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How often have you heard, “I don’t know why I fell?” Quite often, claimants will be unable to explain how the accident occurred but they will file for workers’ compensation benefits because the injury occurred at the workplace. These situations are known as unexplained accident claims and they can be difficult to navigate because the claimant has suffered an injury, which occurred in the course of her employment, but she can provide no explanation of how the accident occurred.
In Virginia, it is the claimant’s burden to show that there is a causal connection between the injury and her employment. This properly places the burden on the claimant to show a link between the accident and a condition of her workplace. Consequently, the accident which cannot be explained fails to establish the necessary link between the workplace conditions and the injury, resulting in non-compensable injury.
So why then are claimants sometimes awarded benefits when they cannot explain how the accident occurred? This is because the law allows for circumstantial evidence to “explain” the details which the claimant is unable to recall. If the adjudicator can reasonably infer from the evidence presented that a condition of the claimant’s workplace caused her injury, then she will be awarded benefits even if she cannot state exactly what happened. (City of Waynesboro v. Griffin, 51 Va. App. 308, 657 S.E.2d 782, 2008 Va. App. LEXIS 102).
For example, in Basement Waterproofing v. Beland, 43 Va. App. 352, 597 S.E.2d 286 (2004), the claimant testified that, although he did not know how the accident occurred, he was working on a ladder, holding a 20-30lb bucket of tar in one hand, and immediately prior to the fall, he was reaching to where he needed to apply the tar. The Court of Appeals held, “although the claimant did not recall the specific moment of falling, he described his actions and locations, immediately before the fall in detail... [this] created the critical link between the claimant’s employment, his fall, and his injury.”
By way of contrast, in Pya/Monarch & Reliance Ins. Co. v. Harris, 22 Va. App. 215, 468 S.E.2d 688, 1996 Va. App. LEXIS 221, the Court of Appeals denied benefits to the claimant. In this case, the claimant fell from his truck cabin after he stopped to make a delivery. There were no witnesses to the fall and the claimant testified that he could only remember reaching for the truck’s grab bar and then waking up on the ground. Additionally, evidence was presented that the truck cabin was covered in ice and that the cabin was approximately seven feet off of the ground. Specifically, the Court noted that the claimant never testified that he slipped on ice or lost his grip on the grab bar. The Court denied benefits stating that “the mere fact that the truck cab was icy or that the cab was seven feet from the ground is insufficient to establish the basis for the fall.”
The facts from Beland create a clear timeline of events, and invited adjudicator to insert the last piece of the puzzle to complete the picture, and, explain the accident. The evidence in Pya/Monarch, on the other hand, provides isolated details and forced the adjudicator to speculate, or guess, at what occurred. The claimant’s fall was determined to be non-compensable because the circumstantial evidence did not explain the accident in the absence of the claimant’s memory of the event.
When you hear “I don’t know how it happened” start to look for an answer to the question “is there a reasonable explanation for what happened?” The compensability of an unexplained accident depends on if the circumstantial evidence can “explain” the accident in the absence of the claimant’s memory of the event.
