Lane v. Avis Budget Group, Inc.: Foundation Required to Treat “Low-Impact/Biomechanics” IME Opinions as Substantial Evidence Rebutting HRS § 386-85

I. Introduction

This case concerns a familiar battleground in workers’ compensation: a claimant reports symptoms after a workplace accident, later imaging confirms a specific injury, and the employer attempts to defeat compensability by arguing the accident was too minor to have caused it.

Roxanne Lane, an Avis transporter, was stopped in an airport parking lot when another vehicle reversed into the front of her Avis van. Lane testified that her body moved forward/backward and her nose hit the steering wheel “hard.” Avis accepted as compensable several injuries (neck, low back, right shoulder) but denied liability for a right-sided, non-displaced nasal fracture that was confirmed by x-ray seven days after the collision.

The DLIR Director found Lane’s nasal injury compensable. On appeal, the Labor and Industrial Relations Appeals Board (LIRAB) reversed on the nasal fracture, relying largely on two employer IME reports. The Intermediate Court of Appeals (ICA) affirmed. The Supreme Court of Hawaiʻi granted certiorari to decide whether Avis produced “substantial evidence” sufficient to rebut the HRS § 386-85 presumption that Lane’s nasal fracture was work-connected.

II. Summary of the Opinion

The Supreme Court vacated the ICA judgment and vacated in part the LIRAB’s orders to the extent they found Lane’s nasal fracture non-compensable. The court affirmed the DLIR Director’s determination that the nasal injury was compensable and remanded for further proceedings.

The court held that Avis failed at the threshold step: it did not meet the initial burden of production because the evidence the LIRAB treated as rebuttal “substantial evidence” lacked probative value. Most importantly, the LIRAB credited an IME physician’s “low force/biomechanics” opinion without any record foundation that the physician was qualified to render such an opinion. Additionally, the employer IME analysis failed to grapple with undisputed contemporaneous medical documentation of right-sided facial/nasal complaints shortly after the accident and before the fracture was diagnosed by imaging.

III. Analysis

A. Precedents Cited

1. The statutory presumption and the employer’s “heavy burden”

• Respicio v. Waialua Sugar Co. — Cited for the “beneficent and liberal construction” of Hawaiʻi’s workers’ compensation statute in favor of employees. The Lane court uses this as interpretive backdrop: close questions are not neutral; the system is designed to protect coverage.
• Flor v. Holguin — Describes the compensability presumption as a “keystone principle.” Lane relies on this to reaffirm that rebuttal is not routine; it is exceptional and must be supported by a high-quality evidentiary showing.
• Korsak v. Hawaii Permanente Med. Grp. — Central to Lane. Korsak emphasizes (i) the employer bears a “heavy burden” to disprove work-relatedness, and (ii) the presumption is not a vanishing “procedural device.” Lane also draws on Korsak’s requirement that rebuttal evidence must be sufficiently specific and probative on causation, not generalized or conclusory.
• Akamine v. Hawaiian Packing & Crating Co. — Reinforces that the presumption persists and that, once weighing occurs, reasonable doubts are resolved in the claimant’s favor. Lane also echoes Akamine’s caution against relying on generalized medical opinions as “substantial evidence.”
• Cadiz v. QSI, Inc. — The court treats Cadiz as a modern restatement of the burden sequence: (1) burden of production (substantial evidence to rebut), then (2) burden of persuasion (weighing). Lane uses Cadiz to keep the analysis disciplined: if the employer never clears step one, the claimant “must prevail.”
• Panoke v. Reef Dev. of Hawaii, Inc. — Lane analogizes closely to Panoke: the employer’s doctors relied on an “expected immediate symptoms” rationale, but did not explain why symptoms began after the work incident if not caused/aggravated by it. Lane extends that logic to facial/nasal symptoms documented within hours/days of the crash.
• Chung v. Animal Clinic, Inc. — Cited for the principle that if the employer fails to adduce substantial evidence, the claimant prevails; and that conflicts are resolved in the claimant’s favor under the statutory design.

