Tyler Halsey v. Townsend Tree Service Company, LLC

(Affirming Award and Decision of Administrative Law Judge with Supplemental Opinion)

**Injury No. 16-053905**

**Employee:** Tyler Halsey (deceased)

**Employer:** Townsend Tree Service Company, LLC

**Insurer:** Ace American Insurance Company

This workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 287.480 RSMo. Having read the briefs, reviewed the evidence, heard the parties' arguments, and considered the whole record, we find that the award of the administrative law judge allowing compensation is supported by competent and substantial evidence and was made in accordance with the Missouri Workers' Compensation Law. Pursuant to § 286.090 RSMo, we affirm the award and decision of the administrative law judge with this supplemental opinion.

We find, as a factual matter, that while employee's obesity may have contributed to his heat stroke and resulting collapse and death, his work outside as a laborer in extremely hot weather on July 22, 2016, constituted an unexpected traumatic event or an unusual strain and was the prevailing factor in causing both employee's heat stroke and resulting collapse and death. We note that the exclusion from category of compensable injuries of an injury resulting directly or indirectly from idiopathic causes is in the nature of an affirmative defense to the employer and is not the employee's burden to prove. *Gleason v. Treasurer of the State*, 455 S.W.3d 494, 502. (Mo. App. 2015).

We affirm the administrative law judge's finding that employee's heat stroke and death arose out of and in the course of employee's employment with employer and, accordingly, is compensable under Chapter 287.

This clarification of the administrative law judge's award does not detract from her correct analysis of the evidence in the record or her ultimate legal conclusions.

We affirm and adopt the award of the administrative law judge as supplemented herein.

The award and decision of Administrative Law Judge Maureen Tilley, dated July 31, 2019, is attached and incorporated herein to the extent not inconsistent with this supplemental decision.

Given at Jefferson City, State of Missouri, this **9th** day of April 2020.

**LABOR AND INDUSTRIAL RELATIONS COMMISSION**

**Robert N. Cornejo, Chairman**

**Reid K. Forrester, Member**

**Shalonn K. Curls, Member**

---

**Attest:**

**Secretary**

Employee: Tyler Halsey

Injury No. 16-053905

ISSUED BY DIVISION OF WORKERS' COMPENSATION

FINAL AWARD

Employee: Tyler Halsey (deceased)

Injury No. 16-053905

Dependents: N/A

Employer: Townsend Tree Service Company, LLC

Additional Party: N/A

Insurer: ACE American Insurance

Hearing Date: April 29, 2019

Checked by: MT/kg

SUMMARY OF FINDINGS

1. Are any benefits awarded herein? Yes

1. Was the injury or occupational disease compensable under Chapter 287? Yes

1. Was there an accident or incident of occupational disease under the Law? Yes

1. Date of accident or onset of occupational disease? July 22, 2016

1. State location where accident occurred or occupational disease contracted: Poplar Bluff, Butler County, Missouri

1. Was above employee in employ of above employer at time of alleged accident or occupational disease? Yes

1. Did the employer receive proper notice? Yes

1. Did accident or occupational disease arise out of and in the course of the employment? Yes

1. Was claim for compensation filed within time required by law? Yes

1. Was employer insured by above insurer? Yes

1

Employee: Tyler Halsey

Injury No. 16-053905

1. Describe work the employee was doing and how accident happened or occupational disease contracted: Employee was trimming trees and chipping and hauling brush in extreme heat when he collapsed from a heat stroke and died the next day.

1. Did accident or occupational disease cause death? Yes

1. Parts of body injured by accident or occupational disease: Death case

1. Nature and extent of any permanent disability: N/A

1. Compensation paid to-date for temporary total disability: None

1. Value necessary medical aid paid to date by employer-insurer: The employer voluntarily paid medical expenses of $18,322.20

1. Value necessary medical aid not furnished by the employer-insurer: None

1. Employee's average weekly wage: 360.00

1. Weekly compensation rate: 240.00

1. Method wages computation: By agreement

1. Amount of compensation payable: See award

1. Second Injury Fund liability: N/A

1. Future requirements awarded: None

Employee: Tyler Halsey

Injury No. 16-053905

On April 29, 2019, attorneys, Kirk Presley, Sean Brown, and C.H. Parsons appeared, on behalf of the deceased Employee, for a hearing for a final award. The employer was represented at the hearing by its attorneys, George P. Coughlin and William Lemp.

