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Meeting the Burden of Proof in a Workers’ Compensation Case

Woman coughing with her hand covering her mouth and her other hand on her heart

The COVID-19 pandemic has led to numerous lawsuits for a variety of reasons, with one major issue being allegations of healthcare providers and systems not following personal protective equipment guidelines, leading to the transmission of COVID-19 and resulting in numerous deaths.

Another significant area where lawsuits were filed was under state workers' compensation laws workers' compensation laws.

As mentioned in a previous blog post, workers' compensation cases are intricate, and the process of reaching a decision after an employee files a claim can be lengthy.

In the following case, the issue wasn’t the timely resolution of the nurse's claim. Instead, the problem for the nurse lay in her inability to provide sufficient evidence to support her assertion that she contracted COVID-19 while working at a nursing center.

COVID-19 and other diagnoses

After completing her most recent shift at the facility, the 63-year-old nurse developed a fever a day or two later and promptly informed her supervisor. The supervisor then directed her to come to the facility for a COVID-19 test.

As she awaited the test results, she believed she was experiencing symptoms of a urinary tract infection (UTI). She sought medical attention, and a doctor diagnosed her with a UTI and prescribed an antibiotic.

The next day the COVID-19 test results indicated she was positive for COVID-19. The nurse was instructed to quarantine at home for two weeks. At the end of the quarantine period the nurse contacted her supervisor and explained that she was still ill and couldn’t come to work. 

The nurse went to a medical clinic with persistent COVID-19 symptoms, including a cough, and was prescribed antibiotics and cough medicine by a nurse practitioner (NP).

About a month or so later, the nurse returned to the medical clinic with continuing symptoms related to COVID-19, including lingering cough, nausea and vomiting, shortness of breath, and extreme fatigue. The NP noted swelling in the left leg. The nurse was diagnosed with a UTI of an “unspecified type.”

The nurse was also referred to a nearby hospital for a Doppler ultrasound of her left leg. The ultrasound did not indicate a blood clot or any other worrisome issues.

Several months later, the nurse returned to the medical clinic with escalating leg pain. The doctor prescribed physical therapy and pain medication. The nurse also complained of persistent fatigue. As a result, the doctor advised her to work only four eight-hour shifts per week until her next visit.

Three months later, the doctor cleared the nurse to return to work without limitations.

Nurse files workers’ compensation claim

The nurse submitted a workers’ compensation claim, asserting that she had "developed a blood clot in her leg" and other "pulmonary injuries" as a result of COVID-19. She claimed that she contracted COVID-19 while employed at the center. In her claim, she requested temporary total disability benefits, permanent partial disability benefits, and medical treatment.

The center and its insurance carrier denied the nurse's claim. A hearing was conducted before a hearing officer to address these issues, including whether the nurse's diagnosis was linked to her employment at the center and whether she was diagnosed with a blood clot.

During the hearing, the nurse stated that she worked in the center's COVID-19 wing. She also mentioned that she believed she was the ninth person to have tested positive for COVID-19 since the start of the pandemic.

Despite this testimony, the nurse could not identify any other individuals she had been in contact with at work who tested positive for COVID-19.

She confirmed that she and the staff adhered to guidelines to prevent the spread of COVID-19 such as wearing N95 masks, face shields, gowns, and gloves. She also testified that aside from going to work, she stayed at home except for one occasion when she got gas at a local station. She did mention that she lived with someone who had never been sick.

The hearing officer determined that the nurse had not provided sufficient evidence to demonstrate that she contracted COVID-19 while at work. Additionally, the officer concluded that the nurse had not proven that she was diagnosed with a blood clot in her leg, and there was no medical evidence linking her leg pain to her COVID-19 diagnosis or her employment.

Following the decision, the nurse appealed to the full workers’ compensation commission for a review of the hearing officer’s ruling. The commission upheld the hearing officer’s decision.

The nurse filed an appeal alleging that the workers’ compensation commission had erred in finding that she had not met the burden of proof. The state court of appeals upheld the decisions of the hearing officer and the full commission, stating that the nurse provided no medical or other evidence to support her claim that she had contracted COVID-19 at the center. 

The court noted that she relied solely on her own testimony and her medical records, which did not substantiate her claim.

Ultimately, the court emphasized that in a workers’ compensation claim, the burden of proof lies with the claimant to establish every element of the claim.

Tips for nurses

This case highlights the importance of fulfilling the burden of proof in a claim alleging that an injury occurred or an illness was contracted while at work. While the nurse did contract COVID-19, she was unable to establish a direct link to her job.

It's crucial to provide clear evidence that an injury or illness arose as a result of and during the course of employment. Additionally, the work-related injury must be supported by medical evidence, which was lacking in this case, according to the appellate court.

Although every worker has the right to file a claim under workers’ compensation statutes, establishing a clear connection between the injury or illness and the workplace is essential to succeed in that claim.

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