2. “Substantial evidence” and administrative appellate review

• Skahan v. Stutts Constr. Co., Inc. and Ihara v. State Dep't of Land & Nat. Res. — Provide the administrative review framework under HRS § 91-14(g), including when reversals are warranted (e.g., clearly erroneous findings, errors of law).
• Est. of Klink ex rel. Klink v. State — Supplies the definition of “clearly erroneous” (no substantial evidence or definite and firm conviction of mistake).
• Borrson v. Weeks — Restates that, in workers’ compensation, “substantial evidence” is a “high quantum” of relevant and credible evidence sufficient for a reasonable person to conclude the injury is not work connected.
• Acoustic, Insulation & Drywall, Inc. v. Labor & Indus. Relations Appeal Bd. — Used twice: (i) to define substantial evidence generally, and (ii) to describe the two-step process (determine whether employer evidence is substantial; if so, then weigh employer vs. claimant evidence).

3. Biomechanics/accident reconstruction: qualification and methodological foundations

Although not essential to workers’ compensation doctrine, Lane cites non-Hawaiʻi authorities to illustrate why “force/biomechanics” opinions are specialized and typically require explicit expertise and a transparent analytic method.

• Udac v. Takata Corp. — Cited for a concrete description of biomechanics and injury causation analysis steps, underscoring that “biomechanics” is a distinct discipline with defined methodologies.
• Thoens v. Safeco Insurance Co. of Oregon — Used as an exemplar of what a methodologically grounded biomechanics opinion looks like (education, calculations, transmission of forces, occupant kinematics, and comparison to human tolerance data).
• State ex rel. Jones v. Recht — Cited for the proposition that physicians should be restricted to medical testimony and that force-of-impact issues belong to qualified accident reconstruction/biomechanics experts.
• Maines v. Fox, Johnston-Forbes v. Matsunaga, and Wilson v. Rivers — Cited to show courts often admit biomechanics testimony when the expert’s qualifications and analytical basis are demonstrated (degrees, testing, data review, experience, and impact testing).

B. Legal Reasoning

1. The court polices the “step one” gate: the burden of production

Lane is driven by sequencing. The Supreme Court insists that LIRAB must not “weigh” evidence unless the employer first introduces substantial evidence sufficient to rebut the presumption. This is not a technicality: it is how HRS § 386-85’s presumption retains real force.

Accordingly, the court scrutinized what LIRAB treated as “substantial evidence” at step one: primarily, IME statements that (i) the crash was low force so Lane could not have hit the steering wheel hard enough to fracture her nose, and (ii) a fracture would have produced immediate, obvious symptoms (bleeding, swelling, deformity) that were supposedly absent.

2. Foundational defect: an unsupported “biomechanics” opinion has no probative value

The decisive move is evidentiary. The court held that the record contained no foundation demonstrating that Dr. Cupo (and by extension Dr. Sasaki, who leaned on Dr. Cupo’s “low-speed” characterization) was qualified to opine on biomechanics/accident reconstruction. The IME report offered:

• no quantified force estimates;
• no engineering or reconstruction methodology;
• no occupant kinematics analysis (seat position, distance to wheel, posture, arm position while horn-honking); and
• no stated credentials in biomechanics, engineering, or accident reconstruction.

Because the presumption can be rebutted only by a “high quantum” of relevant, credible evidence, the absence of foundational reliability meant the “low force” opinion could not do the rebuttal work LIRAB assigned it. In practical terms, Lane makes clear that an IME physician’s ipse dixit about crash forces—without demonstrated expertise and analytic support—cannot be treated as “substantial evidence” against compensability.

3. Specificity defect: the IMEs did not directly address the documented symptom timeline

Even aside from biomechanics, the court found the IMEs did not “expressly, directly, and specifically” rebut work-relatedness because they failed to account for undisputed records showing right-sided facial/nasal complaints within hours and days of the crash:

• ER documentation of right-sided facial discomfort on the day of the collision;
• “facial pressure,” sinus symptoms, and notably “[p]ain along right side of [her] nose” two days post-collision; and
• imaging seven days post-collision showing a “right-sided” non-displaced nasal fracture—the same side as the early complaints.

The employer’s symptom-based theory (“she would have been acutely symptomatic”) also collided with the fact that when the fracture was diagnosed by x-ray, the records still noted no significant swelling, deformity, or septal complications—undercutting the inference that such external markers were necessary for the fracture to exist.

