectly from idiopathic causes is not compensable.
(4) A cardiovascular, pulmonary, respiratory, or other disease, or cerebrovascular accident or myocardial infarction suffered by a worker is an injury only if the accident is the prevailing factor in causing the resulting medical condition."
These two sections attempt to limit the compensability of injuries that occur due to something peculiar to an individual. An idiopathic condition is one that is "peculiar to the individual: innate." Alexander v. D.L. Sitton Motor Lines, 851 S.W.2d 525, 527 n.3 (Mo. banc 1993).
Finally, does the employee’s injury come "from a hazard or risk unrelated to the employment to which workers would have been equally exposed outside of and unrelated to the employment in normal nonemployment life." Section 287.020.3(2)(b). There are two steps to this analysis:
The first step is to determine whether the hazard or risk is related or unrelated to the employment. Where the activity giving rise to the accident and injury is integral to the performance of a worker's job, the risk of the activity is related to employment. In such a case, there is a clear nexus between the work and the injury. Where the work nexus is clear, there is no need to consider whether the worker would have been equally exposed to the risk in normal non-employment life. Only if the hazard or risk is unrelated to the employment does the second step of the analysis apply. In that event, it is necessary to determine whether the claimant is equally exposed to this hazard or risk in normal, non-employment life.