GQ Corner

Q. Claimant reached above head to get a small item, placed it into a box and then took a couple of steps when she felt a pop in her left hip which “took her breath away.” Is merely stepping considered injurious activity, and would this be a compensable injury?

A. This is known as an “idiopathic” injury in WC law, even though that is a misnomer since idiopathic means without a known cause, and in this case there does appear to be a cause for her hip injury. 

The issue of whether merely stepping is considered injurious activity and whether it constitutes a compensable injury has been addressed by the Appeals Panel in cases such as APD 070284-s. These decisions hold that as long as a claimant can demonstrate they suffered harm while in the course and scope of their employment, there is no additional requirement to prove a specific motion such as a pivot, twist, or turn. Notably, this decision cited a 2004 decision, APD 042641, involving the State Office of Risk Management (SORM) and a State of Texas employee. However, SORM appealed this and it resulted in the decision Lyons v. State Office of Risk Management, 2009 WL 2596053 (Tex. App. – Corpus Christi 2009, no pet.).

As they often do, the Appeals Panel in APD 042641 failed to conduct the necessary analysis and merely referenced prior rulings, leading to an erroneous factual rendition. SORM appealed and persuaded a jury that the injury was not compensable. The court of appeals upheld the jury’s decision, indicating that the jury acted appropriately. SORM had offered expert medical opinion indicating that Lyons’s injury was a neuropathic stress fracture caused by pre-existing diabetes, not his employment. The court said: “The critical determination the jury had to make was whether Lyons’s fracture was a Jones fracture or a neuropathic stress fracture.”

So as long as your claimant can prove she sustained damage/harm to the physical structure of the body, and that it was related to an incident occurring in the course and scope of her employment, she can potentially prove that her injury is compensable. However, this case underscores the importance of a robust defense and peer review when a claimant presents a plausible mechanism of injury causation. That is, while a claimant may establish compensability if they demonstrate injury related to their employment, to do so the claimant must provide the proper diagnosis and demonstrate that the mechanism of injury aligns with the actual injury.