Texas has a substantial factor requirement in workers’ compensation cases which the Claimant’s evidence frequently fails to meet in our hearing offices and court rooms. Also, if the medical evidence of causation is conclusory, it is insufficient.
1) SUBSTANTIAL FACTOR REQUIRED
The causation standard on whether an injury is work related is based on a recent Texas Supreme Court case called Transcontinental Insurance Co. v. Crump . It says that “producing cause in workers’ compensation cases is defined as a substantial factor in bringing about an injury, and without which the injury would not have occurred.”
The Crump court said: “In other words, for an act or event to rise to the level of cause in the legal sense, the act or event must be such that reasonable jurors would identify it as being actually responsible for the ultimate harm. The cause must be more than one of the countless ubiquitous and insignificant causes that in some remote sense may have contributed to a given effect as, for example, simply getting up in the morning. That the term substantial factor is given to this commonsense aspect of legal causation simply makes plain to jurors that more than causation in this indirect, “philosophic sense” is required.”
2) EVIDENCE CANNOT JUST BE CONCLUSORY
And in Texas Workers Compensation Appeals Panel Decision 110054, the Appeals Panel stated that “[a]lthough the claimed conditions are listed in the record, there is not any explanation of causation for the claimed conditions in the record. We hold that in this case the mere recitation of the claimed conditions in the medical records without attendant explanation how those conditions may be related to the compensable injury does not establish those conditions are related to the compensable injury within a reasonable degree of medical probability.”
Reversing the Hearing Officer, The Appeals Panel stated:
“There are no medical records in evidence, neither those of the treating doctor or the designated doctor, that explain how the work injury of [date of injury], caused the claimed right lower extremity myelopathy, arthrosis at L4-5, disc bulge at L5-S1, and aggravation of degenerative disc disease. The peer review doctor, testified at the CCH as to what each of these claimed conditions were, and why, in his medical opinion, the medical records of the claimant did not establish the claimed conditions resulted from the work injury, within reasonable medical probability. In contrast, the Designated Doctor’s letter of causation is a mere recitation of the claimed extent-of-injury diagnoses and is conclusory. Accordingly, that portion of the hearing officer’s finding that the claimant’s right lower extremity myelopathy, arthrosis at L4-5, disc bulge at L5-S1, and aggravation of degenerative disc disease arose out of and naturally flowed from the compensable injury of [date of injury], is so against the great weight and preponderance of the evidence as to be clearly wrong and manifestly unjust.”
We as Insurance Carrier Attorneys frequently make these and similar arguments with success in Contested Case Hearings at the Division of Workers’ Compensation. Gone are the days of minimal proof of causation with little or no supporting expert opinion evidence. This trend has been favorable for our insurance company clients.
Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Texas civil litigation attorneys based in Fort Worth who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.