Common Sense “Prevails” In Work Comp At Supreme Court

The Missouri Supreme Court recently reviewed what a “prevailing factor” means in a workers compensation case and struck a major blow for common sense and grammar.

What Does Prevailing Factor Mean?

Work Comp Prevailing Factor

In order to win a Missouri Work Comp Case, an employee’s lawyers must prove that he or she was involved in an “accident” that was the “prevailing factor” causing an injury that arose out of and in the course of employment.

The Court tells us that a “prevailing factor” is “the primary factor, in relation to any other factor, causing both the resulting medical condition and disability.”  Basically, this means that a “Prevailing Factor” exists when the work activity was the primary cause of the employee’s injury.  Notably, an accident that simply causes a pre-existing injury to flare up or become symptomatic is not covered by the Missouri Work Act because the work incident is the the “prevailing factor” in causing the injury in the first place.  Insurance companies consistently argue that every injury is pre-existing, and it is one of the biggest fights that the work comp lawyers at BiState have on every case.  Importantly, if you cannot prove “prevailing factor” then you lose your work comp case.

Expert Opinions To Prove Prevailing Factor

One way that lawyers prove the prevailing factor standard is to use expert opinions.  In fact, experts are often required to prove issues in Missouri work comp cases, especially in cases involving complex medical questions.  “Medical causation, which is not within common knowledge or experience, must be established by scientific or medical evidence showing the relationship between the complained of condition and the asserted cause.” Gordon v. City of Ellisville, 268 S.W.3d 454, 461 (Mo. App. 2008).

In Ronald Malam vs. Missouri Department of Corrections, a prison guard was injured when restraining an inmate.  Specifically, he suffered a “hypertensive crisis” or cardiac incident and was in the hospital for a week.  The prison’s insurance company rejected the employee’s work comp claim, arguing that the heart condition was pre-existing and not compensable under the Missouri Worker’s Compensation Act.

To help prove the prevailing factor standard and defeat the insurance company’s pre-existing argument, the employee hired a doctor to serve as his expert.  The doctor opined that “the direct, proximate and prevailing factor precipitating [the employee’s] hypertensive crisis.”  Based on the language of the prevailing factor standard, it seems the doctor used all of the correct magic language to prove the employee’s claim.  However, the work comp judge disagreed.  He thought that the doctor must use the phrase “prevailing factor” rather than “prevailing factor precipitating,” and found the employee had not proven the prevailing factor standard.  The work comp judge threw out the injured employee’s claim, even though the insurance company did not have an expert.

Common Sense in Missouri Work Comp

The Missouri Supreme Court reviewed the work comp judge’s decision and disagreed.  The Court stressed that the employee’s doctor performed a full examination of the injured worker, reviewed all of the medical records, and submitted a valid report detailing his findings.  Importantly, “the words a medical expert uses . . . are often important, not so much in and of themselves, but as a reflection of what impression such witness wishes to impart.” Mayfield v. Brown Shoe Co., 941 S.W.2d 31, 36 (Mo. App. 1997). This means that even though the magic language is important, work comp judges should not emphasize formality over valid expert opinions.  The Supreme Court reversed the opinion and sent the case back down to the work comp judge to be ruled on again.

The result of this case is extremely important on two fronts: 1.) common sense does have a place in workers compensation law (though that is still debated); and 2.) the use of “magic language” is required and crucial to proving and winning your Missouri work comp case.

If you have questions about the necessary magic language in your work comp case, or you want to know how to win your Missouri Workers Compensation claim, contact the BiState Law Center at (888) 519-2215.