SUPREME COURT OF MISSOURI

en banc

LUCILLE SCHOEN, ) 

) 

Appellant, ) 

) 

v. ) No. SC98168 

) 

MID-MISSOURI MENTAL ) 

HEALTH CENTER, ) 

) 

and ) 

) 

TREASURER OF THE STATE OF ) 

MISSOURI – CUSTODIAN OF THE ) 

SECOND INJURY FUND, ) 

) 

Respondents. )

APPEAL FROM THE MISSOURI LABOR AND 

INDUSTRIAL RELATIONS COMMISSION 

Lucille Schoen (hereinafter, “Employee”) appeals from the Labor and Industrial 

Relations Commission’s (hereinafter, “the Commission”) decision denying her workers’ 

compensation benefits because she failed to prove her work injury was the prevailing or 

primary factor causing any permanent disability. Employee also claims the 

Commission’s finding denying her claim against the Second Injury Fund (hereinafter, 

“Fund”) as moot was erroneous. Employee asserts the Commission misapplied the law 

Opinion issued April 14, 2020
2

and its award was contrary to the evidence presented. The Commission’s decision is 

affirmed.1

Procedural and Factual Background

On May 8, 2009, Employee was exposed to cypermethrin, an insecticide, while 

working as a charge nurse at Mid-Missouri Mental Health Center (hereinafter, 

“Employer”). Employee complained of throat and eye irritation; she also began coughing 

and wheezing. Employer sent her to the emergency room on May 11, 2009. Employee 

was prescribed medication and returned to work without any limitations. 

Employee continued to complain, and Employer sent her to Dr. Eddie Runde 

(hereinafter, “Dr. Runde”) for further evaluation. While at Dr. Runde’s office, another 

patient had a dog in the office. Employee was being escorted for pulmonary function 

testing when the dog got loose. Dr. Runde attempted to divert the dog from Employee’s 

path, but he accidently tripped Employee. Employee fell and claimed she sustained 

permanent injuries to her knees, lower back, hip, and neck.

After falling, Dr. Runde completed Employee’s evaluation and released her to 

regular work duty without restrictions. Dr. Runde also opined he expected no permanent 

disability due to Employee’s exposure to cypermethrin. 

On June 10, 2009, Employee was evaluated by Dr. Lawrence Lampton 

(hereinafter, “Dr. Lampton”) for her respiratory symptoms. Dr. Lampton concluded 

Employee’s respiration issues were likely related to allergies or possibly asthma. 

 1 This Court has jurisdiction under article V, section 10, of the Missouri Constitution

because it granted transfer after opinion by the court of appeals.
3

Following a pulmonary functions test, Dr. Lampton determined Employee was within 

normal limits. 

Employer requested Employee obtain an independent medical examination by 

Dr. Thomas Hyers (hereinafter, “Dr. Hyers”). Dr. Hyers assessed Employee had 

transient bronchitis and upper airway irritation. He opined these conditions were not 

chronic or permanent. Dr. Hyers also assured Employee she would not develop chronic 

asthma as a result of her cypermethrin exposure. Dr. Hyers placed Employee at 

maximum medical improvement and assessed no permanent disability. 

Employee underwent additional treatment due to her alleged injuries sustained 

after being tripped accidently in Dr. Runde’s office.2

 Employee requested Dr. David T. 

Volarich (hereinafter, “Dr. Volarich”) evaluate her. Dr. Volarich took Employee’s 

history, reviewed her medical records, and performed a physical evaluation. Dr. Volarich 

diagnosed Employee with upper airway and pulmonary irritation with a residual nonproductive cough. He determined based upon the cypermethrin exposure, Employee had 

a five percent permanent partial disability rating of the body as a whole. Dr. Volarich 

provided additional diagnoses and ratings connected to her accidental tripping at 

Dr. Runde’s office.

Employee sought workers’ compensation benefits for her exposure to 

cypermethrin. Employee then filed an amended claim for workers’ compensation, 

 2 The issue in this appeal is whether Employee’s accidental tripping arose out of and in 

the course of her employment. Accordingly, there is no need to engage in a recitation of 

Employee’s alleged injuries resulting from being tripped.
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asserting, in addition to cypermethrin exposure, Employee sustained injuries from being

tripped while walking out of Dr. Runde’s office after an examination. 

An administrative law judge (hereinafter, “ALJ”) awarded Employee benefits for 

her exposure to cypermethrin and her injuries from being tripped accidently at 

Dr. Runde’s office because it was the “natural and probable consequence of” the 

cypermethrin exposure. Employer appealed this decision to the Commission.

The Commission reversed the ALJ’s decision and award. The Commission found 

Employee failed to meet her burden of proving her cypermethrin exposure was the 

prevailing or primary factor in causing any alleged injury from being tripped accidently 

at Dr. Runde’s office. Employee appeals the Commission’s decision regarding the denial 

of benefits for injuries arising from being tripped accidentally.

Standard of Review

“This Court may modify, reverse, remand, or set aside the Commission’s decision 

only when: (1) the Commission acted ultra vires; (2) the decision was procured 

fraudulently; (3) the facts found by the Commission do not support the award; (4) there 

was not sufficient competent evidence to support the award.” Mantia v. Mo. Dep’t of 

Transp., 529 S.W.3d 804, 808 (Mo. banc 2017); section 287.495.1.3

 The whole record 

must be examined to determine whether there is sufficient and competent evidence to 

support the Commission’s decision. Hampton v. Big Boy Steel Erection, 121 S.W.3d 

 3 This statutory reference is to RSMo 2000. All other statutory references are to RSMo 

Supp. 2008.
5

220, 222-23 (Mo. banc 2003). Questions of law are reviewed de novo. Cosby v. 