4. Consequence: failure at production ends the case

Because the employer failed to satisfy step one (production), the court stated it “need not reach” step two (persuasion). It nevertheless added that, even assuming production had been met, the evidentiary picture would at best be conflicting, which would trigger the Akamine/Chung rule that reasonable doubts are resolved in the claimant’s favor.

C. Impact

1. A practical evidentiary rule for LIRAB: “low-impact” defenses require real foundations

Lane’s most immediate effect is to raise the evidentiary floor for employers relying on “low-speed/low-force” arguments to defeat compensability:

• IME reports that drift into biomechanics/accident reconstruction must have a foundation in the record showing the physician is qualified to render that opinion (or the employer must present a properly qualified expert).
• General statements (“insufficient force,” “would have been symptomatic”) are unlikely to qualify as “substantial evidence” if they do not engage with the claimant’s actual documented symptom onset and course.

2. Reinforcement of the HRS § 386-85 presumption as a substantive protection

The decision strengthens the presumption’s “non-vanishing” nature by insisting on a genuine threshold showing before LIRAB may treat the presumption as overcome. This may shift litigation strategy: employers will more often need (i) qualified causation experts with disclosed methodology, and/or (ii) clearer alternative-cause evidence, rather than relying on plausibility arguments about minimal vehicle movement.

3. Guidance on symptom-timeline reasoning

Lane warns against overreliance on “expected immediate symptoms” theories—particularly where (as here) the confirmed injury is consistent with minimal external signs and where contemporaneous complaints exist but were not meaningfully addressed by the employer’s experts. Future IMEs that do not reconcile the symptom timeline risk being treated as non-substantial at the production stage.

IV. Complex Concepts Simplified

1. The HRS § 386-85 presumption of compensability

Hawaiʻi law starts with a default rule: if an injury is claimed to be related to work, it is presumed compensable unless the employer produces substantial evidence that it is not work-connected.

2. Burden of production vs. burden of persuasion

• Production: The employer must first come forward with substantial evidence that could rebut compensability. If the employer fails here, the claimant wins without further balancing.
• Persuasion: Only after production is met does LIRAB weigh all evidence. If the evidence is in conflict, reasonable doubts are resolved for the claimant.

3. “Substantial evidence” in workers’ compensation is a high bar

It is not “any evidence.” It is a “high quantum” of credible, relevant evidence that would justify a reasonable person concluding the injury is not work connected.

4. Biomechanics vs. medical causation

• Medical causation: Whether an event could cause or aggravate an injury medically (symptoms, pathology, imaging, differential diagnosis).
• Biomechanics/accident reconstruction: Whether the physics of a crash (speed, forces, energy transfer, occupant motion) could produce a given impact and injury mechanism.

Lane holds that when an IME opinion depends on biomechanics concepts (e.g., “the force was too low for her nose to hit the steering wheel”), the record must establish the expert’s qualifications and analytical basis; otherwise, it lacks probative value as rebuttal evidence.

5. “Non-displaced” fracture and “epistaxis”

• Non-displaced fracture: A break where bone alignment remains largely normal—often with limited deformity.
• Epistaxis: Nosebleed. Lane underscores that a minor nasal fracture may or may not involve epistaxis or visible swelling, so absence of these signs is not definitive.

V. Conclusion

Lane v. Avis Budget Group, Inc. is a significant reinforcement of Hawaiʻi’s pro-claimant workers’ compensation architecture. The Supreme Court did not simply reweigh medical evidence; it enforced the structure of HRS § 386-85 by demanding that employers clear the initial “production” threshold with truly substantial, probative evidence.

The key takeaway is evidentiary and practical: an employer cannot rebut compensability with conclusory “low-impact” biomechanics assertions embedded in IME reports unless the record establishes the expert’s qualifications and the opinion meaningfully engages with the claimant’s documented symptom timeline. By vacating LIRAB’s reliance on an unfounded biomechanics opinion and by emphasizing the need for specific, credible rebuttal evidence, Lane will shape how IMEs are drafted, how experts are presented, and how LIRAB evaluates rebuttal evidence in future compensability disputes.