Workers’ Compensation Claims in DC

What Are Workers’ Compensation Claims?

Compensation Under Workers’ Compensation Act

“To be compensable under the Workers' Compensation Act, an injury must aris[e] out of and in the course of employment. The requirement that an injury arise out of employment refers to the origin or cause of the injury.” (See Gaines v. D.C. Dep't of Emp't Servs. (2019) 210 A.3d 767, 771; Gaines v. D.C. Dep't of Emp't Servs. (2019) 210 A.3d 767, 770-71; Bentt v. District of Columbia Dep't of Emp't Servs. (2009) 979 A.2d 1226, 1232; D.C. Code § 32-1501(12).)

“[R]isks causing injury to a claimant can be brought within three categories: risks distinctly associated with the employment, risks personal to the claimant, and ‘neutral’ risks[ -- ]i.e. , risks having no particular employment or personal character. Harms from the first are universally compensable. Those from the second are universally noncompensable.” (See id.)

“To determine whether harm from an injury caused by a neutral risk arises out of one's employment, this court has adopted the positional-risk test. Under the positional-risk test, an injury arises out of employment so long as it would not have happened but for the fact that conditions and obligations of the employment placed claimant in a position where he [or she] was injured.” (See id.)

“The positional-risk test is a ‘liberal’ standard which obviates any requirement of employer fault or of a causal relationship between the nature of the employment and the risk of injury. Nor need the employee be engaged at the time of the injury in activity of benefit to the employer.” (See id; Clark v. District of Columbia Dep't of Emp't Servs. (2000) 743 A.2d 722, 727.)

Court’s Determination of Whether an Injury Arose out of the Course of Employment

“We determine whether an injury arose in the course of employment on the basis of the time, place[,] and circumstances under which the injury occurred.” (See Gaines v. D.C. Dep't of Emp't Servs. (2019) 210 A.3d 767, 771; Bentt v. Dept. of Employment (2009) 979 A.2d 1226, 1234.)

“[A]n accident occurs ‘in the course of employment’ when it takes place within the period of employment, at a place where the employee may reasonably be expected to be, and while he or she is reasonably fulfilling duties of his or her employment or doing something reasonably incidental thereto.” (See id.)

“Injuries that occur outside the precise hours of employment may in certain circumstances be deemed to have occurred in the course of employment, if they occur during a reasonable and foreseeable activity that is reasonably related to or incidental to [the] employment or [that] resulted from a risk created by [the] employment.” (See id; Vieira v. District of Columbia Dep't of Emp't Servs. (1998) 721 A.2d 579, 583.)

“Although ‘arising out’ of employment and ‘arising in the course of’ employment are distinct concepts, the two are not totally independent; frequently proof of one will incidentally tend to establish the other.” (See id; Kolson v. Dept. of Employment Services (1997) 699 A.2d 357, 360.)

“Moreover, when it is established that an injury or death occurs in the ‘course of employment,’ that fact strengthens the presumption that it ‘arises out of the employment,[’] and any doubts as to that fact should be resolved in the claimant's favor.” (See Gaines v. D.C. Dep't of Emp't Servs. (2019) 210 A.3d 767, 771.)

Prima Facie Case for Workers’ Compensation Claims

“The purpose of the claimant's initial showing at the presumption stage is to ensure that there is a causal connection between the disability and the employer, so that the claim is appropriately adjudicated as a workers' compensation case.” (See Storey v. Dist. of Columbia Dep't of Emp't Servs. (2017) 162 A.3d 793, 804-05; Ferreira v. D.C. Dept. of Empl. Services (1987) 531 A.2d 651 [the purpose of the Workers' Compensation Act was so that employees and employers can both gain by a system in which common law tort remedies were discarded].)

“Once we are satisfied that there is a prima facie causal connection between the injury and employment, however, the burden of proof is on the employer to rebut the presumption that the injury falls within the purview of the Act through ‘substantial evidence.’” (See Storey v. Dist. of Columbia Dep't of Emp't Servs. (2017) 162 A.3d 793, 804-05; McNeal v. Employment Services (2007) 917 A.2d 652, 656 [explaining employer's burden].)

“Only if the employer is able to rebut the presumption of compensability, will the burden turn once again to the employee to prove his or her claim, and it is only at this stage that the ALJ is able to make assessments of credibility.” (See Storey v. Dist. of Columbia Dep't of Emp't Servs. (2017) 162 A.3d 793, 804-05; see, e.g., McGahuey v. Whitestone Logging, Inc. (2011) 262 P.3d 613, 621.)

Burden of Production for Workers’ Compensation Claims

“We have noted that, in the workers' compensation realm, the burden of production may shift once the moving party establishes his case.” (See Ross v. Dist. of Columbia Dep't of Emp't Servs. (2015) 125 A.3d 698, 703.)

“Additionally, burden-shifting frameworks similar to Mahoney have been approved by this court in other contexts that place the initial burden of production on the movant.” (See id; see, e.g., Gatewood v. District of Columbia Water & Sewer Auth. (2013) 82 A.3d 41, 51–52 & nn. 59–60 [discussing the burden-shifting framework for adjudicating disputes with the water authority wherein a customer has the initial burden of proof]; Nader v. de Toledano (1979) 408 A.2d 31, 48 [explaining burden-shifting in the context of a motion for summary judgment].)

Legal Precedents and Case Law on Workers’ Compensation Claims

It is well settled that “Workers' compensation statutes are remedial in character and are generally construed liberally in favor of claimants.” (See Marsden v. District of Columbia (2016) 142 A.3d 525, 529; Gaines v. D.C. Dep't of Emp't Servs. (2019) 210 A.3d 767, 770.)

It is also well settled that “[t]he Workers' Compensation Act provides a comprehensive plan for compensating private sector employees for their work-related injuries. It makes the employer liable without fault if the employee's occupational injury or death falls within the scope of the Act. However, this liability on the part of the employer is exclusive; accordingly, the employee cannot seek any other remedy against the employer for such injury.” (See Wright v. Dept. of Empl. Serv (2007) 924 A.2d 284, 286; See D.C. Code § 32-1503(b); D.C. Code § 32-1504(a).)

“Although in earlier years the Act was largely applied to physical injuries and any consequential mental condition arising therefrom, it is now settled that, in appropriate circumstances, an emotional injury alone may be compensable under the Act.” (See Wright v. Dept. of Empl. Serv (2007) 924 A.2d 284, 286; Gary v. District of Columbia Dep't of Employment Servs. (1998) 723 A.2d 1205, 1208.)

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