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Court of Appeals Affirms Denial of Compensability Under Personal Risks Doctrine

The Court of Appeals recently affirmed an Administrative Law Judge’s denial of compensability for an arm injury under the “idiopathic injury” theory. Duran v. Industrial Claim Appeals Office, ___ P3d ____ (Colo. App. 2015)(14CA0425, March 26, 2015). In Duran, the claimant sustained a fractured arm while unhooking his seat belt while on a work errand. Medical evidence established that the arm had fractured due to a destructive lesion in the proximal humerus that had eroded the bone. The Administrative Law Judge denied the claim for compensation, finding that the fracture of claimant’s arm was the natural and proximate result of the progression of his preexisting multiple myeloma uninfluenced by any work activity at that time. The claimant appealed to the ICAO, which affirmed the decision of the Administrative Law Judge. The claimant then appealed to the Court of Appeals.

The Court of Appeals started its analysis by citing the recent Supreme Court case of City of Brighton v. Rodriguez, 318 P.3d 496 (Colo. 2014), analyzing unexplained falls (click here to see the blog entry regarding that case). In Brighton, the Supreme Court noted that all risks that cause injury to employees can be placed within three well-established, overarching categories: (1) employment risks, which are directly tied to the work itself; (2) personal risks, which are inherently personal or private to the employee him- or herself; and (3) neutral risks, which are neither employment related nor personal. The Court of Appeals in Duran noted that the claimant’s injury to his arm would fall under the “personal risk” category, also known as a pre-existing idiopathic disease or condition. For such conditions, the resulting disability is compensable only if the conditions or circumstances of employment have contributed to the accident or to the injuries sustained by the employee.

In denying compensability of the injury, the Administrative Law Judge relied upon the opinion of employer’s expert in determining that “the bone fractured of its own accord without regard to the claimant’s actions at the time.” The claimant contended that the act of reaching back to unhook the seat belt caused the fracture, and that, therefore, the injury should have been compensable. However, the Court of Appeals concluded that “the direct relationship that must exist between a precipitating event and the resulting disability requires that the precipitating event play more than an insignificant role in the occurrence of the injury.” Thus, the Court of Appeals concluded that “although the routine act of reaching back for a seatbelt constituted the last, immediate event before the fracture, the ALJ was not legally compelled to find that it was a proximate cause of the fracture.”

The claimant argued that the case of H & H Warehouse v. Vicory, 805 P.2d 1167 (Colo. App. 1990), compelled a finding that the arm fracture was compensable. In Vicory, the claimant fractured his arm when he moved his arm “hastily” after a door opened unexpectedly at work and startled him. The arm had a previously undetected cancerous growth that had weakened the humerus bone. The claimant presented evidence that his rapid arm movement in response to the opening door had caused the bone to fracture, and the Administrative Law Judge determined that the fractured humerus resulted from a combination of abnormal motion in response to a startling stimulus, and the preexisting weakness in the bone caused by the cancer. The Court of Appeals in Duran differentiated Vicory primarily because Duran’s activities were no more than an insignificant role int eh occurrence of the injury.

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