Source: http://www.law.cornell.edu/supremecourt/text/455/608
Timestamp: 2013-05-25 01:58:52
Document Index: 745206400

Matched Legal Cases: ['§ 20', '§ 20', 'art 2', '§ 20', 'art 2', '§ 12', '§ 12', 'art 2', '§ 20', '§ 12', '§ 702', '§ 702', '§ 702', '§ 702', '§ 20', '§ 20', '§ 78', '§ 43', '§ 6', '§ 29', '§ 725', '§ 10', '§ 12', '§ 12', '§ 12']

U. S. INDUSTRIES/FEDERAL SHEET METAL, INC., et al., Petitioners v. DIRECTOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS, UNITED STATES DEPARTMENT OF LABOR, et al. | Supreme Court | LII / Legal Information Institute
Supreme Court aboutsearch liibulletin subscribe previews U. S. INDUSTRIES/FEDERAL SHEET METAL, INC., et al., Petitioners v. DIRECTOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS, UNITED STATES DEPARTMENT OF LABOR, et al.
455 U.S. 608 (102 S.Ct. 1312, 71 L.Ed.2d 495)
Argued: Oct. 6, 1981.
[HTML] Syllabus Respondent Riley (hereafter respondent) awoke on the morning of November 20, 1975, with severe pains in his neck, shoulders, and arms. Subsequently, he filed a claim for disability benefits under the Longshoremen's and Harbor Workers' Compensation Act (Act), alleging that he suffered an accidental injury in the course of his employment on November 19, 1975, when he was lifting duct work and felt a sharp pain in his neck. The Administrative Law Judge found that the accident never occurred and denied the claim, and the Benefits Review Board affirmed. The Court of Appeals vacated the Board's decision, holding that respondent suffered an "injury" when he awakened in pain on November 20, and that under § 20(a) of the Actwhich provides that in any proceeding for the enforcement of a claim for compensation under the Act "it shall be presumed, in the absence of substantial evidence to the contrary . . . that the claim comes within the provisions of the Act"respondent was entitled to a presumption that the injury was "employment-bred."
§ 20(a) of the Longshoremen's and Harbor Workers' Compensation Act, 44 Stat. (part 2) p. 1436, 33 U.S.C. 920(a), and vacated the administrative denial of disability benefits. We granted certiorari, 450 U.S. 979, 101 S.Ct. 1512, 67 L.Ed.2d 813, and we now reverse.
Riley's retained counsel filed with the Deputy Commissioner a claim for compensation under the Act. See 33 U.S.C. 913. On standard form LS-203, in response to the direction to "describe in full how the accident occurred,"
Riley wrote that on November 19, 1975, he was "lifting duct work with co-worker, weighing approximately 500 pounds, felt sharp pain in neck and sat down." App. 111.
An evidentiary hearing was convened before an Administrative Law Judge. After construing the evidence in a light most favorable to Riley and resolving all doubts in his favor, the Administrative Law Judge found "that Claimant sustained no injury within the meaning of Sec. 2(2) of the Act on November 19, 1975, as alleged, and that Claimant and Sutherland Riley's co-worker gave false testimony as to the happening of the accident." App. to Pet. for Cert. 24A.
"The Act does not require that claimant prove an accident in order to establish a claim. To the contrary, compensation is payable under the Act if claimant is disabled because of injury which is causally related to his employment. 33 U.S.C. 902(10), 902(2)." 9 BRBS 936, 940 (1979) (emphasis in original).
Member Miller defined an injury as "something gone wrong within the human frame." Ibid. Riley suffered such an injury when he awoke on November 20 with severe pain. Therefore, Member Miller would have remanded the case for a determination of "the real issue in this case," which "is not whether claimant sustained an accident at work but whether claimant's injury is causally related to his employment." Ibid. That determination was to be made in light of the § 20(a) presumption, which "places the burden on employer to prove by substantial evidence that claimant's injury did not arise out of or in the course of employment." Ibid.
On Riley's petition for review, the Court of Appeals vacated the decision of the Benefits Review Board, agreeing with Member Miller's position. Riley v. U. S. Industries/Federal Sheet Metal, Inc., 200 U.S.App.D.C. 402, 627 F.2d 455 (1980). The court stated that "it can hardly be disputed that petitioner suffered an 'injury' when he awakened in pain on November 20, 1975." Id., at 405, 627 F.2d, at 458. The court then turned its "attention to the statutory presumption and the range of situations to which this Court has applied it." Ibid. It construed its earlier cases as holding "that an injury need not have occurred during working hours" and "need not be traceable to any particular work-related incident to be compensable." Id., at 405-406, 627 F.2d, at 458-459.
