Opinion ID: 2599666
Heading Depth: 2
Heading Rank: 1

Heading: Compensability Of Injuries Caused By Occupational Disease Under The Workers' Compensation Law

Text: The term occupational disease does not appear in the Workers' Compensation Law. Although our statute does not specifically have any provision regarding occupational disease, as do the workmen's compensation acts of many States, an examination of these decisions is interesting and instructive because, in substance, we have the same law where the disease is proximately caused by the employment. (R. L.H.1955, § 97-3. [3] ) It is common knowledge that pulmonary tuberculosis is a disease to which the general public is exposed and it is not peculiarly an occupational disease in the sense that the courts have come to regard silicosis or painter's lead poisoning, as examples. It may become an occupational disease, however, if it appears to have had its origin in a risk connected with the employment and to have flowed from that source as a consequence. It seems obvious that if one is employed in a sanatorium for the treatment of tuberculosis, contraction of the disease is a hazard to which the workman would not have been equally exposed outside the employment and therefore the disease is incidental to the business and not independent of the relation of the employer and employee. ( Evans v. Indiana Univ. Medical Center, 100 N.E.2d 828, 121 Ind.App. [679] 678 [1951].) The court stated that if the industrial board had found that the claimant contracted tuberculosis during the course of employment, there was ample evidence to sustain such finding. There are numerous other cases similarly holding tuberculosis is an occupational disease where it can be shown that the employee is more exposed than the general public. ( Gray v. City of St. Paul, 250 Minn. 220, 84 N.W.2d 606; Board of National Missions v. Alaska Industrial Board, 116 F.Supp. 625, and cases cited therein.) Fukuoka v. Dodo, 43 Haw. 337, 343, 1959 WL 11663 (1959) (brackets in original). The foregoing observations, made in the context of the workers' compensation claim of a mortuary employee who had contracted tuberculosis, apply equally to Flor's hepatitis C claim under the contemporary counterpart of R.L.H. § 97-3 (1955), i.e., HRS § 386-3 (1993 & Supp.1999). [4] The case law of other jurisdictions recognizing hepatitis C as an occupational disease includes Muir v. C.R. Bard Inc., 336 S.C. 266, 519 S.E.2d 583 (Ct. App.1999) (hepatitis C was occupational disease for worker who examined failed catheters, some of which were bloody); Bloomington Hospital v. Stofko, 705 N.E.2d 515 (Ind. Ct.App.1999) (hepatitis C was occupational disease for hospital employee); Price v. City of New Orleans, 672 So.2d 1045 (La.Ct.App. 1996) (hepatitis C contracted by fire fighter was occupational disease); Jeannette District Memorial Hospital v. Workmen's Compensation Appeal Board, 668 A.2d 249 (Pa. Cmwlth.Ct.1995) (statute provided that serum hepatitis was occupational disease, thereby raising presumption that registered nurse infected with hepatitis C suffered work-related disability); Fairfax County v. Espinola, 11 Va.App. 126, 396 S.E.2d 856 (1990) (non-A and non-B hepatitis, i.e. hepatitis C, was occupational disease for police department technician exposed to blood products through blood and breathalyzer tests); but see Wheaton v. City of Tulsa Fire Department, 970 P.2d 194 (Okla.Ct.App.1998) (hepatitis C contracted by fire fighter was not occupational disease under Oklahoma workers' compensation law, but could be compensable accidental injury based on repeated exposures to disease while moving injured individuals, even though claimant could not determine the precise exposure that caused him to contract disease). Hepatitis has been expressly recognized as an occupational disease for dental hygienists. Sirkin and Levine v. Timmons, 652 A.2d 1079 (Del.Super.Ct.1994); Hansen v. Gordon, 221 Conn. 29, 602 A.2d 560 (1992). [5] An accidental injury is distinguished from an occupational disease in that the former generally results from a discrete eventthe time and place of which can be fixed, while the latter generally develops gradually over a long period of time. Booker v. Duke Medical Center, 