Hawaii Supreme Court Reinforces High Bar for Challenging Workers’ Comp Claims

The Supreme Court of Hawaii has reinforced the high evidentiary bar employers and insurers must clear to challenge workers’ compensation claims, ruling in favor of an employee whose nasal fracture was disputed by her employer.

In Lane vs. Avis Budget Group, Inc., the court determined that the employer failed to produce the “substantial evidence” required to overcome the state’s strong statutory presumption that an injury is work-related. The decision serves as a critical reminder for claims adjusters and legal teams about the quality and type of expert evidence needed to successfully rebut the presumption of compensability.

The case originated from a 2014 incident where Roxanne Lane, an Avis employee, was involved in a low-speed vehicle collision while on the job. Lane stated that during the impact, her nose struck the steering wheel.

While Avis and its insurance adjuster, Gallagher Bassett Services Inc., accepted liability for Lane’s neck, back, and shoulder injuries, they denied her claim for a non-displaced nasal fracture, which was confirmed by an x-ray seven days after the accident. The claim proceeded through multiple levels of appeal, with a state appeals board initially siding with the employer before the case reached the state’s highest court.

Avis argued that the collision was too minor to have caused the nasal fracture. The company relied on reports from two medical examiners who concluded the injury was not work related. Their arguments centered on two key points: first, that Lane did not exhibit immediate and obvious symptoms, such as significant swelling, bruising, or bleeding, in the hours and days following the incident. Second, one of the doctors provided a biomechanics opinion, stating that the force of the low-impact collision was insufficient to cause Lane to strike her nose on the steering wheel.

Lane countered that she had consistently complained of right-sided facial and nasal pain to her doctors shortly after the accident and argued that the employer’s medical expert was not qualified to offer an opinion on biomechanics.

In its analysis, the Hawaii Supreme Court focused squarely on the employer’s failure to meet its initial burden of production. The court found the employer’s evidence fell short of the “substantial” threshold required by law.

Critically, the court invalidated the biomechanics opinion from the employer’s medical doctor, noting there was no evidence in the record that the physician had any qualifications, training, or expertise in biomechanics or accident reconstruction. The court dismissed this as a generalized opinion, stating that such opinions “do not constitute substantial evidence.”

Furthermore, the court found that the employer’s experts failed to adequately explain why Lane, who had no prior nasal issues, began experiencing persistent right-sided facial and nasal pain immediately after the collision.

The Hawaii Supreme Court vacated the lower appellate decisions and reinstated the original ruling from the Department of Labor and Industrial Relations Director, which found the nasal fracture to be a compensable work-related injury.

View the full decision here. &