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What does “definite proof” mean for workers’ compensation cases?

Every state has laws that protect workers who are injured while on-the-job by providing benefits through the workers’ compensation system. Every once in a while, a case comes along that challenges some relatively foundational points within these laws.

In a recent example, a case out of Maryland challenged the use of a specific legal phrase in the state’s Workers’ Compensation Act. The phrase at issue is part of the law that calls on employers to provide compensation to workers who suffer a work-related hernia if the worker can provide “definite proof” they did not already have the hernia from a prior injury.

What is “definite proof” for hernia cases?

The case, United Parcel Service, et al. v. David Strothers, involved a worker who had a prior history of hernias. He filed a claim stating that he suffered a new hernia from a work related accident. The Maryland Workers’ Compensation Commission agreed with the worker, stating the worker should receive coverage because he had satisfied the following three requirements:

  • Accidental injury suffered at work;
  • Hernia was the result of that injury; and
  • Hernia resulted in total disability.

The workers’ compensation insurance provider disagreed. They stated that the worker should not receive coverage because the worker had not met the required “definite proof” to establish the injury was not the result of a previously existing hernia. The insurance company first took the case to a circuit court, which ruled in favor of the worker, and appealed the lower court’s decision to the Court of Appeals of Maryland.

The Court of Appeals of Maryland recognized that the phrase could apply in two different ways. The law could either refer to the quality of evidence the injured worker should provide or the burden of proof the injured worker needs to meet to establish their claim. They state the correct focus is the quality of evidence. In this case, the worker’s medical expert provided a clear opinion as to causation with a work related incident.

The court also provides some important clarification on the burden of proof. They state that the worker must meet a “preponderance of the evidence” burden. This means that when taking all the evidence into account it is most likely the worker suffered a workplace injury. This is the lowest possible standard used by courts in the state. The insurance provider was pushing the court to instead use the highest standard, “clear and convincing”, which requires the worker establish that their injury occurred while at work “beyond a reasonable doubt.”

What does this mean for my workers’ compensation case?

The case is a win for those who are injured while on the job because the court did not raise the standard that the worker needs to meet when trying to prove their case. The case also highlights the role of expert medical opinions, as they serve as an important piece of evidence reviewed by the court in making their decision.

  • AABA