Section 20(a), 44 Stat. (part 2) 1436, provides that "in any proceeding for the enforcement of a claim for compensation under this Act it shall be presumed, in the absence of substantial evidence to the contrary . . . that the claim comes within the provisions of this Act." The coverage of the presumption is debatable,
but one thing is clear: the presumption applies to the claim. Even if a claimant has an unfettered right to amend his claim to conform to the proof, the presumption by its terms cannot apply to a claim that has never been made.
Section 13 of the Act, 33 U.S.C. 913, provides that a claimant must timely file a claim with the Deputy Commissioner. The content of the claim is not specified in that section. But § 12(b), 33 U.S.C. 912(b), requires that the claimant timely give the Deputy Commissioner and his employer notice of his injury, and provides further that "such notice . . . shall contain . . . a statement of the time, place, nature, and cause of the injury."
The claim, like the notice required by § 12 and like the pleadings required in any type of litigation, serves the purposes of notifying the adverse party of the allegations and of confining the issues to be tried and adjudicated.
In Riley's claim, he alleged that he he suffered an accidental injury in the course of his employment on November 19. No claim has ever been made that the "injury" occurred at home and that it was somehow "employment-bred." Even if such a vague claim stated a prima facie case of compensability, the statutory presumption does not require the administrative law judge to address and the employer to rebut every conceivable theory of recovery. At least when the claimant is represented by counsel,
as Riley was, there is no reason to depart from the specific statutory direction that a claim be made and that the presumption, however construed, attach to the claim.
Section 3(a) provides that "compensation shall be payable under this Act in respect of disability . . . of an employee, but only if the disability . . . results from an injury." 44 Stat. (part 2) 1426, as amended, 33 U.S.C. 903(a). Injury is defined as an "accidental injury . . . arising out of and in the course of employment." 33 U.S.C. 902(2). Arising "out of" and "in the course of" employment are separate elements: the former refers to injury causation; the latter refers to the time, place, and circumstances of the injury.
The "injury" noticed by the Court of Appeals, however, arose in bed, not in the course of employment. Even if the Court of Appeals simply mislabeled the early morning attack of pain as the "injury" itself rather than as a manifestation of an earlier injury, the claim envisioned by the Court of Appeals did not allege any facts that would establish that Riley suffered an injury that arose in the course of employment. The statutory presumption is no substitute for the allegations necessary to state a prima facie case.
Riley's claim stated a prima facie case of compensability; if the Administrative Law Judge had believed Riley's allegations, he would have found that Riley's attack of pain in the early morning of November 20 was caused by an injury suffered when Riley was lifting duct work on the job on November 19. The judge, however, disbelieved Riley's allegations and marshaled substantial evidence to support his findings. The statutory presumption did not require him to adjudicate any claim that was not made, and the Court of Appeals erred in remanding for that purpose. Nor could the statutory presumption have aided Riley had he made the claim envisioned by the Court of Appealsthat he suffered an "injury" at homefor such a claim omits the requirement that a compensable injury arise in the course of employment.
* Section 20(a) of the Longshoremen's and Harbor Workers' Compensation Act (LHWCA), 33 U.S.C. 920(a), provides that "it shall be presumed, in the absence of substantial evidence to the contrary . . . that a claim for compensation comes within the provisions of this chapter." The central issue before us is whether this provision requires the employer in a compensation hearing to offer "substantial evidence" refuting the existence of a causal relationship between a compensation claimant's injury and his employment. The question has been fully briefed and argued, but the Court does not address it. For me, however, the answer is clear and controls the proper disposition of this case.
By its terms, and quite in contrast to the practice in judicial proceedings, § 20(a) requires the employer to take the initial steps to disprove his liability. This preliminary shifting of the burden to the employer exemplifies the "humanitarian nature of the Act," O'Keeffe v. Smith Associates, 380 U.S. 359, 362, 85 S.Ct. 1012, 1014, 13 L.Ed.2d 895 (1965) (per curiam), and the "strong legislative policy favoring awards in arguable cases," Wheatley v. Adler, 132 U.S.App.D.C. 177, 183, 407 F.2d 307, 313 (1968) (en banc). Section 20(a) is clearly broad enough to encompass the question of causation. "The statutory presumption applies as much to the nexus between an employee's malady and his employment activities as it does to any other aspect of a claim." In re District of Columbia Workmen's Compensation Act, 180 U.S.App.D.C. 216, 223, 554 F.2d 1075, 1082 (1976). To defeat a claim for compensation, the employer must rebut the presumption of compensability by offering substantial evidence that the claim is not one "arising out of and in the course of employment." 33 U.S.C. 902(2), 903; see Marra Bros., Inc. v. Cardillo, 154 F.2d 357 (CA3 1946). Only after the employer offers such substantial evidence does the presumption fall "out of the case." Del Vecchio v. Bowers, 296 U.S. 280, 286, 256 S.Ct. 190, 193, 80 L.Ed. 229 (1935).
