The claimant clearly won this one. Better luck next time.

Introduction

The Defense Base Act (DBA) provides workers' compensation benefits to civilian employees working outside the United States on U.S. military bases or under U.S. government contracts for public works or national defense (Defense Base Act Overview). Administered under the Longshore and Harbor Workers' Compensation Act (LHWCA), DBA claims are subject to specific legal provisions that significantly influence how claims are evaluated and adjudicated. One of the most critical provisions is the Section 20(a) presumption, which assumes that a claim is valid and work-related unless proven otherwise with substantial evidence. Additionally, the LHWCA is interpreted liberally in favor of claimants, meaning that when evidence is evenly balanced, decisions often favor the worker. This blog post explores the Section 20(a) presumption, its implications for adjusters handling DBA claims, and why engaging top-tier investigations vendors is crucial for effectively managing these claims.

The Section 20(a) Presumption Explained

The Section 20(a) presumption, codified in 33 U.S.C. § 920(a), states: “In any proceeding for the enforcement of a claim for compensation under this chapter it shall be presumed, in the absence of substantial evidence to the contrary—(a) That the claim comes within the provisions of this chapter.” In practical terms, this means that when a worker files a DBA claim alleging a work-related injury or illness, the claim is presumed to be valid unless the employer can provide substantial evidence to disprove its work-relatedness.

This presumption is a cornerstone of the LHWCA and, by extension, the DBA. It requires the claimant to establish a prima facie case by showing (1) that harm occurred and (2) that the harm could have been caused or aggravated by workplace conditions. Once this threshold is met, the burden shifts to the employer to rebut the presumption with substantial evidence demonstrating that the injury did not arise out of or in the course of employment (Rite4Justice on Section 20(a)).

Moreover, the LHWCA is a remedial statute designed to protect injured workers, and courts consistently interpret it liberally in favor of claimants (McGray Construction v. Director, OWCP). This liberal construction means that when evidence is evenly balanced—equally likely as unlikely—the decision typically favors the claimant. This principle amplifies the importance of robust evidence collection to challenge claims effectively.

Implications for Adjusters

For adjusters managing DBA claims, the Section 20(a) presumption and the liberal construction of the LHWCA present significant challenges. The presumption places the burden on the employer to disprove the claim’s validity, requiring substantial evidence to overcome the assumption that the injury is work-related. This is particularly complex in DBA cases, where employees often work in remote or hazardous locations, such as military bases in conflict zones, making evidence collection logistically difficult.

Adjusters must ensure that all aspects of a claim are thoroughly investigated, including the circumstances of the injury, the claimant’s medical history, and the work environment. Without compelling evidence, the presumption and the liberal interpretation of the Act make it likely that claims will be upheld, potentially leading to significant financial implications for employers and insurers.

The Critical Role of Top-Tier Investigations Vendors

Given the high stakes of DBA claims and the burden imposed by the Section 20(a) presumption, hiring a top tier investigations vendor is absolutely essential. These vendors provide several "must have" advantages:

1. Expertise in Complex Environments: Top-tier investigators have the experience and resources to conduct thorough investigations in challenging settings, such as overseas military bases or remote contract sites. Their ability to navigate these environments ensures comprehensive evidence collection.

2. Comprehensive Evidence Gathering: Superior vendors can collect a wide range of evidence, including witness statements, photographic documentation, medical records, and expert opinions. This evidence is critical for building a strong case to rebut the Section 20(a) presumption when appropriate.

3. Fraud Detection: High level investigators are skilled at identifying potential fraud or exaggeration in claims, which is particularly important in workers’ compensation cases where fraudulent claims can lead to significant financial losses (Compensability in Workers’ Compensation).

4. Timely and Accurate Reporting: Efficient vendors provide detailed, accurate, and timely reports, enabling adjusters to make informed decisions quickly and effectively.