At the time of the hearing, the parties agreed on certain undisputed facts and identified the issues that were in dispute. These undisputed facts and issues, together with the findings of fact and rulings of law, are set forth below as follows:

1. **Covered Employer:** Employer was operating under and subject to the provisions of the Missouri Worker's Compensation Act and liability was fully insured by ACE American Insurance Company.
2. **Covered Employee:** On July 22, 2016, Employee was an employee of Townsend Tree Service Company, LLC, and was working under the Workers' Compensation Act.
3. **Notice:** Employer had notice of Employee's accident.
4. **Statute of Limitations:** Employee's claim was filed within the time allowed by law.
5. **Average Weekly Wage and Rate:** Employee's average weekly wage was 360.00, resulting in a Death Rate Wage of 240.00.
6. **Voluntary medical expenses:** The voluntary medical expenses amounted to $18,322.20.
7. **Voluntary expenses:** Voluntary funeral expenses were paid by Employer-Insurer in the amount of $5,015.61.
8. **Dependents:** There are not any dependents entitled to death benefits.

1. **Accident:** Whether on or about July 22, 2016, the employee sustained an accident or occupational disease arising out of and in the course of his employment.
2. **Medical Causation:** Was Employee's injury and death medically causally related to an accident?
3. **Idiopathic Involvement:** There is a dispute as to whether obesity contributed directly or indirectly to Employee's death and whether obesity qualifies as an idiopathic condition.
4. **Compensability:** Whether the claim is compensable under the Missouri Workers' Compensation Law.

The following exhibits were offered and admitted into evidence:

MNKOI 0001610998

1. Autopsy report
2. Subpoena for deposition of Dr. Russell Deidiker
3. Deposition notice of Dr. Russell Deidiker
4. Quick Entry Report
5. Medical records of Tyler Halsey
6. Mayo Clinic document
7. Certificate of Death
8. Deposition notice of Dr. Kenneth Studyvin
9. Butler County EMT records
10. Heat related claims
11. Tyler Halsey job application
12. Townsend job briefing
13. Photograph of house where injury occurred
14. Satellite photograph of house where injury occurred
15. Deposition notice of Dr. Florence Doman
16. Notes of Dr. Florence Doman
17. Report of Dr. Douglas Casa
18. OSHA report dated 9-1-2017
19. Deposition notice of Dr. John Jardine
20. Dr. John Jardine's CV
21. Report of Dr. John Jardine
22. Excerpts of Tyler Halsey's medical records

A. Tyler Halsey's Death Certificate

B. Physician notes

C. Autopsy report

D. Weather conditions on 07-22-2016

E. Dr. Russell Cantrell's CV

F. Report of Dr. Russell Cantrell

1. Stipulation of facts
2. Photograph
3. Transcript of the deposition of Russell Deidiker, MD
4. Transcript of the deposition of Kenneth Studyvin, MD
5. Transcript of the deposition of Douglas Casa, PhD
6. Transcript of the deposition of Florence Doman, MD
7. Transcript of the deposition of John Jardine, MD

Employee: Tyler Halsey

Injury No. 16-053905

1. Transcript of the deposition of Jeffrey Richardson

1. Transcript of the deposition of Christopher Bennett

1. Transcript of the deposition of Russell Cantrell, MD

The employee, Tyler Halsey ("Employee"), was 23 years old at the time of his death. He was born on September 29, 1993. He weighed approximately 300 pounds and stood 6'1" in height. Employee had never married and had no dependents.