297 N.C. 458, 256 S.E.2d 189, 197 (1979). When a disease causing injury results from an identifiable accident, rather than from a peculiar risk of the employment, it should be compensated as an accidental injury. Baldwin v. Jensen-Salsbery Laboratories, 10 Kan.App.2d 673, 708 P.2d 556, 557-58 (1985) (maintenance worker in plant contaminated by brucella cultures who cut hand on sheet of metal retrieved from floor tool that had fallen into liquid containing brucella and who became ill with brucellosis two weeks laterheld to have contracted brucellosis by accident) (citing Wilson Foods Corp. v. Porter, 612 P.2d 261 (Okla.1980)). See also Booker, 256 S.E.2d 189, 198 (holding that [i]f an employee contracts an infectious disease as a result of his employment and it falls within either the schedule of diseases set out in the statute or the general definition of `occupational disease'... , it should be treated as a compensable event regardless of the fact that it might also qualify as an `injury by accident,' and ruling that hepatitis contracted by laboratory technician was compensable occupational disease). As noted supra at note 4, HRS § 386-3 provides in relevant part that [i]f an employee suffers personal injury . . . by disease proximately caused by or resulting from the nature of the employment, the employee's employer or the special compensation fund shall pay compensation to the employee[.] We have traditionally construed HRS § 386-3 liberally in favor of conferring compensation because our `legislature has decided that work injuries are among the costs of production which industry is required to bear[.]' Chung v. Animal Clinic, Inc., 63 Haw. 642, 649, 636 P.2d 721, 726 (1981) (quoting Akamine v. Hawaiian Packing & Crating Co., 53 Haw. 406, 409, 495 P.2d 1164, 1166 (1972)); Royal State Nat'l Ins. Co. v. Labor and Indus. Relations Appeal Bd., 53 Haw. 32, 38, 487 P.2d 278, 282 (1971); see also Larson, 1B Workmen's Compensation Law, § 43.51 (1993) [hereinafter, Larson] (The theory of [workers'] compensation legislation is that the cost of all industrial accidents should be borne by the customer as a part of the cost of the product. It follows that any worker whose services form a regular and continuing part of the cost of that product ... is within the presumptive area of intended protection.). Moreover, [workers'] compensation laws are highly remedial in character. Their paramount purpose is to provide compensation for an employee for all work-connected injuries, regardless of questions of negligence and proximate cause. Courts should therefore give them a liberal construction in order to accomplish their beneficent purposes. Evanson v. University of Hawai`i, 52 Haw. 595, 600, 483 P.2d 187, 191 (1971) (emphasis added) (citations omitted). Mitchell v. State Dep't of Educ., 85 Hawai`i 250, 255, 942 P.2d 514, 519 (1997) (footnote omitted). Furthermore, HRS § 386-85 (1993) provides in relevant part that [i]n any proceeding for the enforcement of a claim for compensation under this chapter it shall be presumed, in the absence of substantial evidence to the contrary: (1)[t]hat the claim is for a covered work injury. HRS § 386-1 (1993) defines work injury as a personal injury suffered under the conditions specified in section 386-3, see supra note 4. This statutory presumption in favor of compensability supports the liberal construction of the Workers' Compensation Law. Ostrowski v. Wasa Elec. Services, Inc., 87 Hawai`i 492, 496, 960 P.2d 162, 166 (App.1998). The presumption has been described as one of the keystone principles of our workers' compensation plan. Iddings v. Mee-Lee, 82 Hawai`i 1, 22, 919 P.2d 263, 284 (1996) (Ramil, J., dissenting). HRS § 386-85(1) creates a presumption in favor of the claimant that the subject injury is causally related to the employment activity. As we previously explained in Akamine, this presumption imposes upon the employer both the heavy burden of persuasion and the burden of going forward with the evidence. 