In Thomas v. United Ambulance, United Ambulance appealed a Decision (Goodnough, ALJ) granting Thomas’s Petition for Award and granting in part his Petition for Payment. United Ambulance argued that the ALJ erred in determining that an August 14, 2016, injury arose out of and in the course of employment even though the injury manifested off the employer’s premises when Mr. Thomas was not working.

Thomas worked at United Ambulance as a dispatcher beginning in 2004. Although he was promoted to supervisor, he continued to do full-time dispatching. Thomas estimated that he handled 230 to 240 calls per day. He worked ten-hour days, four days a week plus frequent overtime, in a highly stressful environment. He worked in a fixed-posture position performing repetitive movements using a telephone and keyboard.

On August 14, 2016, Thomas was at home, reaching over his bathtub with an arm extended, when he felt a “pop” and immediately felt pain in his neck and left shoulder. He was treated at the emergency department and diagnosed with a thoracic strain. He was ultimately diagnosed with cervical disc herniations at C5-6 and C6-7. He pursued a workers’ compensation claim, contending his cervical disc problems were caused by his employment.

The ALJ based his finding that the injury arose out of the employment on the section 312 examiner Dr. Bradford’s findings. Dr. Bradford found that Thomas worked for many years “in a position with a fixed posture with repetitive if not nearly constant arm postures,” which resulted in a gradual, degenerative neck condition. Dr. Bradford further opined: “The reaching over a bathtub with arm extended may simply have been the “straw that broke the camel’s back,” the maneuver in and of itself [was] probably not sufficient to cause significant disc disease.... I do not feel the bathtub incident, in and of itself, was causative, but simply exacerbated the cervical condition which, as noted above, is related to his work, in my opinion.” The Appellate Division found that the IME’s opinion supports the finding that Thomas developed a degenerative neck condition as a result of his work activities over the years. Thus, the ALJ did not err in finding the neck injury arose out of employment.

United Ambulance argued that Thomas’s injury occurred outside the course of his employment because it occurred on his day off, at home, not while performing his work duties; thus, the injury did not occur at a place where the employee reasonably could be in the performance of his duties and while fulfilling those duties. The ALJ determined that “Mr. Thomas’s neck injury, from a medical perspective, originated in activities that occurred at work over a long period of time.” The ALJ reasoned that the outward manifestation of the injury having occurred at home is not dispositive, noting correctly that the Law Court has found compensable injuries that have occurred off premises. Nor has the Court required an injury to have acquired all of its injurious elements, including the final manifestation of the injury, on the employer’s premises during work hours. The ALJ also based the decision on a “delayed action” theory of work-connection, articulated by Professor Larson. As well, the Appellate Division found the ALJ correctly relied on various Maine cases supporting this. See Stein v. Inland Hosp., Me. W.C.B. No. 19-40, ¶¶ 15-16 (App. Div. 2021) (holding that stroke that occurred nearly four months after the employment ended resulted from a stress-related injury that began before employee left employment); see also Sanders v. Kenkev, W.C.B. 08-02-86-29 (Me. 2012) (holding that a gunshot injury that occurred off premises several months after the instigating incident was compensable based on a delayed action theory). The final test is not whether the ultimate injury happened at work, but whether the injurious activities that caused the injury were undertaken in the course of employment. See Moore v. Daigle & Daigle, Inc., No. 88-232 (Me. W.C.C. App. Div. Dec. 9, 1988) (distinguishing the terms “manifestation” and “consummation” from “arising”).

The Appellate Division affirmed finding competent evidence in the record that the injury fell within the bounds of the employment, despite that its culmination occurred at a time when Mr. Thomas was not working. The Appellate Division effectively held that the test is not whether the symptoms actually occur at work, but whether the activities causing the injury occurred in the course of employment.