Townsend Tree Service Company, LLC ("Townsend Tree") is an Indiana limited liability company with headquarters in Muncie, Indiana. Townsend Tree provides tree trimming, clearance and integrated vegetation management services for power companies. In July of 2016, Employee was hired by Townsend Tree as a groundsman to work in and around Poplar Bluff, Butler County, Missouri. His job included tree trimming, brush and limb chipping/removal, and other activities associated with Townsend Tree's contract with a local electrical cooperative to remove obstacles around or near electrical lines. Employee's first day at work was July 19, 2016. Prior to that date, Employee had not worked in four years. Employee worked approximately 10 hours a day from July 19-22, 2016. That week was extremely hot. The heat index temperatures during the afternoon of July 22, 2016 in Poplar Bluff ranged from 111 degrees to 114 degrees.

July 22, 2016 was one of the hottest days of the year in Southeast Missouri. The heat index temperature at 2 p.m. that day was approximately 114 degrees. Employee was performing his duties well and was not experiencing any difficulty dealing with the heat on Tuesday, Wednesday, and Thursday. That changed on Friday. While Employee was "all right" at the beginning of the shift that day, his condition changed for the worse after lunch. By the afternoon on Friday, Employee was suffering from heat exhaustion. His fellow employees were similarly feeling the effects of the heat that day and were only able to work for approximately 20 minutes before taking water breaks. Around 4 p.m., Employee was asked to collect some caution signs and in the process of doing so he passed out. A 9-1-1 call was initiated, and EMS was dispatched to the location. Employee was transported to the Poplar Bluff Regional Medical Center, where he died the next day, July 23, 2016. The cause of death was listed as hyperthermia.

The medical records at Poplar Bluff Regional Medical Center noted a chief complaint of unresponsiveness. It was documented that Employee had been cutting trees at work all day, for a tree service company, and then became unresponsive. When he initially presented to the emergency room, his rectal temperature was 108 degrees. He was placed in ice and cooling bath and his temperature subsequently dropped to 105.4 degrees. He was noted to be tachycardic in

Employee: Tyler Halsey

Injury No. 16-053905

the 190s and after three liters/bolus of saline, it decreased to 160, and after an additional three liters, it decreased to the 140s. It was noted that he had been intubated, as he was not able to support his airway. His total CPK was 4,362. He was noted to have a past medical history of morbid obesity, bipolar disorder, and psychosis. On that examination, he was intubated, but it was noted on admission that his blood pressure was 120/90. His urine drug screen was reported to be negative. Dr. Florence Doman provided clinical assessments that included hyperthermia, noting that he had apparently had a heat stroke and had a syncopal episode and became unresponsive. He was described as having acute respiratory failure and acute kidney injury with rhabdomyolysis. It was noted that he was oliguric related to his heat injury. There were no reports of him having diabetes mellitus. It was further noted that EMS had reported that they had received a call for him being unresponsive and that he had been working outside all day cutting trees, and co-workers noted him going down and assisted him to the ground. His red blood cell count and hemoglobin were within normal limits. The medical records also reported that Employee had never before experienced a heat stroke or heat exhaustion.

A discharge summary dated July 23, 2016 documented that when Dr. Doman saw him for the first time, he was having agonal breathing and did not require sedation. His pupils were fixed and dilated. After some time, his parents showed up, along with his sisters. It was noted that he was made a Do Not Resuscitate and he subsequently died on July 23, 2016. The Death Certificate for Employee listed the manner of death as "accident."

Dr. Russell Deidiker

Russell Deidiker, MD was deposed on October 19, 2017. Dr. Deidiker is a forensic pathologist. He noted that he had conducted an autopsy on Employee in July of 2016. He noted that the purpose of the autopsy was to provide an impartial determination of the cause of death. He indicated that he had been contacted by the county coroner to perform the autopsy, specifically Jim Akers of the Butler County Coroner's Office. He described the process of an autopsy, noting that with the exception of a trace amount of ethanol in his blood, his toxicology was negative and there was nothing in the toxicology results that indicated a cause of death. He further noted that internal examination revealed no significant disease processes, noting that his heart had some mild and early hypertensive changes, his liver showed some fatty change, and there was congestion in various organs, which was not uncommon, but not specific to any disease or death process. He noted that the findings of early autolysis, which he noted in the organs such as the kidneys, pancreas, and adrenal glands, was a soft finding in someone who died of hyperthermia or increased body temperature, but was not specific for any cause of death. Following his autopsy and based on information available to him, he opined that Employee had died of hyperthermia or increased body temperature. He concurred that Employee was obese and also acknowledged that obesity was a risk factor in developing hyperthermia. Upon further questioning, he noted that on his examination of the heart, it was grossly normal. Dr. Deidiker identified Employee's manner of death as "accident."

