Appeals Panel Concludes that Employee’s Idiopathic Fall Resulted in a Compensable Injury

The Appeals Panel has reversed the decision and order of an administrative law judge that found that a claimant had not sustained a compensable injury and has rendered a decision that claimant was injured while in the course and scope of his employment.

The appeal is posted in Texas Division of Workers’ Compensation Appeals Panel Decision No. 180794, decided May 8, 2018.

The claimant testified he could not recall the events of the date of injury. His employer testified that as he was talking to the claimant while they were smoking the claimant fell to the ground and struck the right side of his head on the pavement. Mr. H called for medical assistance and the claimant was taken via ambulance to the emergency room. EMS records in evidence reflect that EMS arrived at the scene at 11:55 a.m., and note the claimant was confused and had slurring of speech. Although the claimant was transported to the ER, he left prior to being treated there. He was immediately taken to another facility and subsequently discharged from that there 3:49 p.m.

The claimant testified he returned to the second facility around 8:00 p.m. that same day, because blood was coming out of his right ear and he had been told by facility staff earlier that day to come back if this happened. Records regarding this visit reflect that the claimant noticed bloody discharge from his right ear approximately three hours before returning to the facility. Those records also note examination findings of a small contusion on his right eyebrow ridge, bloody discharge from the right ear, and a suggested right temporal bone fracture.

The ALJ determined that there was no credible evidence that the claimant had sustained an injury as a result of his fall, writing:

While it would not be uncommon for a fall to result in some type of damage or harm, EMS records do not indicate [the] [c]laimant had any visible abrasions, contusions, or bruising at the time he was transported to the hospital. The evidence presented fails to establish that [the] [c]laimant sustained damage or harm to the physical structure of his body in the fall of (date of injury).

The Appeals Panel disagreed.

The Appeals Panel noted that an ALJ is the sole judge of the weight and credibility of the evidence and, as the trier of fact, is responsible for resolving the conflicts and inconsistencies in the evidence. The Appeals Panel will not disturb challenged factual findings of an ALJ absent legal error, unless they are so against the great weight and preponderance of the evidence as to be clearly wrong or manifestly unjust. In this case, the Appeals Panel found the evidence of a compensable injury to so preponderate.

It is undisputed that the claimant struck the right side of his head on the pavement when he fell to the ground. Although the ALJ is correct in stating that the EMS records do not indicate the claimant had any visible abrasions, contusions, or bruising at the time he was transported to the hospital, medical records in evidence dated (date of injury), the date of injury, 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. There was no evidence of an intervening injury.
Accordingly, the Appeals Panel reversed the ALJ’s determination that the claimant did not sustain a compensable injury and rendered a new decision that the claimant did sustain a compensable injury on the date of injury.