The employee appeals from the compensation judge’s determination that the employee’s claimed left knee injury did not arise out of and in the course of her employment.  We reverse.

The facts of this case are largely undisputed.  Toni Dykhoff, the employee, claims that she sustained an injury to her left knee as a result of a fall on June 20, 2011.

At the time of her injury, the employee was working for Xcel Energy as a preventative maintenance coordinator.  She normally worked at a site in Maple Grove, but on June 20, 2011, the employee was scheduled to attend a required computer training session at the employer’s headquarters in downtown Minneapolis.

The employee testified that she would normally wear jeans and casual attire to work.  However, she had been advised by her manager that when she attended a meeting at the Xcel headquarters in Minneapolis, she would have to wear “dress clothes” or listen to training or meetings by conference call.  Therefore, the employee testified that she chose to wear shoes with two-inch wooden heels along with a dress shirt and dress pants for the training on June 20, 2011.

The employee arrived at the Minneapolis headquarters on June 20, 2011, at approximately 8:00 a.m.  She took the elevator to the lower level.  She placed her coat, purse, and laptop on a bench in the hallway and walked to the computer lab and conference room, where she turned on the lights.  After turning on the lights, the employee walked back to the bench.  She put her laptop bag over her left shoulder, her purse over right shoulder, and her coat over her right arm.  She then turned and headed back toward the conference room.

As she was walking back toward the conference room, the employee fell, landing on her buttocks on the marble floor of the hallway.  The employee testified, “as I hit the floor, I felt a pop in my left knee.”  She dislocated her left knee as a result of the fall.

The employee testified that when she fell, her right foot “slipped” out from under her.  She attempted to catch herself with her left leg, which also “slipped” out from under her.  When she came to rest on the floor, her legs ended up extended in front of her in a “V” shape.  The employee conceded that the area where she fell was flat, dry, and free of debris.  However, she testified that she believed that she fell because the floor was slippery.  The employee said she thought the floor was slippery because it was highly polished and very clean.  She generally understood shiny floors to be slippery.

About one month later, on July 20, 2011, the employee filed a claim petition alleging that she had sustained an injury to her left knee.  She sought payment of one week of temporary total disability benefits at the maximum compensation rate.  She reserved a permanent partial disability claim, and she also sought medical benefits, payment of attorney fees, payment of interest on all amounts awarded, and reimbursement of taxable costs and disbursements.  The employer and insurer denied primary liability for the employee’s injury, arguing that the employee’s injury did not arise out of and in the course of her employment.

The matter came on for hearing before Compensation Judge Peggy A. Brenden on April 6, 2012.  The issue presented was whether the employee’s left knee injury on June 20, 2011 arose out of and in the course of her employment.  The parties stipulated that the employee’s average weekly wage on the date of injury was $1,416.55.  They also stipulated that the employee’s wage loss and medical expenses were reasonable, necessary, and causally related to the employee’s fall on June 20, 2011, but only in the event that the claim was found to be compensable.  If so, the employer and insurer would be willing to pay the benefits as claimed.

The employee presented evidence, including photographs introduced as Exhibit 11, which she argued established the fact that the employee’s wooden-heeled shoes slid or slipped across the floor, creating a V-shaped scuff mark.

The compensation judge also heard testimony from Larry Hartmann, who is a facility operations manager for Xcel Energy.  Mr. Hartmann testified that the floor where the employee fell had been stripped and waxed on our about May 11 or May 13, 2011.  The floor was made of terrazzo marble, and it was mopped nightly. 

Mr. Hartmann testified that he had inspected the floor immediately after the fall, and although it was shiny and clean, there was nothing on the floor, and it was dry.  Mr. Hartmann specifically stated that “the floor was not slippery.”

The compensation judge found that “the floor where the employee fell was highly polished, very clean, dry and flat,” and “at the time the fall occurred, the employee was not walking fast.  She did not trip before falling.”  The compensation judge found that the employee’s decision to wear the shoes with the wooden heels was “a personal decision.”