See Riley v. U.S. Industries/Federal Sheet Metal, Inc., 200 U.S.App.D.C. 402, 406, n. 3, 627 F.2d 455, 459, n. 3 (1980). Riley has an arthritic neck condition, and "the pain he suffered . . . was due to an exacerbation of his arthritic neck condition." Id., at 405, 627 F.2d, at 458. Given the existence of this condition, and the statutory presumption, the relevant inquiry was whether the employer had shown that the condition was not sufficiently work-related to render the employer accountable.
No such finding was ever entered. Rather, the Administrative Law Judge and the Benefits Review Board focused exclusively on the testimony of Riley and his co-worker that something happened to Riley while lifting duct work on November 19, 1975, causing an immediate pain in his neck. The Administrative Law Judge concluded only that no such incident occurred; the Benefits Review Board affirmed that finding.
Had the Administrative Law Judge credited the testimony of Riley with respect to the November 19 incident, it would surely have strengthened Riley's position that the exacerbation of his arthritic neck condition was work-related. But the finding that this incident did not occur hardly demonstrates that Riley's disability did not arise out of and in the course of employment. An injury need not be traceable to a single event at work in order to be compensable. "Even if the asserted work-related incident had never occurred, the injuries suffered by the claimant might nevertheless have been 'employment bred.' "
Id., at 406, 627 F.2d, at 459. Absent a finding excluding this possibility, compensation could not be denied. In addition, the failure of the Administrative Law Judge to focus on the broader issue of the injury's work-relatedness suggests that he may have failed to conduct the proceedings with proper attentiveness to the basic issue in a case such as this: namely, had the claimant been disabled as a result of his employment? Because the agency did not make the crucial finding, the Court of Appeals quite properly remanded this case so that the necessary determination could be made.
"In any proceeding for the enforcement of a claim for compensation under this Act it shall be presumed, in the absence of substantial evidence to the contrary . . . that the claim comes within the provisions of this Act." (Emphasis added.)
The Court appears to glean its understanding of the word "claim" from the meaning assigned to the term "claim for relief" by Rule 8(a) of the Federal Rules of Civil Procedure. The Court concedes, as it must, that this understanding of the word "claim" finds no direct authority in the LHWCA itself. The Act does require the employee to file a timely "claim" with the Deputy Commissioner. 33 U.S.C. 913(a). See ante, at 613. But it is clear that the referred-to "claim" is nothing more than a simple request for payment,
carrying with it the implicit assertion of an entitlement to compensation. To the extent an allegation of "time, place, nature, and cause of injury" is statutorily required, it is only in connection with the notice to the employer referred to by § 12.
Under the present regime of administrative enforcement, issues are not narrowed through pleadings, but rather through a mixture of formal and informal prehearing procedures. 20 CFR §§ 702.311-702.317 (1981). The regulations governing the administration of the Act reflect the method chosen by the agency charged with administering the Act for addressing the practical problems of issue narrowing that inevitably arise in the course of administrative proceedings. In addition to the prehearing conference report, which sets forth the issues for the hearing, the parties are required to submit a prehearing statement defining the issues to be considered. See § 702.317. Nevertheless, the employee's failure to raise a particular issue at the prehearing conference, or in his prehearing statement, does not preclude him from raising that issue at the formal hearing. See § 702.336(a). In addition, "at any time prior to the filing of the compensation order . . . the administrative law judge may in his discretion" reopen the hearing to consider a new issue. § 702.336(b).
As Justice Douglas once had occasion to remind us, "the problems under this Act should rest mainly with the Courts of Appeals." O'Keeffe v. Smith Associates, 380 U.S., at 371, 85 S.Ct., at 1019 (dubitante). The Court's treatment of the relatively simple issues raised by the present case underscores the wisdom of that counsel of deference. The Court of Appeals concluded below that the relevant issues were never resolved by the Administrative Law Judge. I can hardly disagree. Therefore, I dissent.
We need not resolve that debate in this case. It seems fair to assume, however, that the § 20(a) presumption is of the same nature as the presumption created by § 20(d) of the Act, 33 U.S.C. 920(d), as construed in Del Vecchio v. Bowers, 296 U.S. 280, 285-287, 56 S.Ct. 190, 192-93, 80 L.Ed. 229, and the presumption defined in Rule 301 of the Federal Rules of Evidence. See also Texas Dept. of Community Affairs v. Burdine, 450 U.S. 248, 101 S.Ct. 1089, 67 L.Ed.2d 207.
