COMPENSABLE INJURY / Injury From Merely Walking Can Be Compensable – Clarifying ALJ’s Misstatement Of Law
Appeal 180046
The ALJ determined that the claimant sustained a compensable injury. The evidence established the claimant stepped on an uneven surface which resulted in damage and harm to the physical structure of his body in the form of a fracture of the fifth metatarsal of his right foot. However, the ALJ stated in the Discussion that “[w]hile [the] [c]arrier’s argument that an injury sustained from merely walking is not compensable is correct . . . .”
The Appeals Panel affirmed but clarified that the ALJ’s statement was not a correct statement of law. As determined in APD 070284-S, decided April 20, 2007, the Appeals Panel rendered a decision that the claimant did sustain a compensable injury where the evidence established the mechanism of injury was simply walking as the injury occurred in both the course and scope of employment and arose out of the employment.
COMPENSABLE INJURY / ALJ Misstated Evidence, Thus Remanded
Appeal 180315
The claimant testified that she injured her back when the corner of a rug got caught in the vacuum cleaner while she was vacuuming at work. In evidence was a medical record dated March 2, 2016, that stated that: “[s]ymptoms started about a week ago after vacuuming at work.” However, in his discussion of the evidence, the ALJ noted that it was only during the March 1, 2017, visit that a reference to the vacuum cleaning episode from the DOI was made for the first time. This was a misstatement of evidence presented at the CCH. Accordingly, the Appeals Panel reversed the ALJ’s determination that the claimant did not sustain a compensable injury, and remanded the issue of compensability.
COMPENSABLE INJURY / Finding Of No Compensable Injury Reversed Due To Medical Evidence Of A Bruise And Blood Even Though Not Noted By Ems
Appeal 180794
The ALJ determined that the claimant did not sustain a compensable injury. However, it was undisputed that the claimant struck the right side of his head on the pavement when he fell to the ground. Although the ALJ was correct in stating that the EMS records did not indicate the claimant had any visible abrasions, contusions, or bruising at the time he was transported to the hospital, medical records in evidence from the DOI note examination findings of a small contusion on his right eyebrow ridge, bloody discharge from his right ear, and a suggested right temporal bone fracture. Under the facts of this case, the ALJ’s determination was so against the great weight and preponderance of the evidence as to be clearly wrong and manifestly unjust.
Accordingly, the Appeals Panel reversed the ALJ’s determination and rendered a new decision that the claimant did sustain a compensable injury.
COMPENSABLE INJURY/ Remanded Due To ALJ’s Misstatement Of Material Fact
Appeal 181953
A CCH was held on the issues of compensability and disability. The ALJ stated that after review of the evidence presented, there is no mechanism of injury and no injury event described by the claimant. However, the claimant testified he hurt his back while lifting boxes at work and the same mechanism of injury is described in the first medical report.
Accordingly, the Appeals Panel viewed the ALJ’s misstatement of evidence as a material misstatement of fact and remanded back to ALJ to correct her misstatement of evidence and make a determination on the issues of compensability and disability.
COMPENSABLE INJURY / An Injury In The Course And Scope Of Employment Is Not Compensable If Compensation Is Not Payable
Appeal 190183
The ALJ determined that the claimant sustained a compensable injury. However, the ALJ also found that the carrier was relieved of liability due to the claimant’s failure to file a claim for compensation with the DWC within one year. The Appeals Panel reversed the finding that the claimant sustained a compensable injury. Section 401.011(10) defines “compensable injury” as “an injury that arises out of and in the course and scope of employment for which compensation is payable under this subtitle.” Even though the claimant sustained an injury in the course and scope of employment, the carrier was relieved of liability. Therefore, the work injury could not be a “compensable injury” because compensation was not payable.
