eNotes: Workers’ Compensation – January 2025 – West Virginia

SIGNIFICANT CASE SUMMARIES

West Virginia Case Summaries

Carter v. Humana, Inc.
Intermediate Court of Appeals of West Virginia
Case No. 2056-23-2

Decided: Dec. 23, 2024

Claim denial is appropriate when a Claimant fails to show she is at an increased risk of injury in her employment as the injury is not causally related to her employment.

Background

The Claimant alleged to have sustained a knee injury when standing from a couch while at a client’s home. The claim administrator denied the claim on the basis that the Claimant was not injured as a result of her employment, and the claim was therefore missing the requisite causal element of a valid workers compensation claim. The Workers’ Compensation Board of Review affirmed the claim administrator’s order, finding that the evidence did not establish the knee injury occurred as a result of the Claimant’s employment and that there was no increased risk for the Claimant in standing up from the sofa, which was not unique to her employment, nor did she face an increased quality of risk. The Claimant appealed to the Intermediate Court of Appeals.

Holding

The Intermediate Court of Appeals of West Virginia upheld the Board of Reviews’ opinion that the Claimant’s injury did not result from her employment, citing Hood v. Lincare Holdings, Inc., 249 W. Va. 108, 894 S.E.2d 890 (2023). Although the Claimant was at work at the time of her alleged injury, there was insufficient evidence to establish a causal relationship between the injury and her work under the increased risk doctrine. The Claimant argued that the couch was unusually low which caused her to twist her knees, causing a higher risk of injury, but the Court rejected this argument. On the contrary, the Court held that simply standing up from sitting on a couch was not an increased risk.

Takeaway

The Court directly cites to the Hood v. Lincare case and utilizes the increased risk doctrine in its holding here. The Court affirmed the Board’s analysis of the causal relationship under this doctrine. This case now stands as an example of the application of the increased risk doctrine. While the increased risk doctrine is not a mandatory step of a causality analysis, when the factfinder opts to utilize it, it does provide significant discretion to factfinder.

Questions about this case can be directed to Evan Jenkins at (412) 697-7403 or ejenkins@tthlaw.com.