Opinion ID: 2112830
Heading Depth: 1
Heading Rank: 2

Heading: Psychic Insult Causing Physical Injury

Text: We have traditionally required that, to recover workers' compensation benefits for a psychic injury, a claimant must prove by objective evidence that: (1) he suffered a psychic insult; (2) the psychic insult produced an injury; and (3) the injury is other than a subjective reaction to normal working conditions. Martin v. Ketchum, Inc., 523 Pa. 509, 568 A.2d 159 (Pa.1990). This approach recognized the highly subjective nature of psychic insults and required that the occurrence of the injury and its causal relationship to the claimant's employment be adequately established. As recognized by the Majority, in the early years of workers' compensation litigation, the 1915 Act limited recovery exclusively to an accident resulting in physical injuries, generally requiring some violence to the body. Early workers' compensation tribunals perceived some difficulty with this definition and developed two doctrines meant to cover injuries that were obviously work related, but fell outside actual violence to the body. Those doctrines were styled as the doctrines of unusual strain and unusual pathological result. These doctrines enabled early jurists to circumvent the requirement for an actual accident where, although no accident occurred, the injury was clearly related to the individual's employment. The accident in the case of the unusual strain doctrine was supplied by finding that the injuries were the result of excessive exertion by a worker while performing a task atypical to his employment. See, e.g., Skroki v. Crucible Steel Co., 292 Pa. 550, 141 A. 480 (1928) (finding that heart attack was accident that occurred because of overexertion in a hot room); Hilt v. Roslyn Volunteer Fire Co., 445 Pa. 149, 281 A.2d 873, 875 (1971) (denying benefits pursuant to unusual strain doctrine for firefighter who suffered from a heart attack by doing an occasional act involving sustained muscular effort, though the work is not hard). In the case of the unusual pathological result doctrine, benefits were awarded by finding that the accident occurred because there was an extraordinary effect of work performed in the usual fashion. Hinkle v. H.J. Heinz Co., 462 Pa. 111, 337 A.2d 907 (1975) (mechanic in can-making factory suffered accident by sustaining unexpected loss of hearing performing his normal job); Parks v. Miller Printing Mach. Co., 336 Pa. 455, 9 A.2d 742, 744 (1939) (accident resides in the extraordinary nature of the effect rather than in the cause); Lane v. Horn & Hardart Baking Co., 261 Pa. 329, 104 A. 615 (1918) (casualty attributable solely to the unexpected and violent effect of heat upon the physical structure properly held to be an accident). These doctrines ultimately metamorphed into the abnormal working conditions standard we established in Martin to review mental insults. In 1972, the General Assembly amended the Workers' Compensation Act to include all work-related injuries, including occupational diseases. However, tribunals concerned with workers' compensation matters continued to require an elevated standard to distinguish normal workplace occurrences from those that were compensable work-related injuries. See, e.g., Haverford Twp. v. Workmen's Comp. Appeal Bd. (Angstadt), 118 Pa.Cmwlth.467, 545 A.2d 971 (1988) (decedent's heart attack precipitated by excessively stressful demands of employer, unusually stressful work environment, and series of abnormal, stressful incidents at work); American St. Gobain Corp. v. Workmen's Comp. Appeal Bd. (Kordalski), 11 Pa. Cmwlth.388, 314 A.2d 40 (1974) (holding that accident may not be inferred from the fact that employee sustained a heart attack as a result of exertion necessary for performance of usual duties and work is done in same quantity and manor as performed in the past). In Workmen's Compensation Appeal Board v. Bernard S. Pincus Co., 479 Pa. 286, 388 A.2d 659 (1978), we appeared to lower the standard, when in fact we essentially applied the unusual pathological result doctrine to find that heart attacks were compensable work injuries due to the damage to the internal tissues of the workers' hearts. Many cases cited to the decision of this Court in Krawchuk v. Philadelphia Electric Co., 497 Pa. 115, 439 A.2d 627 (1981), for the proposition that, where employment stress produced a heart attack, the claimant only had to show that the injury was related to his employment. However, no challenge was mounted in Krawchuk as to the work-relatedness of the heart attack or the existence of a mental insult. The only issue there was whether the claimant could be compensated for the death of her husband when he was working on behalf of his employer in his own home. The determination that Krawchuk's heart attack and death were compensable was based on the finding that he experienced unusual stress, strain[,] and exertion in his employment that directly resulted in his fatal coronary attack and that he was working in furtherance of his employer's interests at the time of his death. In Martin, this Court clarified the law on this issue by explicitly stating that the proper standard for reviewing psychic insults is whether they result from other than subjective reactions to normal working conditions. Subsequent courts reasoned that a psychic stimulus that produced an effect other than a subjective reaction to normal working conditions must be caused by abnormal working conditions. Since Martin, this Court has issued at least nine additional Opinions on the standard for granting benefits in cases of psychic insults, all of which require a finding that the precipitating cause of the injury is other than a subjective reaction to normal working conditions. See Volterano v. Workmen's Comp. Appeal Bd. (Traveler's Ins.), 536 Pa.335, 639 A.2d 