Did the Employee Have An Accident?
In order for an injured worker to recover workers compensation benefits in Louisiana, the employee must prove that a work-related accident occurred and that an injury was sustained.
So basically, besides occupational disease and other types of work-related illnesses, there must have been a specific accident for an injured employee to recover under Louisiana workers compensation.
The employee must show that a work-related accident occurred by the legal standard of proof of preponderance of the evidence. That simply means that the injured employee must show it is more likely than not likely that a work-related accident occurred. In other words, being 51% sure is good enough.
What Is Considered An Accident In Workers Compensation?
In Louisiana workers compensation, an “accident” is legally defined as “an unexpected or unforeseen event happening suddenly or violently, with or without human fault, and producing at the time objective symptoms of an injury, which is more than simply a gradual deterioration or progressive degeneration.”
So another words, for there to be an accident in workers compensation, there technically should be:
- An unexpected or unforeseen event,
- Happening suddenly or violently, and
- Producing symptoms of an injury.
However, Louisiana Office of Workers Compensation courts do not necessarily always stick to these technical requirements. In fact, regarding the meaning of an “accident,” the Louisiana courts have gone as far as to say that when the performance of the usual duties of an employee cause or contribute to an injury, then the requirements for an accident have been met. And again, these requirements do not apply to occupational disease and other types of work-related illnesses.
Additionally, under Louisiana law, workers compensation laws are "liberally construed" to find coverage for an injured worker. Essentially, that means that he injured worker is given many benefits of the doubt, which is a great thing for the worker.
Aggravations of Degenerative Conditions
Last, Louisiana workers compensation does not cover an injury or illness which is simply a gradual deterioration or progressive degeneration. That means that degenerative conditions - such as degenerative disc disease - are not covered under Louisiana workers compensation. However, an aggravation of a degenerative condition - such as degenerative disc disease - is covered if there was a work-related accident which aggravated the degenerative condition. For example, if an employee has a pre-existing history of low back pain, but then that back pain suddenly changes or gets worse following some accident at work, then the employee should be able to recover under Louisiana workers compensation.
Must the Accident Be An Actual Event?
The Louisiana Workers' Compensation Act, which defines the term “accident”, includes the requirement that there be an “unexpected or unforeseen actual, identifiable, precipitous event happening suddenly or violently …”
However, Louisiana courts have found that extraordinary physical stress and strain is not essential to the definition of a disabling accident. Instead, the courts have held that the requirements for an accident have been met when the performance of the usual and customary duties of a workman cause or contribute to a physical breakdown.
Therefore, the required “injury by accident” has thus been found to have occurred in instances of heart attack, cerebral hemorrhage, hernia, abscessed lung, spontaneous pneumothorax, ruptured intervertebral disc, rupture of an abdominal tumor, laceration of the internal semilunar cartilage of the knee (football knee), osteomyelitis, rheumatoid arthritis, or hepatitis, even when these occur during the employee's regular work in the regular way, if a causal relationship between working conditions and disability can be found. There need be no disabling event which is different either in kind or intensity from the regular working experiences of the claimant.
Nevertheless, while an accident can be found to exist when heavy lifting or strenuous effort cause or contribute to a physical breakdown, the employee is still required to “identify the event marking the time when one can identify an injury.”
Must the Accident Be Unexpected or Unforeseen?
Though the Louisiana Workers' Compensation Act technically states that the employee's accident must have been unusual or unexpected, Louisiana OWC courts have minimized this requirement, and have held that an employee simply needs to show some causal link between the employment and the disabling event. In other words, the employee simply needs to show that something about the employment caused the injury.
Many times, the workers compensation insurance company will claim that an injury should not be covered because the accident was not “unexpected” or “unforeseen.” This happens a lot particularly in cases where there is some weakness in the employee's physical constitution makes him susceptible to injury by ordinary routine events which would not affect the normal worker. But of course the disability of such a worker is not “unexpected” or “unforeseen” but under the circumstances quite predictable because of his preexisting condition. And Louisiana courts have regularly found that the disabling event need not be different in kind or intensity from the regular work of the employee. So any argument by the workers compensation insurance company that an injury should not be covered because the accident was not unexpected or unforeseen is weak at best.
Must the Accident Happen Suddenly or Violently?
The Louisiana Workers' Compensation Act states that an event which results in injury or death cannot be classified under the statute as an “accident” unless it happens “suddenly or violently.” However, it reality, Louisiana courts have been very flexible in applying this requirement, to the point where they almost do not even consider it.
The simplest incidents of violence, of course, are the inflictions of traumatic blows, or other occasions on which visible force from the outside is applied to the person. So long as the application of force produces an injury, it is immaterial that the blow or impact was gentle and would not be expected to bring about any injury.
But in some cases, almost imperceptible force has satisfied the requirement of a “violent” incident. For example, Louisiana courts have awarded compensation for injuries to the eye where minute particles, or even dust, have produced blindness or an impairment of vision. Also, the inhalation of gas, fumes, lint, or dust, which produces asphyxiation, lead poisoning or pulmonary sickness, has been regarded as an event of “violent” character. And last, Louisiana courts have awarded compensation when there has been contact of the skin with poison ivy or other noxious substances.
Louisiana workers compensation courts have also held that quick movement, a strain or exertion can supply the necessary violence, so long as there is proof of the event. It is unnecessary that the strain be either unusual or that it be intense enough to produce an injury in a normal or average person. For these reasons, Louisiana workers compensation generally (but not always) cover injuries such as hernias, heart attacks, strokes, and back ailments.
What Evidence is Needed to Prove That An Accident Occurred?
When determining whether an injury-causing accident occurred, the employee's testimony is afforded great weight if there are no contradictory circumstances and evidence. This generally means that if there's no evidence (including testimony) showing that the accident did not cause the injury, then the courts will usually believe the employee if the employee says that the accident did cause the injury.
In fact, an employee's testimony alone may be enough to prove that an "accident" occurred, provided two elements are satisfied:
- No other evidence discredits or casts serious doubt upon the worker's version of the incident; and
- The worker's testimony is corroborated (or supported) by the circumstances following the alleged incident.
Corroborating (Or Supporting) Circumstances
Concerning the corroborating circumstances (or circumstances which back-up the employee's statements), the courts will consider:
- Late reporting of the accident or injury by the employee;
- Testimony of the employee's supervisors and co-workers;
- Testimony of the employee's family and friends;
- Medical evidence;
- Continuing to work by the employee; and
- Prior injuries of the employee.
Concerning the late reporting of the accident or injury by the employee, an employee's delay in reporting an injury can show the employee's initial unawareness of the seriousness of the injury, rather than cast doubt on the employee's believability about whether the accident occurred.
Also, concerning corroborating medical evidence, discrepancies or inconsistencies in initial medical reports do not necessarily mean that the employee will not win on his or her claim. Instead, Louisiana courts will want to know if the injured employee has a valid explanation for the discrepancies or inconsistencies.