The Often Overlooked Defense of “No Sudden Mechanical or Structural Change in the Body”
It is important for the Virginia adjuster to closely examine whether the claimant has indeed suffered a “sudden mechanical or structural change in the body.” If not, the claim should be denied. This defense is often overlooked in Virginia.
The determination as to whether the claimant has suffered a “sudden mechanical or structural change in the body” requires a close examination of the medical records and often a specific inquiry to the treating physician(s) in appropriate cases.
The Virginia adjuster should be mindful of this potential denial of a claim particularly in cases involving pre-existing condition and/or in instances where diagnostic films reveal no mechanical or structural change.
The Commission’s recent split 2-1 decision in Davis v. Wal-Mart Associates, Inc., JCN VA02000037952 (Feb. 27, 2023) provides a helpful illustration of this legal issue. In Davis the Full Commission affirmed the finding of the Deputy Commissioner that claimant failed to establish a “sudden mechanical or structural change in the body.” The claimant in Davis reported a sharp pain in his back while kneeling to place a twelve-pack of ginger ale on a bottom shelf. Plain film x-rays taken at the hospital noted postoperative changes from a prior surgery but no acute fracture, dislocation or disease. A later MRI revealed the prior surgical changes but no canal stenosis or foraminal narrowing. The treating physician commented that the MRI looked “similar to prior imaging.” The physician also completed a questionnaire for the employer agreeing that after review of the MRI that he could state within a degree of medical probability that claimant sustained an actual mechanical or structural change in the body.
It is important to also mention the recent Virginia Supreme Court’s decision in Alexandria City Public Schools v. Handel, Record No. 190957 (October 15, 2020). In Handel the Virginia Supreme Court vacated and remanded the finding of the Court of Appeals of Virginia that a “single “sudden mechanical change or structural change” anywhere in the body suffices to establish that a claimant has suffered an “injury by accident””. In Handel the claimant alleged injuries to multiple body parts. The decision in Handel makes it clear that in Virginia the claimant must establish a “sudden mechanical or structural change” for each and every alleged body part claimed. The Court observed that the phrase “sudden mechanical or structural change” was first introduced into the caselaw in 1955 in the decision of Virginia Elec. & Power Co. v. Quann, 197 Va. 9 (1955). Also of significance is the Court of Appeals holding on remand that “mere pain in a body part, standing alone, does not establish a mechanical or structural change to that body part.” Alexandria City Public Schools v. Handel, Record No. 1582-18-4 (May 11, 2021).
Three important take-aways for the Virginia adjuster:
- attempt, if possible, in the recorded statement that there was no sudden pain (no sudden pop, tear, etc.) to each and every body part alleged injured;
- attempt, if possible, in the recorded statement that claimant did not suffer any structural or mechanical change (no swelling, deformation, loss of function, etc.) and
- attempt, if possible, to secure a medical statement that the treating physician cannot state to a reasonable degree of medical probability of any sudden mechanical or structural change in those cases where the diagnostics show none.
Should you have any questions about the issues discussed here or other legal issues, please do not hesitate to contact the lawyers at Ford Richardson.
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