Dr. Kenneth Studyvin

The video deposition of Kenneth Studyvin, MD was taken on December 29, 2017. Dr. Studyvin indicated that he was a physician practicing in emergency medicine. He noted that he

**Injury No. 16-053905**

was employed with Poplar Bluff Regional Medical Center in their emergency department and that he had provided treatment to Employee. He noted that he was the physician in charge of Employee's care upon arrival to the emergency department and that Dr. Doman was a hospitalist that took care of patients once admitted. He noted that observations he had made of Employee when he arrived in the hospital were a very high body temperature and that he was unresponsive. He had an endotracheal tube in place and his heart rate was rapid, and with all those findings, it was assumed that it was due to hyperthermia, describing hyperthermia as simply an elevation in body temperature and distinguishing that from other forms of exhaustion or heat stroke. He confirmed that at no time was Employee able to answer any questions. Reference was made to some laboratory studies, including a BUN and creatinine of 28 and 3.9, which indicated probable renal failure and possibly some dehydration also. He reported that treatment provided to him included large volumes of IV fluids, cooling blankets, and ice bags in an attempt to lower his body temperature, indicating that the IV fluids were both to help correct fluid deficit and to lower his temperature as well. With those treatments, Employee's temperature eventually lowered to 101.5 degrees and his heart rate dropped from the 190s to the 140s. He noted that some of the symptoms of hyperthermia included elevated heart rate, elevated body temperature, sometimes profuse sweating, perspiration, altered mental status, and decreased urinary output dependent upon severity. He noted that hyperthermia resulted in the body's inability to regulate functions at the cellular level and could affect the entire body in every organ and every cell. Employee's body mass index was referenced as 41.35, noting that his weight was not taken in the emergency department, but may have been taken on a bed scale in the intensive care unit. It was his belief that the cause of Employee's death was hyperthermia.

The deposition testimony of Christopher (Eric) Bennett was taken on February 13, 2018. In his deposition, he reported that he knew Employee, having dated Employee's sister in 2006. He reported that he last worked for Townsend Tree in October of 2017, having begun working for Townsend Tree in 2015. He testified that Employee's parents had been asking him to get their son a job for a long time and if an opportunity ever came up, he would give him one, and an opportunity finally arose. His first day working was July 19, 2016. It was noted by Mr. Bennett that Employee had been out of a job since he left Faurecia. He noted that Employee had not been employed for the last four years prior to his work at Townsend Tree, and that he had put on some weight over the years related to playing video games. He reported that on Tuesday, July 19, 2016, he split off from Employee and went to work with another crew, where he worked for half a day, and around 3:00 he was dropped back off with Jeffrey Richardson and Employee. At that time, he noted that Employee was performing ground work and Mr. Richardson was in the bucket truck. He estimated that the temperature on that day was in the 90s. Mr. Bennett described that in the beginning of Employee's employment, Employee was "doing really good up until Friday." He quit around lunchtime on Friday, after which Mr. Bennett gave him what he described as a "like a brother talk" and therefore Employee stayed, but around 3:30 p.m. he quit working and sat in the shade. Later around 4:00 p.m., Bennett asked Employee to collect some caution signs, at which point Bennett described him as crumbling and he was not making sense. It was his estimation that it was 100°, with a heat index up to 115° that day. He noted that on days like that, especially in the summertime, it would be miserable and that you could drink water and "drink, drink, drink" and it still would not be enough. He described his co-employees

**Injury No. 16-053905**

as getting cranky on that day and that everybody was feeling the effects of heat by lunchtime. Mr. Bennett himself said he "was about to pass out" around the time Employee collapsed. He reported that his co-worker, Mr. Richardson, had called the ambulance while he tried to take care of Employee once he collapsed, and by the time ambulance personnel arrived, Employee was described by Mr. Bennett as gasping for air.

