Legal Test for Workers' Compensation

Facts of the Case

In 2012, Agnes Cramer, a dietary manager for nursing care facility Transitional Health Services of Wayne, was standing on a ladder and wiping a light fixture with a damp rag when she sustained an electric shock. She fell off of the ladder, injuring her right shoulder. She went to the emergency department and was cleared to return to work two days later. But, on doing so, she felt dizzy and disoriented, left, and never returned to work after this. She presented to her primary care physician, now reporting having struck her head during the fall and having sustained a loss of consciousness. A concussion was diagnosed, and she was referred to a neurologist. Over time, new symptoms developed, including inability to walk and non-epileptic seizures. She attributed all of these to having been near-fatally “electrocuted” during the workplace incident. She began to have flashbacks when exposed to thunder and lightning, loud noises, or flashing lights. A neurologist and a psychologist both diagnosed conversion disorder and posttraumatic stress disorder (PTSD), each of which were opined to have been caused or significantly aggravated by the workplace accident.

Ms. Cramer petitioned for workers’ compensation benefits for both her physical and mental injuries. A hearing before a magistrate judge included testimony by Ms. Cramer and her treating clinicians. In contrast, a neuropsychologist retained by the defense opined that her conversion non-epileptic seizures were not attributable to her relatively minor workplace accident and that she had experienced preexisting “weaknesses in [her] personality” dating back to adolescence (Cramer, p 35). A neurologist retained by the defense reached a similar conclusion, diagnosing non-epileptic seizures, but expressing skepticism at Ms. Cramer’s “convenient” later self-reporting of symptoms that did not comport with contemporaneous medical records. Further, Ms. Cramer testified at the hearing to having been physically and emotionally abused by her first husband and, on having divorced him six years prior to her injury, rejected by her family, friends, and church community and also having lost custody of her children. No evidence was presented at the hearing that Ms. Cramer, prior to her workplace injury, had ever experienced neurologic or conversion symptoms.

The magistrate denied Ms. Cramer’s claim, opining that she had failed to meet her burden of proof that her employment had “contributed to or aggravated or accelerated” her mental injuries “in a significant” manner, as required by the Michigan state legislature in the WCDA (Cramer, p 35). In doing so, the magistrate applied a four-factor test laid out over 20 years earlier in Martin v. Pontiac Sch. Distr., 645 N.W.2d 665 (Mich. 2002) with regard to whether the occupational contributors were significant: the number of occupational and nonoccupational contributors, the relative amount of each contributor, the duration of each contributor, and the extent of permanent effect from each contributor.

In Ms. Cramer’s case, there were several longstanding, nonoccupational contributors but only a single occupational contributor of contested importance. None of the expert witnesses testifying on behalf of Ms. Cramer had established a hierarchy of importance with regard to the nonoccupational versus occupational stressors. The magistrate also determined that Ms. Cramer was physically disabled from her shoulder injury, but he denied wage-loss benefits because she had not submitted evidence of having made good-faith efforts to secure other employment.

Ms. Cramer appealed her case to the Michigan Compensation Appellate Commission, which reversed the magistrate’s denial of wage loss benefits for her shoulder injury but affirmed the magistrate’s denial of benefits for mental injuries, saying that the magistrate had properly applied the four Martin criteria. Ms. Cramer appealed to the Michigan Supreme Court. Ms. Cramer sought clarification as to whether the magistrate had properly applied the Martin test and also whether the Martin test itself was at odds with the principle that having a preexisting mental condition should not be a bar to being awarded workers’ compensation benefits.

Ruling and Reasoning

The Michigan Supreme Court vacated the magistrate’s findings, reversed the court of appeals judgment, and remanded the case. The court determined that Martin’s four-factor test, in place for over 20 years, was being routinely misapplied such that it required plaintiffs to meet a higher standard than what the state legislature had intended in the WCDA. The Martin test, originally intended to be a broad guide as to which factors should be considered in determining the extent to which a workplace injury had significantly contributed to a claimed disability, had “morphed into a straightjacket” (Cramer, p 29).

The WCDA states that mental disabilities and conditions of the aging process (even cardiovascular conditions and degenerative arthritis) remain compensable under workers’ compensation if they were contributed to, aggravated by, or accelerated by employment “in a significant manner” (Mich. Comp. Laws § 418.301(2)). Magistrate judges understandably struggled to determine how best to determine whether a work-related injury was “significant” enough to be compensated. The Michigan Supreme Court had defined several tests over the years, ultimately settling on the Martin four-question test described above. But, in most cases, there often was a single, brief, work-related incident versus a myriad of preinjury and postinjury nonworkplace situational and temperamental factors.

Ms. Cramer’s case offered one example of this dilemma. Her expert witnesses testified that her relatively minor work-related injury had “significantly” contributed to her having disabling PTSD and conversion disorder, but she also had several preexisting risk factors for these conditions, and her subjective perception of her injury did not comport with her actual injury. Further, her testifying doctors were unable to assign a relative weight to each factor. The court determined that, applying the Martin test, many magistrates over the years had simply added up the number of workplace factors and nonworkplace factors and asked which number was greater. This practice was inappropriate, given that there would almost always be more nonworkplace-related factors. Further, the WCDA’s emphasis was simply on whether a work-related injury had affected an individual’s mental or physical disability in “a significant manner,” not in “the most significant manner” (Cramer, p 50).

The court clarified the standard, stemming from Farrington v. Total Petroleum, Inc, 501 N.W.2d 76 (Mich. 1993). Under the Farrington test, the claimant must show that the health injury was significantly caused or aggravated by employment, considering the totality of all occupational and nonoccupational factors. Occupational factors must include consideration of the temporal proximity of the health problem to the work experience, the physical stress to which the claimant was subjected, the conditions of employment, and the repeated return to work after each instance of a health problem. In applying this Farrington test, the four Martin factors may still be relevant in considering the totality of the circumstances, but only as part of the inquiry, not the whole inquiry. The court did not address whether Ms. Cramer met her burden under the Farrington standard.

Dissent

The dissent argued that there was no evidence that Martin was, in fact, routinely being misapplied by magistrates. It also said that the Martin test had always allowed for consideration of all (or even more) of the factors in the court’s newly proposed Farrington test.