In a far-reaching decision that will benefit workers’ compensation carriers in Connecticut, the Connecticut Supreme Court in Sapko v. State of Connecticut et. al., SC 18680, held that the superseding cause doctrine applies to certain cases under the Workers’ Compensation Act C.G.S § 31-275 et seq. The Court further opined that a claimant’s overdose of a prescription medication cocktail (that included prescriptions taken for unrelated work injuries) broke the chain of proximate causation between the claimant’s compensable work-related injury and his death.
In a workers’ compensation claim, a claimant’s spouse and descendents will typically bring a claim for survivors’ benefits pursuant to C.G.S. § 31-306 if they believe that the death was the result of the claimant’s work-related injury. In Sapko, the claimant was employed by the state of Connecticut as a corrections officer from 1995 until 2006. During his tenure, the claimant filed four workers’ compensation claims for benefits. The final claim made was following a May 16, 2006, incident in which the claimant injured his back. The claimant was taking a host of drugs for pain management, including Oxycodone, Zanaflex, Kadian, Celebrex, Roxicodone, Avinza, Lidoderm Patches and Duragesic.
In 1999, while the claimant was a corrections officer, he began to see a psychiatrist in connection with treatment for depression. This treatment was unrelated to any workers’ compensation claim. On August 9, 2006, the claimant’s psychiatrist prescribed Seroquel for mood stabilization. Nine days later, the claimant died of multiple drug toxicity due to the interaction of excessive doses of Oxycodone and Seroquel. [Registered trademark symbols omitted on all brand names.]
In Sapko, the Connecticut Supreme Court considered the issue of whether the compensable work injuries of the claimant were the proximate cause of the claimant’s death or whether the ingestion of excessive quantities of Oxycodone and Seroquel constituted a superseding event, cutting off the carrier’s liability. In doing so, they also analyzed whether the superseding cause doctrine applied to certain parts of the Workers’ Compensation Act.
Under the superseding cause doctrine, the responsibility of one negligent tortfeasor can be shifted entirely to another tortfeasor (or other force) when the second tortfeasor’s conduct is found to be the causative factor of the injuries alleged. Connecticut is normally a comparative negligence state that disposed of the superseding cause doctrine in connection with tort claims. However, the issue of whether the superseding cause doctrine still applied to workers’ compensation claims was unsettled.
In analyzing the appropriateness of applying the superseding cause doctrine to workers’ compensation cases, the Court looked to the law of other jurisdictions as well as its own and found that the majority of courts in subsequent injury cases have followed the “direct and natural consequence rule.” The direct and natural consequence rule states that a subsequent injury is compensable if it is the direct and natural result of a compensable primary injury. Further, the chain of causation can be broken only by intentional or negligent employee conduct, which is not either expressly or impliedly forbidden by the employer, and that does not stem from a quasi-course activity (e.g., an activity such as traveling to the doctor for treatment of the primary injury).
The Court noted, however, that the analysis of whether a subsequent injury is a direct and natural consequence of the original, compensable injury is necessarily one that is fact driven. Therefore, the Court, as is appropriate, gave enormous import and deference to the opinion of the trial commissioner. Of additional interest, the Court, almost as an afterthought, indicated that unless causation under the facts of the case is a matter of common knowledge, the claimant has the burden of introducing expert testimony to establish a causal link between the compensable workplace injury and the subsequent injury.
Applying these rules to the facts of the case, the Court determined that the commissioner had appropriately ruled that the ingestion of excessive quantities of Oxycodone (prescribed for treatment of the worker’s compensable injury) and Seroquel (prescribed for the worker’s unrelated psychiatric treatment) constituted an intervening event that broke the chain of causation. The Court considered the commissioner’s findings of fact and, in particular, his reliance on the testimony of a medical expert who opined that the elevated level of Oxycodone by itself would likely not have been fatal had the claimant not overdosed on Seroquel as well. Thus, the Court held that it was reasonable for the commissioner to find that the decedent ingested excessive quantities of Oxycodone and Seroquel for reasons that bore no relationship to his employment-related injury.
The Supreme Court’s decision in Sapko will provide some precedent for workers’ compensation carriers when defending claims that involve injury or death to a claimant as a result of accidental or intentional overdose of pharmaceuticals prescribed for treatment of a compensable injury. It is worth noting that the success of challenging accidental or intentional overdose cases will be highly fact-specific.
The fact that the court formally adopted the “superseding cause” doctrine and the “direct and natural consequence” doctrine for use in the workers’ compensation arena is an important development. It remains to be seen how far the decision in Sapko will extend. What is clear, however, is that great deference is paid to the findings of the trial commissioner and, therefore, a vigorous and well-organized defense at the trial level will be invaluable.