Jeffrey Richardson noted that he had come and gone from Townsend Tree a few times, estimating that altogether he had worked about five years, and he had just returned back to work for Townsend Tree on July 18. He reported that on the date of July 22, he was reporting to Travis Burpo, but had not met him until that week. He knew that Employee had not worked at a job for three to four years prior to his employment with Townsend Tree. He did not recall receiving any heat-related training. He described the progression of the day at work on July 22, noting that it was so hot that day that he could not work longer than 20 minutes before having to stop and take water breaks. He also recalled that the heat index that day was 115°. He noted that like Eric Bennett, he also provided Employee some words of encouragement when he expressed interest in quitting, and he also encouraged him to keep going and see how he could do. He noted that at the start of the day, they picked up a truck, got to a gas station for fuel, and checked the water, which was still half full from the day before and still had some ice in it, and therefore he determined that no additional water was needed, but later in that day, he recalled that they were frequently drinking water and he believed that the last time he went up on a tree, Employee had been walking over to the truck and heard him yell that they were out of water, after which a neighbor used a hose to fill up their water. He described his recollection of the events that occurred leading up to Employee passing out at the job site. Richardson noted that he himself was feeling "woozy" on Friday afternoon because of the extreme heat.

The deposition testimony of Dr. Florence Doman was taken on April 18, 2018. She noted that she was one of the doctors that treated Employee in July of 2016. When she first saw Employee, he was on a ventilator, his pupils were fixed and dilated, and he was unresponsive. She discussed her diagnoses, including hyperthermia, heat stroke, acute respiratory failure, where he was not breathing on his own, and an acute kidney injury that was due to rhabdomyolysis, a break-down of muscle tissue, noting that in that context, a side effect of rhabdomyolysis was metabolic acidosis.

The deposition testimony of Dr. Douglas Casa was taken on April 25, 2018. He was a professor at the University of Connecticut. He taught classes on exertional heat stroke and preventing sudden death in sport and physical activity, as well as legal issues of sudden death in sport. In his deposition, Dr. Casa described exertional heat stroke as a medical condition related to someone's body temperature becoming dangerously high and staying there for an extended period of time, causing long-term complications, which he distinguished from classic heat stroke in which infants or elderly individuals were typically involved. Dr. Casa noted that he was not a

Employee: Tyler Halsey

Injury No. 16-053905

medical doctor but had been hired for an OSHA investigation. In his deposition, Dr. Casa noted that he believed that Employee had experienced accumulated heat load throughout his workdays leading up to July 22, indicating that that was one of the reasons in which heat acclimatization plans were in place. It was pointed out that Employee had worked a half a day on Wednesday. He noted that height and weight measurements alone do not necessarily account for a percentage of body fat, and that there may be less exercise and heat tolerance if an individual is out of shape or overweight.

Dr. John Jardine

Dr. Jardine's deposition testimony was taken on April 5, 2019. He works at Our Lady of Fatima Hospital in North Providence, Rhode Island, where he practices as an attending emergency medicine physician. In his deposition, he discussed more specifically some of the intrinsic and extrinsic risk factors for heat-related illnesses, discussing the importance of hydration, heat acclimatization, exercise intensity, and how obese individuals were less apt to dissipate heat. It was his estimation that Employee was likely dehydrated on day one of his job and became increasingly dehydrated on days two, three, and four, noting its cumulative effect. He referenced the BUN and creatinine reflecting his level of dehydration, noting that they were both elevated, suggesting that he had renal injury or renal failure likely secondary to dehydration. In his deposition, Dr. Jardine noted that there was not a lot known about Employee's past medical history and he did not know what medications he may or may not have been on at the time of his death. In referencing emergency room records, it was noted that there had been no indication that Employee had ever had a heat stroke or collapsed in the past. It was also noted by Dr. Jardine that the autopsy did not reveal any testing to determine the percent of body fat in Employee at the time of his death. He described that a heat stroke by definition is when a core body temperature is greater than 104°, with an alteration in mental status. He acknowledged that the heat and working conditions experienced by Employee on July 22, 2016 were "extraordinary." He opined that Employee's "obesity contributed to cause his heat stroke."