Professor Larson writes that an informal substitute for a claim may be acceptable if it "identif[ies] the claimant, indicate[s] that a compensable injury has occurred, and convey[s] the idea that compensation is expected," id., § 78.11, p. 15-9; that "considerable liberality is usually shown in allowing amendment of pleadings to correct . . . defects," unless the "effect is one of undue surprise or prejudice to the opposing party," id., at 15-11; and that "wide latitude is allowed" as to variance between pleading and proof, "[b]ut if the variance is so great that the defendant is prejudiced by having to deal at the hearing with an injury entirely different from the one pleaded, the variance may be held fatal," id., at 15-1315-14. Riley had the benefit of these liberal pleading rules; nonetheless, the Court of Appeals applied the statutory presumption to a claim that was not fairly supported by the existing claim or by the evidentiary record. As Professor Larson warns, "[n]o amount of informality can alter the elementary requirement that the claimant allege and prove the substance of all essential elements in his case." Id., at 15-12.
"If the employer or carrier declines to pay any compensation on or before the thirtieth day after receiving written notice of a claim for compensation having been filed from the deputy commissioner, on the ground that there is no liability for compensation within the provisions of this chapter and the person seeking benefits shall thereafter have utilized the services of an attorney at law in the successful prosecution of his claim, there shall be awarded, in addition to the award of compensation, in a compensation order, a reasonable attorney's fee against the employer or carrier in an amount approved by the deputy commissioner, Board, or court, as the case may be, which shall be paid directly by the employer or carrier to the attorney for the claimant in a lump sum after the compensation order becomes final." 33 U.S.C. 928(a).
See, e.g., Ward & Gow v. Krinsky, 259 U.S. 503, 42 S.Ct. 529, 66 L.Ed. 1033; Thom v. Sinclair, [1917] A.C. 127; 1A Benedict on Admiralty, supra, § 43; 1 A. Larson, supra, § 6.10, at 3-23-3 (1978).
It may be that the opinion for the Court of Appeals suffered from failing to distinguish between the use of the term "injury" in its ordinary meaning, and in its specialized meaning under the Act. See 33 U.S.C. 902(2). But there is absolutely no basis for the suggestion in Part II of the Court's opinion that the Court of Appeals thought it sufficient to ground a compensation claim on an "injury" that "arose in bed, not in the course of employment." Ante, at 616. The suggestion is plainly wrong; virtually every aspect of the opinion for the Court of Appeals reaffirms that the issue before the Administrative Law Judge and the Benefits Review Board was whether there existed some causal connection between the claimant's disability and his employment.
In practice, the two tests of "arising out of" and "in the course of" tend to merge into a single determination of work-relatedness. See 1A A. Larson, The Law of Workmen's Compensation §§ 29.00-29.10, pp. 5-3545-357 (1979). The dissenting member of the Benefits Review Board Panel thus properly described "the real issue in this case" as "whether claimant's injury is causally related to his employment." 9 BRBS 936, 940 (1979).
It is surely plausible that there was a causal relation between the exacerbation of Riley's arthritic neck condition and the overhead sheet metal duct work that he was engaged in until the night he awoke in bed in pain. But however logical this connection might be in some lay sense, it could hardly assure Riley of recovery. The term "substantial" is relative, and the quantum and type of evidence required of the employer correspond to the specificity of the claimant's evidence and allegations. The evidence necessary to overcome the presumption is least when the claim restsas this one apparently did once the testimony respecting the November 19 accident was rejectedon little more than some arguable link between the disabling condition and the nature of the work.
This definition of "claim" comports with its accustomed meaning in the context of comparable compensation statutes. For example, "claim" is defined for purposes of the Federal Mine Safety and Health Act of 1977, 30 U.S.C. 801 et seq. (1976 ed. and Supp.IV), as "a written assertion of entitlement to benefits under [the Act], submitted in a form and manner authorized by the provisions of this subchapter." 20 CFR § 725.101(a)(16) (1981). See also 20 CFR § 10.5(a)(7) (1981) (Federal Employees' Compensation Act, 5 U.S.C. 8101 et seq.).
The Court's reliance on the notice requirement of § 12 to suggest that the claim encompass some allegation of "time, place, and manner," so that the Court can in turn conclude that the statutory presumption applies to what is alleged in the "claim," is a patchwork job. The "claim" is something entirely apart from the § 12 notice. Indeed, § 12(d) employs the very distinction that the Court seeks to blur: "Failure to give such notice shall not bar any claim under this chapter" where the employer had actual notice, the deputy commissioner excuses such notice, or where no objection was raised to the failure "before the Deputy Commissioner at the first hearing of a claim for compensation . . . ." 33 U.S.C. 912(d).