Treasurer of State, 579 S.W.3d 202, 206 (Mo. banc 2019).

Analysis

Employee challenges the Commission’s denial of compensation benefits for

injuries she sustained after being tripped accidently at Dr. Runde’s office.

4

 Employee 

believes she presented sufficient causation demonstrating any injury from being 

accidently tripped arose from her employment. Employee also contests the 

Commission’s denial of Fund compensation as moot. 

Missouri’s Workers’ Compensation Law (hereinafter, “the Act”) provides an 

injury “by accident is compensable only if the accident was the prevailing factor in 

causing both the medical condition and disability.” Section 287.020.3(1). An injury 

must arise “out of and in the course of employment.” Id.

An injury shall be deemed to arise out of and in the course of employment 

only if:

(a) It is reasonably apparent, upon consideration of all the 

circumstances, that the accident is the prevailing factor in causing 

the injury; and 

(b) It does not come from a hazard or risk unrelated to the employment 

to which workers would have been equally exposed outside of and 

unrelated to the employment in normal nonemployment life.

 4 Employee does not challenge the denial of benefits related to her cypermethrin 

exposure.
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Section 287.020.3(2)(a)-(b). A claimant has the burden of demonstrating a causal 

connection between the injury and the work activity. Johme v. St. John’s Mercy 

Healthcare, 366 S.W.3d 504, 509-10 (Mo. banc 2012).

Employee argues her accidental tripping injuries were the “natural and legitimate 

consequent” of her cypermethrin exposure. Employee claims this Court should 

implement a broader application of the natural consequences doctrine to allow her to 

recover workers’ compensation benefits for her alleged injuries following her accidental 

tripping. 

However, Employee fails to acknowledge the Act’s 2005 amendment, which 

provided the Act’s “provisions are to be construed strictly and to require the evidence to 

be weighed impartially without giving any party the benefit of the doubt.” Miller v. Mo.

Highway & Transp. Comm’n, 287 S.W.3d 671, 673 (Mo. banc 2009); section 287.800.1. 

“For an injury to be deemed to arise out of and in the course of the employment under 

section 287.020.3(2)(b), the claimant employee must show a causal connection between 

the injury at issue and the employee’s work activity.” Johme, 366 S.W.3d at 510

(emphasis added). “An injury is not compensable because work was a triggering or 

precipitating factor.” Section 287.020.2.

Employee argues that but for her cypermethrin exposure she would not have been 

in Dr. Runde’s office and would not have been tripped accidently. Hence, Employee

asserts her accidental trip was a “natural and legitimate consequence” of her employment. 

Employee’s risk of being tripped accidently is a risk she equally is exposed to 

outside of her employment. Any of Employee’s injuries stemming from the accidental
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tripping did not occur because of a condition of her employment. See, e.g., Annayeva v. 

SAB of the TSD of the City of St. Louis, No. SC98122, __ S.W.3d __, *8 (Mo. banc 

March 17, 2020) (finding a teacher who slipped in the hallway of the school where she 

taught was not entitled to workers’ compensation benefits because she was unable to 

prove a causal connection with her employment); Johme, 366 S.W.3d at 510 (finding no 

compensable injury for an employee who was making coffee at work when she twisted 

her ankle because her injury did not arise out of her employment in that she was exposed 

equally to the chance of twisting her ankle outside of work); Miller, 287 S.W.3d at 674

(finding no compensable injury because, while the claimant’s injury occurred at work, 

walking was equally a risk of non-employment and there was “no causal connection of 

the work activity to the injury other than the fact of its occurrence while at work”).

5

Employee’s assertion of simple but-for causation is not sufficient to demonstrate a 

causal connection with her work. For her injury to arise out of and in the course of her 

employment, Employee must demonstrate the accident is a prevailing factor of the injury 

and is not a risk that the claimant would have been exposed outside of and unrelated to 

the employment. Section 287.020.3(2)(a)-(b). Employee is unable to demonstrate the 

risk of her accidental tripping was a risk she would not have been exposed to outside of 

her employment as required by section 287.020.3(2)(b). It is not enough for an injury to 

occur while an employee is doing something related to or incidental to work. Employee 

 5 Further, in Annayeva, Johme, and Miller, each claimant’s injury occurred while the

claimant was at work and each was denied compensation because the injury did not arise 

out of and in the course of employment. Employee’s claim is even more attenuated 

because she was not injured on the worksite. 
8

is not entitled to workers’ compensation benefits because this injury did not arise out of 

and in the course of her employment.

Further, Employee’s argument the Commission erred finding her claim against the 

Fund was moot is without merit. Section 287.220.2 imposes liability on the Fund in 

certain circumstances “for injuries arising out of or in the course of employment ... prior 

to January 1, 2014.” Cosby, 579 S.W.3d at 207. Employee seeks SIF compensation 

based upon her belief the accidental tripping arose out of her employment. Because 

Employee’s accidental tripping did not arise out of and in the course of her employment, 

the Fund is not implicated.

Conclusion

Employee is not entitled to workers’ compensation for any injury sustained from

her accidental tripping. The Commission did not err, and its decision is affirmed.

________________________________

GEORGE W. DRAPER III, CHIEF JUSTICE

All concur.