   
   

The complexity of DBA claims, combined with the legal presumptions favoring claimants, underscores the need for investigations that go beyond the standard. An above-average vendor can mean the difference between successfully challenging an invalid claim and facing costly payouts due to insufficient evidence.

Case Study: Ramsay Scarlett v. Director, OWCP

A notable example of the Section 20(a) presumption in action is Ramsay Scarlett v. Director, OWCP (Fifth Circuit Opinion). In this case, the claimant, Ferdinand Fabre, alleged that he developed asbestosis due to workplace exposure during his 30-year tenure with Ramsay Scarlett & Company. Fabre established a prima facie case by providing deposition testimony and an industrial hygienist’s report, invoking the Section 20(a) presumption. The employer attempted to rebut the presumption by impeaching (challenging) Fabre’s credibility and arguing that exposure occurred at a subsequent employer. However, the Administrative Law Judge (ALJ) found the claimant’s evidence credible and the employer’s rebuttal insufficient, as they failed to provide substantial evidence contradicting the workplace exposure. The Fifth Circuit affirmed the decision, emphasizing that employers must present concrete facts, not speculation, to rebut the presumption.

This case illustrates the critical need for robust investigative processes. Had the employer engaged a high-quality investigations vendor, they might have gathered stronger evidence, such as detailed workplace safety records or contradictory medical reports, to challenge the claim more effectively.

Additional Considerations

The liberal construction of the LHWCA further complicates the adjuster’s role. Courts have consistently ruled that ambiguities in the Act should be resolved in favor of the claimant, reinforcing the need for compelling evidence to overcome both the Section 20(a) presumption and the Act’s claimant-friendly interpretation (IRMI on LHWCA). For example, in cases where evidence is evenly balanced, the liberal construction principle often tips the scales in favor of the claimant, making it imperative for adjusters to have access to comprehensive investigative findings.

Another set of factors that also must be taken into consideration (and that makes average investigators and agencies a poor choice) is that DBA claims often involve challenges such as injuries in war zones or remote areas, where access to witnesses or physical evidence may be limited. Only a small fraction of investigations vendors are equipped to handle these obstacles, ensuring that adjusters have the tools they need to make informed decisions.

Practical Steps for Adjusters

To effectively manage DBA claims under the Section 20(a) presumption, adjusters should consider the following steps:

• Engage Early: Involve an investigations vendor as soon as a claim is filed to ensure timely evidence collection.

• Prioritize Quality: Select vendors with proven expertise in workers’ compensation and international investigations.

• Focus on Comprehensive Evidence: Ensure investigations cover all relevant aspects, including workplace conditions, medical history, and potential non-work-related causes.

• Monitor for Fraud: Use investigators to identify signs of fraud or exaggeration that could undermine the claim’s validity.

• Address Statutory Defenses: Ascertain whether the injury was caused by intoxication or willful intent, as these are also covered by the Section 20(a) presumption (33 U.S.C. § 920(c), 33 U.S.C. § 920(d)).

  
  

Conclusion

The Section 20(a) presumption, combined with the liberal construction of the LHWCA, places a significant burden on employers and adjusters to disprove the work-relatedness of DBA claims. In the challenging context of overseas work environments, thorough and effective investigations are critical to gathering the substantial evidence needed to rebut this presumption. By engaging above-average investigations vendors, adjusters can ensure that claims are handled fairly, accurately, and cost-effectively, protecting the interests of employers while maintaining the integrity of the workers’ compensation system. Investing in high-quality investigations is not just a strategic choice. It’s a necessity for navigating the complexities of DBA claims.

Citations

• 33 U.S. Code § 920 - Presumptions

• Ramsay Scarlett v. Director, OWCP - Fifth Circuit Opinion

• Defense Base Act Overview - U.S. Department of Labor

• McGray Construction v. Director, OWCP - 9th Circuit Opinion

• Section 20(a) Presumption Under The Longshore Act - Rite Law

• A Review of the Longshore and Harbor Workers Compensation Act - IRMI