In 2019, the First DCA delved deep into the question of “arising out of” as it relates to whether a workers’ compensation accident “arises out of work performed in the course and the scope of employment” Fla. Stat. 440.09(1). The answer to this question will impact whether an industrial accident is compensable, or not, under the statutory scheme.
As the Court in Valcourt Williams noted, “arising out of” pertains to occupational causation. An accidental injury or death arises out of employment if work performed in the course and scope of employment is the major contributing cause of the injury or death. More simply, the “arising out of” limitation requires that the risks that cause the accident be work-related.
The facts in Sedgwick v. Valcourt Williams paint an interesting scene, one likely familiar to most in the insurance industry: a claims adjuster working for Sedgwick was working remote at her home in Arizona. Three hours into her shift, the Claimant went downstairs for a cappuccino. As she was reaching for a cup, the Claimant tripped over one of her two dogs. The fall resulted in knee, hip and shoulder injuries and the Claimant filed a workers’ compensation claim. Sedgwick denied the claim, arguing that the injuries did not “arise out of” the Claimant’s employment.
Initially, the JCC determined that the claim was compensable, noting that the work-from home arrangement meant the employer “imported the work environment into the Claimant’s home and the Claimant’s home into the work environment”. The First DCA reversed, on the basis that “occupational causation” was not present. The Court relied on precedent which stated, “An accident is thus compensable only if “the employment necessarily exposed the Claimant to conditions that would substantially contribute to the risk of injury and to which the Claimant would not normally be exposed during his nonemployment life” Acker v. Charles R. Burklew Const., 654 So. 2d 1211 (Fla. 1st DCA 1995).
The Court made their goal clear: “If any ambiguity remains, we hope to remove it now. For any injury to be compensable, it must “arise out of” the employment; there must be—as the statute says – “occupational causation”. But I think the JCCs of this state would argue that this decision did not accomplish this goal.
In Caba v. PeopLease, LLC/Next Level Administrators LLC, Judge Mark Massey attempted to break down the Valcourt Williams decision and apply it to the facts at hand. In this case, while at work, the Claimant went to use the restroom, which required him to walk past several stainless-steel poles that were about three feet high. The Claimant tripped over one of these poles and fell to the concrete, injuring his right hip, right side and lower back. The Employer/Carrier argued that the fall was idiopathic or, in the alternative, that the accident was not compensable based on Valcourt Williams. Judge Massey undertook an extensive, and impressive review of the Valcourt Williams decision. After evaluating and dismissing the Employer/Carrier’s argument regarding an idiopathic fall, Judge Massey turned to the “arising out of” argument.
Judge Massey points out that, of the cases that were cited by the First DCA in Valcourt Williams, some similarities arose. First, an example of where there is an argument against compensability would be where the Claimant imported the risk into the workplace (Claimant’s vehicle was being repossessed in the parking lot while Claimant was injured). Second, when the Claimant suffered from an idiopathic pre-existing condition that was aggravated, or caused to become symptomatic by a normal, everyday movement (think: simply looking around, or picking up toilet paper).
What is interesting in Judge Massey’s compensation order, is that he also points out that the Valcourt Williams decision has led to an array of rulings across the state that are not consistent. I think it is fair to take the examples that he gives as a plea to the First DCA to clarify their ruling.
Occupational causation can be a tricky area to navigate. As Judge Massey so aptly points out, most, if not all, work accidents could have happened outside of work. Judge Massey gives the example of slipping on a recently mopped floor, but you could also imagine the Employer/Carrier bringing into evidence that a Claimant utilizes a riding lawnmower at his home, when his injury occurred while riding a lawnmower as part of his occupation and arguing that he is not at any additional risk while at work. This argument would seem to fly in the face of the Acker court, which would stand for the principal that since the Claimant was exposed to this risk in his nonemployment life, therefore it would not be a compensable accident.
Judge Massey found that the Claimant did not import any risk with him to the workplace and did not suffer from a pre-existing condition that contributed to the fall. Therefore, Judge Massey found that the Claimant’s fall was caused by conditions created by his employment. Of course, Judge Massey’s ruling has been appealed to the First DCA. As have numerous other decisions based on Valcourt Williams. Time will tell whether we get clarification on the Court’s meaning behind the stricter requirement of a showing of occupational causation.