What Do You Think?
Employees may be entitled to worker’s compensation benefits if an accident causes an injury that is outside of common knowledge. But they will need reliable medical testimony to show the injury was caused by the accident. A case involving an employee who fell off a ladder suggests the level of reliability a court may require.
The carrier agreed to provide benefits for the wrist and spinal injuries the claimant sustained when he fell. The claimant, however, argued that his compensable injury extended to additional conditions, including a traumatic brain injury which resulted in hallucinations and for which he sought lifetime benefits.
To demonstrate that the TBI was caused by the accident, the claimant provided two letters from doctors. One doctor included a conclusory statement that the claimant suffered a TBI at work, causing hallucinations. The letter was based on the claimant’s statements about how the injury occurred. The doctor expressed uncertainty regarding the precise mechanism of the injury or how the fall caused the TBI. The other letter confirmed that the claimant had a TBI and associated symptoms but didn’t address whether it was job-related.
The court explained that, when it comes to medical conditions outside the common knowledge and experience of laypersons, a claimant must introduce expert testimony to show that the condition was caused by the workplace accident. Further, to constitute evidence of causation, the expert’s opinion must rest in reasonable medical probability.
A district court found that the TBI was compensable. The carrier appealed.
Did the claimant show that his TBI is compensable?
A. No. His doctors didn’t explain how his fall caused his brain injury.
B. Yes. All the claimant needed was one doctor’s statement that the claimant’s workplace accident caused his TBI.
If you selected A, you agreed with the court in American Zurich Insurance Company v. Carrera, No. 04-25-00255-CV (Tex. App. 07/01/26), which found inadequate evidence of causation.
The first letter merely raised a possibility that the claimant’s fall caused a TBI. Also, the doctor wasn’t sure exactly how the TBI resulted from the fall. The fact that the doctor relied heavily on the claimant’s own statements also undermined the reliability of his opinion. The doctor’s opinion on causation did not rest in reasonable medical probability, the court said. As to the other doctor’s letter, it didn’t even address causation.
Also, the letters did not establish that either doctor was qualified to offer an opinion on what causes a TBI. The letters did not indicate that the doctors had the specific knowledge, training and education to offer a reliable opinion on that issue.
For both reasons, the claimant offered legally insufficient evidence to support his argument that the accident caused his brain injury and hallucinations. The court reversed the district’s finding that the additional injury was compensable.
