Causation and the Doctrine of Compensable Consequences

The Latin phrase post hoc ergo propter hoc (“after this, therefore because of this”) and its contorted logic should have no application in determining causal relationships.  Simply because a condition follows an event does not mean the event caused the condition.  Unfortunately, many medical experts (and more than a few attorneys) silently attempt to apply the Latin expression as a legitimate basis to determine causal relationship.  Causation is not so simple.

The doctrine of compensable consequences declares that a physical or mental health condition proximately caused by or otherwise related to a compensable condition is likewise compensable.  An employer (and/or its workers’ compensation insurance company) is liable for every natural consequence that flows from an industrial incident, unless it is the result of an independent intervening, superseding cause.  The doctrine is recognized in and applied to the workers’ compensation systems for coverage of industrial injuries and occupational diseases in Washington[i] and Oregon.[ii]

The compensable consequences doctrine may be applicable in situations where a worker is injured during the commute to or from a claim-related appointment.[iii]    The general rule, noted by Professor Larson[iv] is that a subsequent condition is deemed compensable if proximately caused by, or a natural consequence of, the original compensable injury.[v]

The consequences of treatment for a compensable industrial injury or occupational disease are considered to be part and parcel of the injury itself.[vi]  One of the most common examples of application of the consequential conditions doctrine, which is now universally accepted in nearly every jurisdiction of workers’ compensation, is that a mental health disorder is compensable if attributable to the physical condition caused by an industrial injury or occupational disease.[vii]  The following are some examples of possible compensable consequential conditions:

  • Deep vein thrombosis (blot clot) developed during or immediately following medically-necessary surgical treatment for a condition due to industrial injury or occupational disease.
  • Low back strain and aggravation of pre-existing degenerative disc disease as a result of altered gait caused by an industrial knee injury.
  • Lateral epicondylitis of the right upper extremity caused by overuse as a result of disuse of the left upper extremity due to left carpal.
  • Major depressive disorder and generalized anxiety disorder diagnosed as a result of pain, diminished self esteem and excessive worry in regard to financial security following an industrial injury.

Such examples serve to illustrate the analytical framework of compensable consequential conditions, not as proof of a causal relationship.  Medical evidence, proper application of logic, and the principles of proximate cause must be used to determine whether a physical or mental health condition is related to an event or an underlying, initial compensable condition.

Do not assume a condition that develops subsequent to an industrial incident or initial condition was caused by such incident or initial condition.  Develop a clear understanding of the relevant facts, including the mechanism of alleged injury.  Identify the specific activities that manifest as a result of the injury.  Obtain the medical and/or psychological evidence.  When such information is secured, request a medical and/or psychological assessment of causation.

The physician and/or psychologist should not simply declare whether a condition is related to an industrial incident or the consequence of an initial condition.  The expert should explain the rational for the opinion of causal relationship.  Such explanation should be based upon generally-accepted scientific principles and a reasonable degree of medical and/or psychological certainty.  Only when a subsequent condition is related to the industrial incident or initial condition through the principles of logic and scientific certainty should such subsequent condition be deemed compensable.


[i] Anderson v. Allison, 12 Wn. 2d 487 (1942); Ross v. Erickson Construction Co., 89 Wash. 634 (1916).

[ii] ORS 656.005(7)[ii]; ORS 656.245(1)(a)[ii].

[iii] See, Larson on Workers’ Compensation, Volume 1, Chapter 10; In Re: Iris Vandorn, BIIA Dec. 02 11466 (2003) (The worker’s new injury, suffered when involved in a motor vehicle accident during return from an appointment with a vocational counselor, is covered under the claim).

[iv] Larson’s Workers’ Compensation Law, originally written by Arthur Larson (1910-1993), the James B. Duke Professor of Law at Duke University Law School and an Under Secretary of Labor, and more recently edited by Lex K. Larson.

[v] Id, Larson.

[vi] Anderson v. Allison, 12 Wn. 2d 487 (1942); Ross v. Erickson Construction Co., 89 Wash. 634 (1916);  In re: George Gillilan, Dec’d, BIIA Dec. 24,780 (1967) (A heart attack caused by worry over the physical residuals of an industrial injury is compensable as part of the injury.); In re: Arvid Anderson, BIIA Dec. 65,170 (1960) (A cardiac arrhythmia caused by the stress of surgical treatment for the direct residuals of the industrial injury is attributable to the industrial injury)

[vii] See, In Re: Jacobson v. Department of Labor and Industries, 37 Wn. 2d 444, 224 P.2d 338 (1950); Husa v. Department of Labor and Industries, 20 Wn. 2d 114, 146 P.2d 191 (1944); Anderson v. Department of Labor and Industries, 23 Wn. 2d 76, 159 P.2d 397 (1945).