In any proceeding for the enforcement of a claim for compensation under this Act it shall be presumed, in the absence of substantial evidence to the contrary –
(a) That the claim comes within the provisions of this Act.
As we frequently see with statutory language, this provision cannot be taken at face value. If you look at it standing alone, in a vacuum as we like to say, you would be justified in concluding that Section 20(a) provides for a presumption of coverage, i.e., a presumption that situs and status are met and that a claim is covered by the Longshore Act.
In fact, this is not how Section 20(a) is interpreted and applied. Even though you occasionally see administrative law judges make reference to a “presumption of coverage” in the Act, or to an “unwritten presumption of coverage”, there is, in fact, no such thing.
So, what DOES it mean? It means that under Section 20(a) it is presumed that an injury arose out of employment in the sense that the definition in section 902(2) defines “injury” as “accidental injury or death arising out of and in the course of employment …”
The Section 20(a) presumption relates the injured worker’s injury or harm to his employment. Once an injured worker establishes his “prima facie case”, that is, that he has suffered some injury or harm and that working conditions existed or an accident occurred which could have caused the harm or injury, Section 20(a) then links the injury or harm to the worker’s employment. It is presumed that the worker’s harm was causally related to his employment, or to put it another way, that it arose out of his employment.
The Section 20(a) presumption applies in all cases, whether medical only, death, occupational disease, aggravation, etc., but it does not apply in the following circumstances:
It does not aid the injured worker in establishing his prima facie case;
It does not help to establish the nature of disability, temporary or permanent;
It does not help to establish the extent of disability, partial or total;
It does not help to establish the reasonable and necessary requirement for medical treatment;
It does not help a claimant to establish the eligibility requirements for survivor’s benefits (it only provides a presumption that the death was related to the employment).
A note on presumptions: Section 20(a) provides a rebuttable presumption. It is strictly a procedural tool in the law. It shifts the burden of proof to the employer on the issue of causal relationship. It is not evidence, and it does not strengthen the weight of the evidence for any party.
The analytic and procedural framework of the typical Longshore case provides the context for application of the presumption:
First, the injured worker must establish his prima facie case by proving that he suffered some harm or pain and that working conditions existed or there was an accident which could have caused the harm or pain.
Second, at this point the Section 20(a) presumption kicks in to link the harm or pain with the worker’s employment.
Third, the presumption shifts the burden regarding causation to the employer, who must produce substantial evidence that rebuts the presumption; in other words that the harm or pain was not related to the worker’s employment.
Finally, if the employer produces substantial evidence that the harm or pain was not caused by employment, the presumption is rebutted and it disappears from the case. The adjudicator must then decide the causation issue based on all of the evidence in the record.
If the employer fails to rebut the Section 20(a) presumption by producing substantial evidence then the injured worker has won on the causation issue.
Note: the question of what constitutes “substantial evidence” sufficient to rebut the presumption, as well as the difference between the burden to “produce” such evidence as opposed to the burden to “persuade” based on a preponderance of the evidence, are subjects that merit their own separate discussions. For now, let’s just define “substantial evidence” as “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” In the context of Section 20(a), it most frequently takes the form of a medical opinion stating to a reasonable degree of medical certainty that the harm or pain is not causally related to the employment.
So, to summarize our main point, the Section 20(a) presumption shifts the burden of proof on the issue of causation from the claimant to the employer by providing the causal link between the worker’s harm or pain and his employment. It is not a presumption of coverage.