Opinion ID: 2350712
Heading Depth: 3
Heading Rank: 1

Heading: The Standard For Occupational Disability Benefits

Text: Alaska Statute 39.35.410(a) provides: An employee is eligible for an occupational disability benefit if employment is terminated because of a total and apparently permanent occupational disability. . . . Alaska Statute 39.35.680(27) defines the term occupational disability as: [A] physical or mental condition that, in the judgment of the administrator, presumably permanently prevents an employee from satisfactorily performing the employee's usual duties for an employer or the duties of another comparable position or job that an employer makes available and for which the employee is qualified by training or education; however, the proximate cause of the condition must be a bodily injury sustained, or a hazard undergone, while in the performance and within the scope of the employee's duties and not the proximate result of the wilful negligence of the employee. Occupational disability benefits. . . serve a distinct function and are not intended to replicate the protection given by the workers' compensation system. [14] Therefore, unlike the presumption of compensability in workers' compensation cases, an employee claiming occupational disability benefits bears the burden of proving by a preponderance of the evidence that the disability was proximately caused by an injury which occurred in the course of employment. [15] If one or more possible causes of a disability are occupational, benefits will be awarded where the record establishes that the occupational injury is a substantial factor in the employee's disability regardless of whether a nonoccupational injury could independently have caused disability. [16] The underlying injury need not be caused by the employment to receive occupational disability benefits. We have explained that [i]t is basic that an accident which produces injury by precipitating the development of a latent condition or by aggravating a preexisting condition is a cause of that injury. [17] This is because  increased pain or other symptoms can be as disabling as deterioration of the underlying disease itself. [18]
The ALJ concluded that Shea established sitting contributed to her disabling pain, but that she did not prove her employment was a substantial factor in causing this disability. There were two reasons for this conclusion: (1) Dr. Smith testified that sitting only aggravated her condition by five to ten percent; and (2) sitting did not contribute to her pain any more or less than her other activities of daily life. Shea argues the ALJ used the wrong legal threshold to determine that prolonged sitting was not a substantial factor in causing her disability. She claims she met the burden of proving that her employment was a substantial factor simply by demonstrating that prolonged sitting at work aggravated her symptoms. One of the primary issues in this case is whether the definition of substantial factor requires Shea's employment to have been the substantial cause of her injuryi.e., the sole or predominant causeor whether it must only have been a substantial cause of her injury. We have previously adopted the substantial factor causation standard in occupational disability benefits cases, but we have not yet had the occasion to define the term substantial factor for purposes of these cases. We have defined the term in more detail in other contexts, such as negligence claims and workers' compensation cases and we look to these other contexts to guide our definition of substantial factor here.
We first had the opportunity to define substantial factor in the realm of tort law. For example, the passenger-plaintiff in State v. Abbott was harmed in an automobile accident and sued the State claiming that it had been negligent in the design, construction, and maintenance of the road and in failing to post signs warning of the hazardous condition of a curve. [19] The State claimed the automobile driver had been negligent, and therefore the road maintenance was not a proximate cause of plaintiff's injury. [20] In rejecting the State's argument, we adopted the definition of substantial factor from the Restatement (Second) of Torts. It provides: In order that a negligent actor may be liable for harm resulting to another from his conduct, it is only necessary that it be a legal cause of the harm. It is not necessary that it be the cause, using the word the as meaning the sole and even the predominant cause. The wrongful conduct of a number of third persons may also be a cause of the harm, so that such third persons may be liable for it, concurrently with the actor.[ [21] ] We further explained that it [is] proper to find that a defendant's negligent conduct was the `legal cause' of plaintiff's injury if the negligent act `was more likely than not a substantial factor in bringing about (plaintiff's) injury.' [22] In other words, the actor's conduct need not be the legal cause of an injury for liability to attach to the actor; it is only necessary that the actor's conduct be a legal cause. [23] Because the State's negligence was a proximate cause of the accident, we concluded in Abbott that the State could be liable, regardless of the driver's negligence. [24] We have adopted this same definition of substantial factor in workers' compensation cases. [25] Our initial use of the substantial factor causation standard in workers' compensation cases arose from the need to define which employer should be responsible for an employee's injury when an injury becomes progressively worse over a series of jobs. To make this determination, we adopted the last injurious exposure rule, which imposes full liability on the employer at the time of the most recent injury that bears a causal relation to the disability. [26] This rule requires two determinations: (1) whether employment with the subsequent employer `aggravated, accelerated, or combined with' a pre-existing condition; and, if so, (2) whether the aggravation, acceleration or combination was a `legal cause' of [the] disability, i.e., `a substantial factor in bringing about the harm.' [27] In Ketchikan Gateway Borough v. Saling , the Borough argued that we should limit application of the last injurious exposure rule to cases where the last injurious exposure is the `substantial cause' in producing disability. [28] We rejected that position and explained that liability should be imposed whenever employment is established as a causal factor in the disability. . . . [A] causal factor is not a legal cause of the injury unless it is a substantial factor in bringing about the harm. [29] We concluded that the employee need only have shown that employment with the [B]orough was a legal cause of his disability, not the legal cause. [30] We later elaborated on this definition in Fairbanks North Star Borough v. Rogers and Babler and held that an employment-related act, omission, or force will not be a substantial factor unless reasonable persons would regard this act, omission, or force as a cause and attach responsibility to it. [31] In State, Public Employees Retirement Board v. Cacioppo, we explained that workers' compensation and occupational disability benefits claims draw on common principles and raise similar issues, and we incorporated the substantial factor causation standard into our occupational disability benefits jurisprudence. [32] We clarify here that the same definition of substantial factor applies in the occupational disability context; [33] Shea must show that prolonged sitting at work was a substantial factor in causing her disability, such that reasonable persons would recognize the employment as a legal cause of her injury.
The fact that multiple causes contribute to an injury does not automatically preclude recovery. The substantial factor test requires a claimant to demonstrate that: (1) the disability would not have happened `but for' an injury sustained in the course and scope of employment; and (2) reasonable persons would regard the injury as a cause of the disability and attach responsibility to it. [34] The first element is commonly referred to as cause-in-fact and the second as proximate cause. [35] The cause-in-fact or but-for test only requires a showing that the plaintiff's damages would not have been incurred but for the complained-of conduct, in this case the conditions of Shea's employment. [36] But not every cause results in liability or the award of benefits. Once it has been established that the defendant's conduct has in fact been one of the causes of the plaintiff's injury, there remains the question whether the defendant should be legally responsible for the injury. [37] To satisfy the substantial factor requirement, a claimant must prove that her employment was so important in bringing about the injury that reasonable [persons] would regard it as a cause and attach responsibility to it. [38] We have described this requirement as asking whether the conduct has been so significant and important a cause that the defendant should be legally responsible. [39]