How Do I Prove My Injury Was Work Related?

Under the Longshore and Harbor Workers’ Compensation Act (Longshore Act), or any workers’ compensation plan for that matter, there is a general rule that a person injured at work will be compensated quickly.  There is, by design, a “no-fault” sensibility surrounding workers’ comp plans.  An injured worker typically does not need to prove in a court of law that his or her injury was directly caused by a work activity.

While that is the general rule, there are always exceptions.  There are times when an employer may challenge or question whether the injury was truly work-related.  For example, say that your injury occurred during a lunch break, during a company off-duty event, or when employees are fooling around during work time.  Those types of gray-area situations show that determining what is or is not “work-related” becomes a more difficult question.

This blog discusses how the Longshore Act process allows an injured worker to demonstrate that he or she was, in fact, injured on the job when confronted with resistance from an employer.  This blog, however, will only provide some basic information about this area of the Longshore Act.

If you need more specific information tailored to your own situation, you need to call the top workers’ comp attorneys in Jacksonville, FL – Doolittle & Tucker, P.A.  Our Doolittle & Tucker Longshore Act attorneys have the kind of expertise you need to make sure there is no question that your injury was work-related.  We pride ourselves on ensuring that you get the workers’ compensation you deserve.  So, when evaluating workers’ comp attorneys in Jacksonville, FL, look no farther than Doolittle & Tucker at 904-396-1734.

The Importance of Evidence

Procedural crime television shows and courtroom dramas give us a certain sense of how lawyers behave in the courtroom, and how evidence is used to prove a case.  The TV shows and movies make evidence seem exciting as they present a picture that there is always a smoking gun that will either win the day for you, or utterly destroy your case.  It is all very dramatic.

Reality, however, can be a little different, and certainly a lot less dramatic.  Typically in any case, whether it is a criminal robbery or a Longshore Act workers’ compensation dispute, there is a lot of evidence through which the parties need to sift.  There is normally no single smoking gun.  A sense of where the truth lies can be found when all the evidence is presented together.

All of that is to say that when you are getting resistance from an employer’s insurance company with regard to a Longshore Act workers’ compensation claim, you would be wise to marshal all of the facts that help your case.  In addition, make sure you are aware of any evidence that might be used against you.  For example, say that you fell at work, and you failed to tell the examining doctor during the initial examination about a particular shoulder injury that resulted from your fall.  That fact may be used against you later on.  Be sure that you know all the facts so that you are prepared to address any such credibility issues.

The Proof Process Under the Longshore Act

There are generally three phases with regard to proving that your injury was work-related.  You do not need to go through all three phases.  Sometimes your case is resolvable after just one or two phases.  Here’s how it works.

  1. Phase One – Your Claim Creates a Presumption

The first thing you should do after you suffer an injury at work – after you get any necessary medical attention, of course – is to file a workers’ comp claim.  The Department of Labor has certain forms and deadlines for such a claim under the Longshore Act (our other blogs go into detail about how to file a claim under the Longshore Act).

In your claim, you have the opportunity to specify what occurred at work and what injury resulted.  Once you have filled out that claim, a “presumption” takes effect.  That means, specifically, that as long as you state that (i) you suffered some harm and (ii) a work-related condition or accident occurred which could have caused the harm, then your view of the facts is presumed to be true.  In legal terms, we call that making a prima facie case of compensable injury.

In some cases, the employer may not challenge your claim, and, thus, the presumption holds and you are entitled to compensation.  However, an employer may take issue with the claim, meaning that we must move to Phase Two.

  1. Phase Two – Employer Rebuts the Presumption

The employer, who disagrees that your injury is work related – thereby challenging the presumption that your claim is true – has the burden of providing “substantial evidence” to rebut that presumption.  In other words, the employer needs to have evidence showing that your working conditions neither caused your injury, nor aggravated a pre-existing injury.  An example of “substantial evidence” to rebut the presumption could be testimony from a physician, stating that there is no relationship between your injury and your working conditions.

If the employer presents “substantial evidence,” that does not mean that the case is over.  Of course, you may choose not to pursue the claim any further in the face of the employer’s response.  But in terms of your claim, the employer has only rebutted the presumption of the truth of your claim.  They have not won the case.  Please note that if you have gotten to Phase Two, it is likely that your Longshore Act claim is now before an adjudicating body, like an administrative law judge.  Now, let’s go to Phase Three.

  1. Phase Three – Weighing All the Evidence

At Phase Three, assuming that you are now trying your claim before an administrative law judge (ALJ) from the Department of Labor, the ALJ must now weigh all the evidence together.  The goal for the ALJ is to resolve the question of whether your injury was caused by your working conditions.

The ALJ may find that the employer did not provide “substantial evidence” to rebut the truth of your claim.  Then, you get the benefit of the presumption and are eligible for compensation.  However, if the ALJ decides that the employer has provided “substantial evidence,” then the presumption goes away.  And, as noted, the ALJ will make a decision based on all of the evidence.

Without the presumption in your favor, you need to work more diligently to prove that your injury was work related.  That requires the help of an experienced workers’ comp attorney.

Accordingly, we welcome you to call the best workers’ comp attorneys in Jacksonville, FL – Doolittle & Tucker.  We can be reached for a free case review at 904-396-1734. Call today.