Opinion ID: 2599666
Heading Depth: 2
Heading Rank: 3

Heading: Application Of The Workers' Compensation Law To Flor's Occupational Disease Claim

Text: Because Flor did not press the fiction that she had actually contracted hepatitis C either on April 17, 1996 or on January 12, 1994 ( i.e., second date that Flor initially identified on her claim form as the injury date), and because she was, in fact, willing to acknowledge that she had not contracted the virus on those dates, the LIRAB found that Flor did not sustain or suffer any injury on either of those dates. The LIRAB therefore mechanistically concluded, a fortiori, that Flor had not sustained an injury arising out of or in the course of her employment with the Employers on those dates and that, as a consequence, the Employers were entitled to summary judgment against Flor on her workers' compensation claims. In doing so, the LIRAB erred for several reasons. First, as we have noted, an injury caused by a disease is compensable under the Workers' Compensation Law when the disease is proximately caused by or result[s] from the nature of the employment. See HRS 386-3, supra note 4. The statute does not speak of injuries generically arising out of and in the course of employment, but, rather, of personal injury . . . by accident ... or by disease. Id. The distinction between the injury itself and the occurrence giving rise to it may not be significant when the occurrence is an accident because the injury generally manifests itself contemporaneously with the accident causing it. However, the distinction is critical when the occurrence gives rise to a disease. As we indicated supra in section III.A, a worker's compensation claim premised on a disease such as hepatitis C, should, in general, be deemed an injury-by-disease claim. The LIRAB's COL treated Flor's injury by disease claim as if it involved an injury by accident. Second, the LIRAB erred in finding that there was no genuine issue of material fact as to whether Flor had suffered an injury on April 17, 1996, inasmuch as the factual questions regarding the relationship between Flor's hepatitis C diagnosis and both her employability as a dental hygienist and her ability to work in general were not resolved. Moreover, as discussed supra in section III.B, Flor's workers' compensation claim was not foreclosed merely because she asserted that the date on which she discovered her disease was the date of injury. Third, the LIRAB mistakenly assumed that the unknown date on which Flor first contracted the hepatitis C virus was the date of injury. Obviously, the contracting of a virus does not, in and of itself, constitute a compensable injury. A compensable injury i.e., a disability from worktypically occurs well after the virus has first entered the claimant's bloodstream. This is especially true in the case of a virus, such as hepatitis C, that remains asymptomatic for decades and, indeed, may never manifest itself. Accordingly, whether Flor contracted the virus on the precise date of her claimed injury is not dispositive of the compensability of her claim. Finally, fourth, the LIRAB failed to apply the statutory presumption, set forth in HRS § 386-85, in favor of the compensability of Flor's claim. In this connection, the medical opinions adduced by the parties corroborated, rather than rebutted, the proposition that Flor's risk of contracting hepatitis C as a dental hygienist exceeded the risk of contracting the disease by virtue of employment or life in general. Moreover, the medical opinions proffered by the Employers suggested, at most, an inability to pinpoint the precise cause of Flor's hepatitis C. Such opinions were insufficient to rebut the presumption that Flor's employment as a dental hygienist contributed to the development of her disease. See Jeannette District Memorial Hospital, 668 A.2d at 251-52 (evidence that hospital nurse suffered hepatitis C raised rebuttable presumption that her disability was work-related, and presumption was not rebutted by expert testimony of hospital's witnesses that they were unable to determine cause of claimant's illness); see also Akamine, 53 Haw. at 409-15, 495 P.2d at 1167-68 (physician's testimony that (1) heart diseases originate relatively early in life, (2) pre-existing pathological conditions must have spurred claimant's heart attack, and (3) heart attack could just as well have occurred elsewhere than at work did not rebut presumption of compensability when physician testified that he did not know whether heart attack was related to claimant's work activity). In fact, some of the physicians' proffered opinions acknowledged that Flor probably acquired the virus by virtue of her employment as a dental hygienist. Accordingly, the Employers failed to carry their burden of demonstrating by substantial evidence that Flor's claim was not compensable. That being the case, we hold that Flor's disability, caused by hepatitis C, is compensable under the Workers' Compensation Law, inasmuch as the Employers failed to demonstrate by substantial evidence that Flor's disease (1) was not caused by conditions that were characteristic of or peculiar to her employment as a dental hygienist, (2) did not result from her actual exposure to such conditions, and (3) was not due to causes in excess of the ordinary hazards of employment in general. See supra section III.A. Nevertheless, the Employers argue that, because some of the physicians opined that Flor probably acquired the virus during the early 1980sor even in the 1970s, the employers for whom Flor commenced employment after those time periods lacked a sufficient connection with her disability to be liable for the payment of any workers' compensation benefits. This argument would more properly be raised by the Employers in a proceeding regarding allocation of liability among Flor's employers and/or the Special Compensation Fund, see infra note 10, for her compensation. However, we offer the following observations: [A] medical man may give a generalized opinion that there was no connection between an incident at work and a heart attack, and, in his own mind, may mean thereby that a pre-existing pathological condition was the overwhelming factor in bringing about the attack and that the part played by the work was insignificant. But, while it may be sound medically to say that the work did not `cause' the attack, it may well be bad law, because, in general, existing law treats the slightest factor of aggravation as an adequate `cause.' McNiece, Heart Disease and the Law 135 (1961). [ Akamine, ] 53 Haw. at 410, 495 P.2d at 1167. The primary focus of medical testimony for the purposes of determining legal causation should be whether the employment situation in any way contributed to the employee's injury. Id. at 412, 495 P.2d at 1168. Testimony that a pre-existing heart disease may have been a contributing or precipitating cause of the heart attack should be accorded little probative weight. Id. The only relevant inquiry is whether [claimant's] heart attack in fact was aggravated or accelerated by his work activity. Id. at 413, 495 P.2d at 1169. Chung, 63 Haw. at 652, 636 P.2d at 727-28. The same principles apply in the case of an injury caused by a disease such as hepatitis C. While it may be true that Flor was first exposed to the hepatitis C virus early in her career as a dental hygienist, the record establishes that her contact with potentially contaminated blood continued throughout her employment with the Employers. The testimony adduced by the parties focused on the time when Flor originally contracted the disease. However, nothing in the record suggests that subsequent exposures did not contribute to the ongoing progression of the disease. Ultimately, the cause of Flor's hepatitis C and its precise relationship to each of her employers remains unknowable. None of the Employers, however, carried their burden of demonstrating that Flor's employment with them did not contribute to her disability.