Missouri: Court Reverses Denial of SIF Benefits for Unexplained Fall

A worker fell 20-25 feet from a rail car. He settled his case with the employer and proceeded  with a claim for second injury fund benefits.  The court of appeals reversed the Commission’s award  which denied  SIF benefits because claimant failed to prove "why" he fell. Gleason v Treasurer of the State of Mo., 2015 MO App. Lexis 216 (lexis.com), 2015 MO App. Lexis 216 (Lexis Advance) (March 3, 2015).

The Commission found the worker established that he had an accident, the accident was the prevailing cause of his injuries, but he did not prove an accident that arose out of his employment because he did not identify a hazard or risk that caused him to fall.  The worker  had no memory of the event and could not explain why he fell.  There were no witnesses.

The court found Gleason did not have to show why he fell.  The court found the commission erroneously concluded a fall is not compensable just because it is unexplained.  A fall is  compensable from an unexplained cause if a worker identifies a risk source  and distinguishes the risk from non-occupational exposure.  Claimant was exposed to an unusual risk of injury not shared with the general public because he performed work on top of rail cars.  The second injury fund did not offer any evidence to support an affirmative defense that he fell because of any idiopathic reasons. 

The case was a remanded.  The ALJ denied the case for two reasons:  claimant failed to prove injury arising out of employment and failed to prove a “combo” disability to invoke SIF benefits.   The Commission did not address the second issue. In the end, the Commission could affirm a denial of benefits based on the second ground. 

Section 287.020.3 (lexis.com), §287.020.3 (Lexis Advance) requires an occupational risk different from a risk of the general public.   The case reflects a trend of recent decisions chipping away at this legal defense to the point where a positional risk is nearly always  factually distinguishable either by hazard or specific location.    While the risk from falling is easy to appreciate when a worker falls 25 feet, the risk source becomes more murky when a worker falls out of her shoes.

Source: Martin Klug, Huck, Howe & Tobin. Read Martin Klug’s Mo. Workers’ Comp Alerts.

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