Georgia courts will presume that an employee’s death arises out of and in the course of employment when: 1) the employee is found dead at a place he might reasonably be expected to be in performance of his job; and 2) the death is unexplained. 

            The seminal case establishing this presumption is  Zamora v. Coffee General. Hospital, 290 S.E. 2d 192 (1982).  In Zamora, a maintenance worker was found strangled at work.  The court found that although the “immediate cause” of death (strangulation) was known, the “precipitating causative factor” of the death (why the employee was strangled) remained unknown.  Thus, the employee’s death was presumed to arise out of his employment, and therefore, was compensable.  Once the presumption is established, the Employer/Insurer’s task is to prove that the precipitating cause of the death is known and unrelated to the employee’s employment. 

            Recently, the Georgia Court of Appeals dramatically expanded the Zamora presumption and created a high hurdle for the Employer/Insurer to overcome in rebutting the presumption of compensability in unexplained death cases, particularly in the context of possible heart attack claims.  In Keystone Automotive v. Hall, 665 S.E. 2d 392 (2008), Hall worked as salesman for Keystone Automotive.  After arriving at work that morning, he spoke with his general manager.  He subsequently walked to the front of the warehouse, spoke to two other employees, and then walked to the back of the warehouse.  He was not seen again until he was discovered unconscious on the ground outside of the warehouse bay door beside his truck.  Another employee performed CPR, but Hall never regained consciousness.  He died after three weeks of hospitalization. 

            Hall’s widow made a claim for death benefits, which was denied by Keystone.  At the hearing, the parties stipulated that Hall performed no strenuous work-related tasks that day.  Despite this, the ALJ relied on the apparent failure of doctors to reach a consensus on the exact cause of death in granting death benefits.  Because there was no apparent consensus, the ALJ found that the Employer/Insurer was unable to overcome the Zamora presumption since they could not affirmatively demonstrate that the employee’s death was unrelated to his employment.  However, the ALJ felt that the death would not be compensable without the Zamora presumption. 

            The Appellate Division reversed the decision of the ALJ in a 2-1 decision, thereby denying benefits to the employee’s widow.  The majority concluded that the Zamora presumption did not arise.  They felt that all of the medical evidence demonstrated the employee died of a natural causes unrelated to his work duties.  Specifically, the majority found that the cause of the employee’s cardiopulmonary arrest was most likely due to an underlying condition.  The majority held that even if the presumption applied, the medical evidence was sufficient to overcome the Zamora presumption. 

            The superior court subsequently reversed the decision of the Appellate Division holding that it had confused the “immediate” cause of death  with the “precipitating” cause of death components of Zamora.  The superior court reasoned that because no evidence suggested what exactly caused Hall’s cardiopulmonary arrest, there was no evidence of an unrelated, precipitating cause of death to overcome the Zamora presumption. 

            Keystone appealed to the Georgia Court of Appeals arguing that the superior court 1) misapplied the “any evidence” standard, 2) wrongfully used the unexplained death presumption of Zamora since the medical evidence actually explained the precipitating cause of Hall’s death; and 3) ignored the heart attack exclusion in O.C.G.A. § 34-9-1(4) (excluding heart attacks from “injury” unless a preponderance of evidence shows that the heart attack was attributable to the employee’s performance of his typical job duties). 

            The Court of Appeals ultimately affirmed the decision of the superior court holding Zamora applied and that Hall’s death was compensable.  After a lengthy overview of the medical opinions presented at the initial hearing, the Court of Appeals emphasized that these reports were “only” opinions and not definitive proof as to the precipitating cause of the employee’s death.  The Court of Appeals felt that all of the medical evidence went to the immediate cause of death and not the precipitating cause of death.  The court reconciled O.C.G.A. § 34-9-1(4) by holding that this was not a heart attack case because there was no conclusive medical evidence that Hall died of a heart attack.  Further, even if it was a heart attack case, Zamora’s unexplained death presumption would satisfy the elevated proof requirement of O.C.G.A. § 34-9-1(4).  As a result, Hall’s death was compensable as determined by the Court of Appeals. 

            What is particularly troubling about this decision, is that the Court of Appeals went to great lengths to characterize the medical opinions as mere “speculation,” finding that the medical evidence was far from conclusive.  In so ruling, the Court of Appeals went beyond the “any evidence” by which they were bound and essentially weighed the evidence, which should be left to the Appellate Division as a fact finder.  

            The Hall court suggests that all of the medical evidence presented must definitively prove that the precipitating cause is known and unrelated to the employee’s employment.  From a practical standpoint, however, this is nearly impossible for an Employer/Insurer to establish in these types of cases.  Medical opinions will inevitably differ.  Simply because one medical opinion differs or a doctor does not state that his opinion is based on 100% certainty, should not prevent an Employer/Insurer from defending such claims.  Rather,  the ALJ and Appellate Division, as the fact-find bodies, are the proper venues to determine whether the evidence rebuts the presumption.  Those findings should be left undisturbed on appeal. 

            Hall demonstrates that the Employer/Insurer is left with essentially no options when dealing with these types of cases if the factual findings of the Appellate Division are disturbed on appeal.  Also, in certain cases, such as the strangulation circumstances in Zamora, differentiating “how” and “why” an employee’s death occurred is possible.  However, good case law should be (as argued by Keystone) that the immediate cause of death and the precipitating cause of death are one in the same when there is no evidence showing that some significant external event may have triggered an employee’s death.