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Is unexplained fall at work eligible for comp benefits?

On the way to her office, a woman fell down stairs at work. No one knows why she fell, including two witnesses. Is she eligible for workers’ comp benefits?

Helen Rodriguez worked as a special events coordinator for the City of Brighton, CO. On Jan. 8, 2009, she stopped at the top of a stairway on the way to her office to talk to two co-workers. After talking, she walked down a few steps and then tumbled forward, hit her head and lost consciousness.

Rodriguez suffered head, neck and back injuries, and doesn’t remember how she fell. The two co-workers could recount the fall, but they had no idea what may have caused her to fall.

Twenty days after her fall, the City filed an admission of liability. However, almost two years later, the City sought to withdraw the admission entirely, saying Rodriguez’s fall didn’t arise out of her employment. The City argued her fall was either caused by dizziness from brain aneurysms which were found while Rodriguez was hospitalized, or it was unexplained. None of the four aneurysms had ruptured at the time of her fall, and she had no previous symptoms.

The case went to an administrative law judge (ALJ) who heard medical testimony from three doctors. Two said Rodriguez’s brain aneurysms weren’t the cause of her fall; one said the aneurysms were most likely the cause although he couldn’t state this conclusion with a reasonable degree of medical probability. The ALJ weighed the medical testimony and concluded Rodriguez’s fall was unexplained and therefore she wasn’t eligible for workers’ comp because she failed to show her injury arose out of her employment. The Industrial Claims Appeals Office (ICAO) affirmed the decision.

The Colorado Court of Appeals overturned the ICAO’s order. The court’s reasoning: Since it had initially admitted liability for her fall, the City now had to prove Rodriguez’s injuries didn’t arise out of her employment. Since the ALJ found her fall was unexplained, the city failed to prove its case and Rodriguez deserved workers’ comp benefits.

The case then went to the Colorado Supreme Court.

Appeals court’s reasoning wrong, but …

This is one of those cases in which a state’s highest court upheld a lower court ruling, but for an entirely different reason than what was stated by the lower court.

In its written opinion, the high court noted all risks that cause injury to employees can be placed into one of three categories:

  1. Employment risks directly tied to the work itself. Examples: a gas explosion that burns a worker; breakdown of an industrial machine that causes a finger amputation. These are eligible for workers’ comp benefits.
  2. Personal risks. Examples: a preexisting medical condition that’s completely unrelated to work, such as fainting spells, heart disease or epilepsy. These are generally not eligible for workers’ comp benefits.
  3. Neutral risks, which are neither employment-related nor personal. Examples: employee killed by car thieves on the way back from an employment errand; a farm worker is killed by a lightning strike while tending to livestock; employee was murdered in a random act by a mentally disturbed person. These are potentially eligible for workers’ comp benefits.

When are neutral risks eligible for comp? In Colorado, injuries from neutral risks arise out of employment when they wouldn’t have occurred “but for” the conditions of employment. In other words, the employment contributed to the injury because it obligated the employee to engage in work functions at the time of the injury. This is known as the “but for” test.

When it comes to falls, if the cause is truly unknown, that’s a neutral risk, so the “but for” test must be applied. If the resulting injury arises out of employment because it wouldn’t have occurred but for the obligations of employment that placed the employee where he or she was injured, then the employee is eligible for workers’ comp.

Regarding this case, the court wrote:

“Because Rodriguez’s fall would not have occurred but for the fact that the conditions and obligations of her employment — namely, walking to her office during her work day — placed her on the stairs where she fell, her injury ‘arose out of’ employment and is compensable.”

The Colorado Supreme Court noted in its opinion that the “but for” test appears to be the approach taken by the majority of states that have addressed unexplained falls.

What do you think about this case? Let us know in the comments.

(City of Brighton v. Rodriguez, CO Supreme Court, No. 12SC737, 2/3/14)

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  1. But a lady pulling her car off of work property gets unemployment because the tail end of her car was still in the driveway? More proof that there is no consistency in laws or the way they are applied….

  2. “But for…” her walking on stairs… I thought you did that during the normal course of living?? Maybe I’m wrong. Its not like she fell from a ladder on the side of a tank which would be an unusual situation. Again I’m amazed the decisions judges make regarding occupational injuries. And if the attorneys don’t get the decision they like, they just keep moving up the appeals ladder until they find a panel of judges that rule in their favor… An employer has to find a procedural problem to appeal to a higher judicial body.

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