Dr. Russell C. Cantrell

Dr. Cantrell is a physician who is board certified in physical medicine and rehabilitation. His office is located in Kirkwood, Missouri. Dr. Cantrell reviewed all of the above transcripts and medical records. It was his opinion, based on a reasonable degree of medical certainty, that Employee's occupational activities and the heat on July 22, 2016 were the prevailing factor to cause his heat stroke and ultimate death. It was his opinion that the working conditions, extreme heat, and heat index, particularly when considering the probable dehydration associated in inadequate ad libitum hydration, were the prevailing factor to cause his heat stroke and ultimate death. It was also his opinion that his underlying obesity was not the prevailing factor in the cause of his death, and while it may have played a contributing factor as has been pointed out in medical records, he could not state with certainty the actual percentage of body fat present in Employee at the time of his death.

Employee: Tyler Halsey

Injury No. 16-053905

The term "accident" is defined in Section 287.020.2 of the Revised Statutes of Missouri. It provides as follows: "The word 'accident' as used in this chapter shall mean an unexpected traumatic event or unusual strain identifiable by time and place of occurrence and producing at the time objective symptoms of an injury caused by a specific event during a single work shift. An injury is not compensable because work was a triggering or precipitating factor."

Taken apart, the beginning of the definition of the word "accident" describes two categories: "unexpected traumatic event" or "unusual strain." Neither of those phrases are defined in the statute. Nevertheless, it is clear that the phrases are not redundant and have distinctive meanings. *Young v. Boone Electric Cooperative*, 462 S.W. 3d 783, 792 (Mo. App. 2015). It is recognized that "a particular 'strain' or 'event' could fall within both categories; it is compensable if it falls under a single category." *Williams v. Dir. Revenue*, 446 S.W. 3d 272, 273 (Mo. App. 2014).

Based on all of the evidence presented, I find that Employee's work outside as a laborer in the extremely hot weather on July 22, 2016, was both, an unexpected traumatic event or an unusual strain. The testimony establishes that Employee was doing fine until the afternoon on Friday, July 22, 2016, at which point he eventually collapsed from a heat stroke, and his body functions began to shut down. He was diagnosed and treated for heat stroke that day, and he died the following day.

Other worker's compensation cases in Missouri involving similar circumstances have found that working under extraordinary circumstances, such as Employee experienced on July 22, 2016, constitutes an unexpected traumatic event or an usual strain under Missouri's Workers' Compensation Laws. See, e.g., *Brown v. Domino's Pizza*, 2016 WL7335386, Injury No. 12-052588 (Mo. Lab. Indus. Rel. Com. Dec. 15, 2016), affirmed without opinion, 527 S.W. 3d 185 (Mo. App. 2017) (by date of heat exhaustion, the claimant "had been working all week in the excessive heat in the store and progressively felt worse as the week continued"); *Miles v. Fred Weber, Inc.*, 2019 WL 1057188, Injury No. 11-058211.

Based on all of the evidence presented, I find that Employee sustained an accident arising out of and in the course of his employment on July 22, 2016.

Employee's attorneys retained Dr. John Jardine, an emergency medical physician in Rhode Island, as their medical causation expert. Dr. Jardine opined that Employee was not acclimated to the heat stress of his new job as a groundsman for Townsend Tree. He further noted that Employee would be considered extremely obese with a body mass index of 41.3. Dr. Jardine testified that individuals who are of the size of Employee have a likelihood to be less tolerant of heat than others. Dr. Jardine specifically opined that Employee's obesity contributed to cause his heat stroke. Importantly, Dr. Jardine gave no opinion whether the heat and working

10

Employee: Tyler Halsey

Injury No. 16-053905

conditions under which Employee was operating on July 22, 2016, were a factor, prevailing or otherwise, in his collapse and death. Dr. Jardine acknowledged that the autopsy report established that Employee had no heart issues and that no testing was ever done of the percentage of fat that was present in Employee's body at the time of his death. Dr. Jardine acknowledged that test data as to the percentage of fat or fat content in a person that weighs 300 pounds is needed to make a medically accurate estimate as to how susceptible such a person is to heat stress.