453 (1994) (mental/mental); Romanies v. Workmen's Comp. Appeal Bd. (Borough of Leesport), 537 Pa.440, 644 A.2d 1164 (1994) (mental/mental); Wilson v. Workmen's Comp. Appeal Bd. (Aluminum Co. of America), 542 Pa.614, 669 A.2d 338 (1996) (mental/mental); Phila. Newspapers, Inc. v. Workmen's Comp. Appeal Bd. (Guaracino), 544 Pa.203, 675 A.2d 1213 (1996) (mental/mental); Hershey Chocolate Co. v. Workmen's Comp. Appeal Bd. (Lasher), 546 Pa.27, 682 A.2d 1257 (1996) (mental/mental); Pa. Human Relations Comm'n v. Workmen's Comp. Appeal Bd. (Blecker), 546 Pa. 83, 683 A.2d 262 (1996) (mental/mental); Ryan v. Workmen's Comp. Appeal Bd. (Cmty. Health Servs.), 550 Pa.550, 707 A.2d 1130 (1998) (mental/mental); Davis v. Workmen's Comp. Appeal Bd. (Swarthmore Borough), 561 Pa.462, 751 A.2d 168 (2000) (mental/mental with physical symptoms); and Phila. v. Civil Serv. Comm'n, 565 Pa. 265, 772 A.2d 962 (2001) (mental/mental). Although the Majority attempts to define the instant matter solely in terms of the physical injury, the mental element, which supplies the causation that is required by the Act, should not be swept aside as insignificant. It makes no sense to evaluate psychic insult on different planes depending on whether the resulting injury is mental or physical. I remain convinced that all psychic insults should be evaluated in the same manner. I cannot agree with the position of the Majority that, in mental/physical cases, the claimant must only show distinct identifiable physical injuries and present unequivocal medical testimony that connects the physical disability to the workplace in order to receive benefits. The flaw in this reasoning is that it circumvents the causative link between the physical injury and employment that the Act requires. Pursuant to this theory, any employee who gets sick at work will be entitled to workers' compensation benefits. For example, an employee who gets a migraine headache because a work deadline is approaching can claim a work-related injury. One who has a stroke at his or her work desk can claim a work-related injury. Finally, one who has a heart attack after a routine, non-disciplinary meeting at work can claim a work-related injury. It is well established that a claimant in a workers' compensation case has the burden to prove all the statutory elements that comprise a compensable injury by a preponderance of the evidence. Inglis House v. Workmen's Comp. Appeal Bd. (Reedy), 535 Pa.135, 634 A.2d 592 (1993). This includes establishing the cause of the condition for which compensation is claimed and proving that the injury arose out of and in the course of employment. To meet the preponderance standard, the claimant must present evidence that leads the trier of fact to find that the existence of the contested fact is more probable than its non-existence. However, nothing in the Act requires that the evidence be liberally construed in a claimant's favor when determining whether an injured worker has met his or her burden of proof. I believe that a claimant must also prove that the injury occurred either because of a work-connected risk or because the employment placed the claimant at a risk of exposure exceeding that of the general public. When working conditions create a higher-than-normal degree of stress, and that stress contributes to an employee's injury, only then has the necessary causation been established. Subjective, perceived, or imagined employment events do not supply the causative element that mandates liability for an employer. It is critical to maintain the same standards by which we judge psychic insults regardless of whether they spawn psychic injuries or physical ones. Removing the causative mental insult from the analysis will result in an employer becoming subject to workers compensation liability for terminating a worker, [5] promoting an employee, [6] reassigning an employee, [7] giving a performance evaluation, [8] or a single incident of egregious supervisory behavior. [9] It is interesting that the Superior Court was once faced with a situation similar to that in the present case. Elisha Hoffman (Hoffman), a train engineer, died following a heated argument with his foreman after arriving late for work one morning. The court explained: The argument lasted five or ten minutes and was accompanied by provocative epithets by the foreman and some gesticulations by Hoffman. At the conclusion of the argument Hoffman mounted his loky engine, on which he was employed as engineer, ran it about 1,000 or 1,500 feet, stopped to take a drink of coffee, and either dismounted or fell from the engine and died a few minutes thereafter. No assault was made upon him by the foreman. No blow was struck, or attempted to be struck, by either of them. Neither threatened the other with any show of force. Hoffman was white with anger when he mounted the engine; and he died from [myocardial infarction], he was suffering from chronic myocarditis  undoubtedly induced by the intensity of his own emotions. But there was no compensable accident within the meaning of the Workmen's Compensation Act. Hoffman v. Rhoads Constr. Co., 113 Pa.Super. 55, 172 A. 33, 33 (1934). The court opined that purely subjective emotions, the result of anger, grief, joy, or other mental feeling, if unaccompanied by physical force or exertion, cannot be made the basis of a compensable accident. Id. at 33-34. I believe that a better approach is to require that a claimant show exposure to a greater degree of emotional stress than experienced by his or her peers, the general working public, or his work environment to demonstrate a compensable injury. This approach is fairer to a claimant and fairer to the employer. Rather than applying different standards without justification, it treats all psychic insults consistently regardless of whether they result in mental or physical injury.