53 Haw. at 408, 495 P.2d at 1166. The claimant must prevail if the employer fails to adduce substantial evidence that the injury is unrelated to employment. The term substantial evidence signifies a high quantum of evidence which, at the minimum, must be relevant and credible evidence of a quality and quantity sufficient to justify a conclusion by a reasonable man that an injury or death is not work connected. Id. at 408-9, 495 P.2d at 1166; Survivors of Timothy Freitas v. Pacific Contractors Co., 1 Haw. App. 77, 85, 613 P.2d 927, 933 (1980). The statute nowhere requires, as appellants suggest, some preliminary showing that the injury occurred in the course of employment before the presumption will be triggered. Rather, HRS § 386-85 clearly dictates that coverage will be presumed at the outset, subject to being rebutted by substantial evidence to the contrary. This is so in all claims proceedings, regardless of the existence of conflicting evidence, as the legislature has determined that where there is a reasonable doubt as to whether an injury is work-connected, it must be resolved in favor of the claimant. Akamine, supra at 409, 495 P.2d at 1166. Chung, 63 Haw. at 650-51, 636 P.2d at 726-27. In addition to the presumption of compensability, the broad humanitarian purpose of the workers' compensation statute read as a whole requires that all reasonable doubts be resolved in favor of the claimant, DeFries v. Ass'n of Owners, [57 Haw. 296,] 304, 555 P.2d [855,] 860 [ (1976) ] (emphasis in original), for diseases arising from the nature of the employment are among the costs of production which industry must bear. See Akamine v. Hawaiian Packing, supra, 53 Haw. at 409, 495 P.2d at 1166. Thus, an injury is compensable if it reasonably appears to have resulted from the working conditions. Lawhead v. United Air Lines, 59 Haw. 551, 560, 584 P.2d 119, 125 (1978) (holding that a disease or illness such as influenza is an injury within the meaning of HRS § 386-3). Liberal construction and the presumption of compensability notwithstanding, workers' compensation law conditions an employer's liability for an employee's injury upon the injury's causal nexus to the job. See, e.g., Holt v. Acme Mattress Co. & London Guarantee & Accident Co., 40 Haw. 660, 670, 675 (1955) (recognizing that [t]he basic current problem in this area ... is the extremely difficult medico-legal question of causation and that [t]he workmen's compensation law is not designed as a complete substitute for life insurance, or sick and accident insurance, for employees, nor can sympathy be allowed to broaden its express statutory provisions) (citations and internal quotation marks omitted). This court has held that [f]or an injury to be compensable under a workers' compensation statute, there must be a requisite nexus between the employment and the injury. The nexus requirement is articulated in Hawai`i, as in the majority of jurisdictions, on the basis that, to be compensable, an injury must arise out of and in the course of employment. Tate v. GTE Hawaiian Tel. Co., 77 Hawai`i 100, 103, 881 P.2d 1246, 1249 (1994) (footnote omitted). In Tate, we explained that, in determining whether an injury meets this criterion, the court has adopted a unitary test that considers whether there is a sufficient work connection to bring the accident within the scope of the statute. First articulated in Royal State National Insurance Co. v. Labor and Industrial Relations Appeal Board, 53 Haw. 32, 487 P.2d 278 (1971), the work connection approach simply requires the finding of a causal connection between the injury and any incidents or conditions of employment. Chung, 63 Haw. at 648, 636 P.2d at 725 (citations omitted). Id. HRS § 386-3 provides that an injury by accident is compensable when the accident arises out of or in the scope of the employment, but an injury by disease is compensable when the disease is proximately caused by or resulting from the nature of the employment. Thus, the nexus requirement articulated in Tate, see supra, traces the language of the injury-by-accident prong of HRS § 386-3. Similarly, the work connection requirement, as articulated in Tate, expressly pertains to accidental injury. As far as we can determine, however, this court has never before construed the causation requirements applicable to the injury-by-disease prong of HRS § 386-3. A disease resulting from the nature of the employment is, by definition, an occupational disease. See Komatsu