Employer-Insurer's attorneys also retained Dr. Russell C. Cantrell as their medical causation expert. Dr. Cantrell is a physician from Kirkwood, Missouri. He is board certified in physical medicine and rehabilitation. Dr. Cantrell opined that based on a reasonable degree of medical certainty, Employee's occupational activities and the extreme heat on July 22, 2016 were the prevailing factor which caused Employee's diagnosed heat stroke and ultimate death. Dr. Cantrell went on to opine that "the working conditions, extreme heat and heat index, particularly when considering the probable dehydration associated with inadequate and limited hydration, was a prevailing factor in the cause of his heat stroke and ultimate death." While Dr. Cantrell acknowledged that Employee's obesity "may have played a contributing factor" in his collapse and death, Dr. Cantrell noted that it could not be stated with any medical certainty that his obesity was the prevailing factor because of the lack of testing for percentage of body fat and the lack of medical history on Employee.

The medical and deposition evidence in this case establishes that Employee suffered a heat stroke and eventually died as a result of the extreme heat and the extraordinary conditions under which he worked on July 22, 2016. Dr. Cantrell confirmed that the extreme heat and adverse working conditions on July 22, 2016 were the prevailing factor that caused both Employee's heat stroke and eventual death. It is apparent that the hazardous risk that Employee was subjected to on July 22, 2016, was not one that he would have been exposed to outside of or unrelated to his employment in normal nonemployment life. In other words, the extreme heat and strenuous labor performed by Employee on July 22, 2016 was a special risk that would not be encountered by him in normal nonemployment life.

Section 287.020.3 (1) of the Revised Statutes of Missouri provides that an "injury by accident is compensable only if the accident was a prevailing factor in causing both the resulting medical condition and disability. The 'prevailing factor' is defined to be the primary factor, in relation to any other factor, causing both the resulting medical condition and disability." The statute goes on to provide that an "injury shall be deemed to rise out of and in the course of the employment only if (a) It is reasonably apparent, upon consideration of all the circumstances, that the accident is the prevailing factor in causing the injury; and (b) It does not come from a hazard or risk unrelated to the employment to which workers would have been equally exposed outside or unrelated to the employment in normal nonemployment life."

Dr. Jardine opined that Employee's obesity contributed to cause his heat stroke. However, Dr. Jardine gave no opinion regarding the prevailing factor. Dr. Cantrell opined that the working conditions were the prevailing factor in the cause of his heat stroke and ultimate death.

Based on all of the evidence presented, I find that Dr. Cantrell's opinion regarding medical causation was more persuasive than the opinion of Dr. Jardine on this issue.

11

Employee: Tyler Halsey

Injury No. 16-053905

Based on all of the evidence presented, I find that Employee's work accident on July 22, 2016 was the prevailing factor in causing Employee's heat stroke and ultimate death. Furthermore, I find that Employee's heat stroke and death were medically causally related to Employee's work accident that occurred on July 22, 2016.

**Issue 3. Whether obesity contributed directly or indirectly to Employee's death and whether obesity qualifies as an idiopathic condition.**

Counsel for Employee argue that Employee's claim herein is not subject to Missouri's Workers' Compensation Act because his obesity qualifies as an idiopathic condition under Section 287.020.3 (3). That sentence provides as follows: "An injury resulting directly or indirectly from idiopathic causes is not compensable."

Missouri courts have held that the "idiopathic condition" under Chapter 287 is one that is "peculiar to the individual; innate." *Taylor v Contract Freighters, Inc*, 315 S.W. 3d 379, 381 (Mo. App. 2010); *Ahern v. P & H, LLC*, 254 S.W. 3d 129, 132-133 (Mo. App. 2008); *Stricker v Children's Mercy Hospital*, 304 S.W. 3d 189, 191 (Mo. App. 2009). While the term "innate" is sometimes defined as being inborn or resulting from birth, the Court of Appeals in *Stricker v. Children's Mercy Hospital* stated that the condition "does not need to be inborn." *Id.* at 191, fn. 3.

