Fidelity & Guaranty Insurance Underwriters, Inc. v. La Rochelle
587 S.W.2d 493, 1979 Tex. App. LEXIS 4085 (1979)
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Rule of Law:
For a worker's compensation claim in Texas, an injury must be proven to be "accidental," necessitating a specific jury instruction and definition; however, recreational activities may fall within the "course of employment" if they occur on the employer's premises during a regular break with employer approval, and a jury's common experience may be sufficient to establish causation without expert medical testimony.
Facts:
- Nine months before the incident in question, Michelle La Rochelle injured her lower back (diagnosed as a protruding disc) while working for a different employer.
- La Rochelle opted for several months of bed rest instead of surgery for her prior back injury and later returned to work.
- In July 1976, La Rochelle became an employee of Del-Mar Scientifics, Inc., where she built monitors and detectors.
- Del-Mar Scientifics, Inc. provided a ping-pong table for employees to use for recreation during lunch and other work breaks on the employer's premises.
- On November 8, 1976, during an afternoon work break, La Rochelle engaged in a game of ping-pong in a building next to her workplace, but still on Del-Mar Scientifics, Inc.'s premises.
- Shortly after the ping-pong game, La Rochelle experienced pain in her lower back, was again treated for a disc condition, and subsequently underwent surgery.
- During the surgery, a degenerated disc condition was discovered, two discs were removed, and a spinal fusion was performed.
- La Rochelle initially filed a group-health insurance claim and a worker's compensation claim against her former employer, contending the disc condition was a result of her earlier injury; she later filed the current worker's compensation suit against Del-Mar Scientifics, Inc. and Fidelity & Guaranty Insurance Underwriters, Inc., claiming an "accidental" injury from the November 8, 1976 ping-pong game.
Procedural Posture:
- Michelle La Rochelle sued Fidelity & Guaranty Insurance Underwriters, Inc. on a worker’s compensation claim in a trial court.
- Trial was to a jury, which found in favor of Michelle La Rochelle.
- The trial court rendered judgment on the verdict for Michelle La Rochelle.
- Fidelity & Guaranty Insurance Underwriters, Inc. appealed the trial court's judgment.
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Issue:
1. Does a trial court err by refusing to submit a special issue to the jury inquiring whether an employee's injury was "accidental" and failing to provide a definition for "accidental" in a worker's compensation case? 2. Can an injury sustained by an employee while playing ping-pong on the employer's premises during an afternoon work break be considered to have occurred "in the course of employment" for worker's compensation purposes? 3. Is expert medical testimony always required to establish a causal connection between an employee's activity and an injury in a worker's compensation claim?
Opinions:
Majority - Robertson, Justice
1. Yes, the trial court erred in refusing to submit a special issue inquiring whether Michelle La Rochelle's injury was "accidental" and in failing to provide a definition of "accidental" to the jury. 2. No, the jury's finding that the injury occurred within the course of employment was supported by the evidence. 3. No, expert medical testimony is not always required to establish a causal connection between an act and an injury in worker's compensation cases. The court held that Olson v. Hartford Accident and Indemnity Co. is controlling, which established that to have an accidental injury, there must be an "undesigned, untoward event traceable to a definite time, place and cause." Therefore, the proper jury issue must inquire about an "accidental" injury and include its definition. The court acknowledged that this is a harsh result that places an additional burden on claimants but stated that as an intermediate appellate court, it is bound by Supreme Court authority. Regarding the course of employment, the court referenced Tex.Rev.Civ.Stat. Ann. art. 8309, § 1(4) and applied the rule from Clevenger v. Liberty Mutual Ins. Co. (quoting Professor Larson), stating that "recreational or social activities are within the course of employment when (1) they occur on the premises during a lunch or recreation period as a regular incident to the employment." Given that Del-Mar Scientifics, Inc. permitted ping-pong on its premises, regulated its use, and games occurred regularly, the facts were sufficient to satisfy this definition. Finally, concerning causation, the court clarified that Parker v. Employers Mutual Liability Insurance Company does not mandate expert medical testimony for showing injury. It stated that expert opinion is not conclusive or necessary except for matters of scientific fact, and a claimant's factual testimony alone can support a finding of disability. The jury's common experience and knowledge are sufficient to determine causation in many areas.
Dissenting - Carver, Justice
I agree with the majority that the trial court erred in failing to submit an issue and definition of "accidental injury" to the jury. However, I disagree with the majority's conclusion that the ping-pong game, merely permitted or tolerated by the employer, was an activity "having to do with and originating in the work, business, trade or profession of the employee" or received "while engaged in or about the furtherance of the affairs or business of his employer." I also disagree with the majority's holding that the claimant, with only ordinary human experience, can prove an injury occurred when there was no event from which an injury could ordinarily be inferred by common sense. Justice Carver argued that the majority's reliance on Larson's treatise and Clevenger v. Liberty Mutual Ins. Co. for the "course of employment" rule was misplaced. He contended that Clevenger involved a company picnic where attendance was strongly urged by superiors, making it an intentional part of the job. He asserted that recreation (and its risks) is not part of the job unless "the employer makes it so," citing other Texas cases like Campbell v. Liberty Mutual Ins. Co. and Employer’s Mutual Liab. Ins. of Wis. v. Sanderfer which applied this stricter test. He believed that recreation chosen by an employee and merely permitted or tolerated by the employer should not be covered. Additionally, Justice Carver contended that given La Rochelle's pre-existing ruptured disc and degenerated disc, and surgery that failed to reveal any new injury from the ping-pong game, ordinary human experience or common sense was insufficient to establish causation. He argued that under these circumstances, only competent medical testimony, as directed by Parker v. Employers Mutual Liberty Insurance Company of Wisconsin, could show the cause in fact of the disability.
Analysis:
This case significantly clarifies the strict requirements for proving an "accidental injury" in Texas worker's compensation, emphasizing adherence to the Supreme Court's definition even if considered burdensome for claimants. It broadens the scope of "course of employment" for recreational activities by establishing a clear test based on employer approval, regularity, and on-premises occurrence, moving beyond a strict requirement of employer compulsion. Furthermore, the decision reinforces the jury's role as the primary finder of fact regarding causation in injury cases, limiting the instances where expert medical testimony is deemed absolutely necessary.