v. Board of Trustees, Employees' Retirement System, 5 Haw.App. 279, 284, 687 P.2d 1340, 1344 (1984) ([A]n occupational disease is one `which results from the nature of the employment, and by nature is meant ... conditions to which all employees of a class are subject, and which produce the disease as natural incident of a particular occupation, and attach to that occupation a hazard which distinguishes it from the usual run of occupations and is in excess of the hazard attending employment in general.') (Quoting Harman v. Republic Aviation Corp., 298 N.Y. 285, 82 N.E.2d 785, 786 (1948).) (Quoting Goldberg v. 954 Marcy Corp., 276 N.Y. 313, 12 N.E.2d 311, 313 (1938).)) (Ellipsis points and brackets in original.), vacated on other grounds, 67 Haw. 485, 693 P.2d 405 (1984); see also Department of Labor and Industries v. Kinville, 35 Wash.App. 80, 664 P.2d 1311, 1314-15 (1983) (interpreting statute defining occupational disease as one arising naturally and proximately out of employment). Thus, injuries caused by an occupational disease are compensable pursuant to HRS § 386-3. However, [a]n ailment does not become an occupational disease simply because it is contracted on the employer's premises.... There must be a recognizable link between the disease and some distinctive feature of the claimant's job, common to all jobs of that sort. Anderson v. General Motors Corp., 442 A.2d 1359, 1360 (Del.1982) (quoting Harman, 82 N.E.2d at 786). In other words, an ailment or disease is a compensable occupational disease if the employer's working conditions produced the ailment as a natural incident of the employee's occupation in such a manner as to attach a hazard distinct from and greater than the hazard attending employment in general. Id. at 1361. See also Wood v. Harry Harmon Insulation, 511 So.2d 690 (Fla.Dist.Ct.App. 1987) (to be compensable under occupational disease theory, disease must (1) actually be caused by employment conditions that are characteristic of and peculiar to particular occupation, (2) actually be contracted during employment in that occupation, and (3) have incidence substantially higher in that occupation than in usual occupations or, in case of ordinary disease of life, in general population); Muir, 519 S.E.2d at 591-92 (workers' compensation benefits for having contracted occupational disease are available, inter alia, when disease (1) is due to hazards in excess of those that are ordinarily incident to employment in general, (2) is peculiar to occupation in which claimant was engaged, and (3) results from claimant's actual exposure to working conditions of that occupation); Hansen, 602 A.2d at 562 (occupational disease is any disease (1) peculiar to the occupation in which employee was engaged and (2) due to causes in excess of ordinary employment as such, and it is compensable if it originated while employee was engaged in line of duty for employer); Booker, 256 S.E.2d at 196 (for occupational disease to be compensable under North Carolina statute, it (1) must have been due to causes and conditions that were characteristic of and peculiar to particular trade, occupation, or employment, (2) could not have been ordinary disease of life to which general public was equally exposed outside of that employment, and (3) must have been causally connected with that employment, which could be determined by circumstantial evidence such as extent of exposure to disease during employment, compared with exposure outside of employment and absence of disease prior to work-related exposure). We hold that an employee's injury caused by a disease is compensable as an injury by disease, pursuant to HRS § 386-3, when the disease (1) is caused by conditions that are characteristic of or peculiar to the particular trade, occupation, or employment, Booker, 256 S.E.2d at 196; Wood, 511 So.2d at 692, (2) results from the employee's actual exposure to such working conditions, Muir, 519 S.E.2d at 592, and (3) is due to causes in excess of the ordinary hazards of employment in general, Hansen, 602 A.2d at 562. In this connection, and pursuant to HRS § 386-85, the burden is on the employer seeking to avoid liability to demonstrate by substantial evidence that these conditions are not present.