Even though the current idiopathic exception under Section 287.020.3 (3) has been around since 2005, there appears to be only one reported case under that statutory section where the exception was found to be applicable. That case is *Ahern v. P & H, LLC*, 254 S.W. 3d 129 (Mo. App. 2008). In *Ahern*, the claimant fell off a roof after experiencing a seizure episode. The worker's compensation record established that the seizure was the result of a prior motorcycle accident. The Commission found that the idiopathic exception applied, and the Court of Appeals affirmed.

There are several Missouri cases where the Commission or appellate courts have denied use of the idiopathic exception. One case is *Taylor v Contract Freighters, Inc.*, supra. There, the employer argued that an alleged "idiopathic" cough had caused its driver to lose control of his truck, which in turn resulted in the truck veering off the road. The Commission rejected the coughing argument and the Court of Appeals affirmed. In doing so, the Appellate Court noted that the alleged cough did not cause any physical violence to claimant's body structure, and that "[e]videntiary support is required to successfully claim an event is entirely idiopathic" *Id.* at 381. This "entirely idiopathic" principle was acknowledged and repeated in *Deville v. Hiland Dairy Co.*, 157 S.W. 3d 284, 288 (Mo. App. 2005) and *Woodruff v Health Management Associates, Inc*, Injury No. 07-072722 (Mo. Lab. Indus. Rel. Com. Nov. 9, 2012).

What the foregoing decisions appear to be saying is that in order for an idiopathic condition to qualify for the current workers' compensation exception, the employee's injury must be entirely idiopathic in nature such that no other factor precipitates the injury. In other words, an idiopathic condition qualifies for the exclusion only if it exposes the individual employee to a special risk of injury that only exists because of the presence of the idiopathic condition in that employee. Thus, an employee who has an epileptic seizure and falls from a rail car comes within the Workers' Compensation exception because the risk of injury to that employee only exists because of that employee's unique and personal medical condition.

12

Employee: Tyler Halsey

Injury No. 16-053905

Under the foregoing logic, Employee's obesity did not expose him to a unique and special risk of heat stroke because all of the employees of Townsend Tree who were working with Employee on July 22, 2016, were equally exposed to the possibility of heat stroke by virtue of their shared working conditions and the shared extreme heat. Moreover, Eric Bennett acknowledged that by the afternoon of July 22, 2016, everybody was feeling the effects of the heat by lunchtime. Mr. Bennett also acknowledged that he was about to pass out around 4:00 p.m. that day.

In *Ahern v. P & H, LLC*, supra, the injured employee suffered a seizure. The seizure directly caused the employee to lose control of his behavior, and then he fell off a roof. Obesity, however, does not cause any uncontrolled change in an employee's behavior by itself.

Based on all of the evidence presented, I find that Employee's obesity does not qualify as an idiopathic condition under Chapter 287. Therefore it is not necessary to make a determination whether that condition directly or indirectly contributed to Employee's heat stroke and eventual death.

Issue 4. Whether the claim is compensable under the Missouri Workers' Compensation Law

An injury is considered compensable under Chapter 287 "if the accident was the prevailing factor in causing both the resulting medical condition and disability." Mo. Rev. Stat. § 287.020.3 (1). It has been shown through the facts of the case, medical evidence, and medical testimony, that Employee's accident on July 22, 2016 was the prevailing factor in causing both his heat stroke and resulting collapse and death. It is clear that Employee's heat stroke and death arose out of and in the course of Employee's employment with Townsend Tree. Accordingly, Employee's claim herein is compensable under Chapter 287.

Employer-Insurer paid voluntary medical expenses and voluntary funeral expenses. Employee did not have any dependents, he had never been married and did not have any children; therefore no additional compensation shall be awarded.

13

Employee: Tyler Halsey

I certify that on 7-31-19, I delivered a copy of the foregoing award to the parties to the case. A complete record of the method of delivery and date of service upon each party is retained with the executed award in the Division's case file.

By _______________________


Made by:

Maureen Tilley

Administrative Law Judge

Division of Workers' Compensation