Alabama Court of Civil Appeals Addresses Medical Causation
On April 13, 2012, the Alabama Court of Civil Appeals released its opinion in Maxim Healthcare Services, Inc. v. Freeman, in which the Court addressed an employee’s burden of proof as to medical causation of an alleged injury. Freeman worked as a LPN for Maxim Healthcare Services, Inc., a nursing referral agency. In December 2008, she was allegedly lifting a patient from a toilet to place her in a wheelchair when the wheelchair moved, causing Freeman to over-extend herself. As a result, Freeman complained of a burning sensation in her lower back that extended into her hips and legs. Freeman filed a lawsuit against Maxim for workers’ compensation benefits. The parties stipulated that Freeman suffered an injury to her left hip and leg but Maxim denied that Freeman’s alleged back problems were the result of any compensable accident. At trial, the Court received the testimony of Freeman’s authorized treating physician and her own personal primary care physician. The authorized treating physician testified that some of Freeman’s back pain was pre-existing but some of it was related to the accident. However, the authorized treating physician further testified that she had ordered an FCE for Freeman and that the FCE showed that Freeman could return to work without restrictions. Freeman’s personal physician testified that in his opinion, the December 2008 accident was the source and cause of Freeman’s back pain. The primary care doctor admitted that he lacked the qualifications to disagree with the authorized treating physician’s opinions, and stated that he "deferred to her opinions and conclusions", as well as the results of the FCE. The trial Court found that Freeman established both legal and medical causation, and Maxim appealed, arguing that the testimony of Freeman and her primary care doctor was insufficient to establish medical causation.
In its appeal, Maxim relied on the holdings of three particular cases: Ex parte Southern Energy Homes, Inc., 873 So. 2d 1116 (Ala. Civ. App. 2003); Jackson Landscaping, Inc. v. Hooks, 844 So. 2d 1267 (Ala. Civ. App. 2002); and Valtex, Inc. v. Brown, 897 So. 2d 332 (Ala. Civ. App. 2004).
In its decision in Freeman, the Court noted that although the Court in Ex parte Southern Energy Homes had previously found that a worker’s testimony standing alone did not constitute substantial evidence of medical causation, the facts of Freeman were different in that the testimony of Freeman’s primary care physician established a causal link between the December 2008 accident and Freeman’s complaints of back pain. The Court also differentiated the facts in Freeman from those in Hooks by stating that in Hooks, one of the doctors testified that the workers’ back injury was not related to his on the job accident and the other doctor testified that there was a possibility that there could have been a causal relationship between the accident and the injury. In contrast, one of Freeman’s physicians testified that he could state within a reasonable degree of medical certainty that Freeman’s back pain was the result of the accident. Additionally, the Court noted that, in Hooks, the employee did not complain of back pain until almost sixteen months after the alleged accident, whereas Freeman began complaining of back pain immediately following her accident. Finally, the Court in Freeman differentiated this case from the facts of Brown, in that Brown was a non-accidental injury case where the worker was required to produce clear and convincing evidence of medical causation. The Court in Freeman held that since Freeman had established that an accident occurred, she only had to establish medical causation by a preponderance of the evidence, and that her primary care physician’s testimony, along with her own testimony, was sufficient to meet that burden of proof. Based on these findings, the Court of Appeals affirmed the trial Court’s judgment.