The compensation judge stated that in order to prevail on her claim for compensation, the employee needed to show that the injury was caused by an “increased risk” that related to her work activity or environment and heightened the likelihood of injury beyond the level of risk experienced by the general public.  In her memorandum, the compensation judge explained that although the floor may have been highly polished, shiny, and clean, it was not necessarily slippery.  The compensation judge refused to credit the employee’s testimony that the floor was slippery, and she stated that she specifically relied on the following:

Therefore, the compensation judge concluded that the “weight of the evidence fails to establish the employee was at any increased risk for falling due to the condition of the floor at the time she fell on June 20, 2011,” and she denied the employee’s claims in their entirety.  The employee appeals.

On appeal, the Workers’ Compensation Court of Appeals must determine whether “the findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.”  Minn. Stat. § 176.421, subd. 1.  Substantial evidence supports the findings if, in the context of the entire record, “they are supported by evidence that a reasonable mind might accept as adequate.”  Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984).  Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed.  Id. at 60, 37 W.C.D. at 240. Similarly, findings of fact should not be disturbed, even though the reviewing court might disagree with them, “unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of evidence or not reasonably supported by the evidence as a whole.”  Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).

However, “a decision which rests upon the application of a statute or rule to essentially undisputed facts generally involves a question of law which [the Workers’ Compensation Court of Appeals] may consider de novo.”  Krovchuk v. Koch Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993).

Pursuant to Minn. Stat. § 176.021, subd. 1, employers are liable to pay compensation “in every case of personal injury . . . arising out of and in the course of employment without regard to the question of negligence.”  (Emphasis added.)  “‘Personal injury’ means any injury arising out of and in the course of employment and includes personal injury caused by occupational disease; but does not cover an employee except while engaged in, on, or about the premises where the employee’s services require the employee’s presence as a part of that service at the time of the injury and during the hours of that service.”  Minn. Stat. § 176.011, subd. 16.

The employee must prove that the injury both “arose out of” and “in the course of” employment.  Bohlin v. St. Louis Cnty./Nopeming Nursing Home, 61 W.C.D. 69, 79 (W.C.C.A Sept. 20, 2000), summarily aff’d (Minn. Jan. 16, 2001) (citing Gibberd v. Control Data Corp., 424 N.W.2d 776, 780, 40 W.C.D. 1040, 1047 (Minn. 1988)).  The phrase “in the course of” refers to the time, place, and circumstances of the incident causing the employee’s injury.  Gibberd, 424 N.W.2d at 780, 40 W.C.D. at 1047.  Thus,

The “arising out of” element connotes a causal connection between the employee’s injury and the employment, although not necessarily in the sense of proximate cause.  Bohlin, 61 W.C.D. at 71 (citing Gibberd, 424 N.W.2d at 780, 40 W.C.D. at 1047).  For an injury to arise out of the employment, there must be a causal connection between the employment and the injury.  Lange v. Minneapolis-St. Paul Metro. Airport Comm’n, 257 Minn. 54, 99 N.W.2d 915, 21 W.C.D. 61 (1959).  The requisite causal connection “exists if the employment, by reason of its nature, obligations, or incidents may reasonably be found to be the source of the injury-producing hazard.”  Nelson v. City of St. Paul, 249 Minn. 53, 55, 81 N.W.2d 272, 275, 19 W.C.D. 120, 123 (1957).  Generally, “as a matter of law, an injury which occurs during working hours and on the employer’s premises, even if it could have as easily occurred elsewhere, is compensable.”  Ferrell v. Buffalo Mem’l Hosp., 42 W.C.D. 1129, 1132 (W.C.C.A. 1990), summarily aff’d (Minn. June 15, 1990) (citing Okerstrom v. Carter-Day Co., 41 W.C.D. 23 (W.C.C.A. 1988)), summarily aff’d (Minn. July 6, 1988)).

The “arising out of” and “in the course of” requirements express two different concepts.  Bohlin, 61 W.C.D. at 79.  In practice, however, these requirements are not independent but “are elements of a single test of work-connection.”  Id.  In any given case,

Larson’s, indicates that:

The risks in category one, which are distinctly associated with the employment, “fall readily within the increased risk test.”  Bohlin, 61 W.C.D. at 73 n.2 (citing Larson, § 7.10).  Here, the compensation judge found that the employee did not slip and fall because of any particular defect with the floor.  She found that the employee’s shoes could have been a plausible explanation for the fall, but she felt the shoes were a “personal” choice.  Therefore, the judge found that the evidence did not establish that the employee was at any increased risk.

The increased risk test is considered the primary test applied in Minnesota to analyze the arising out of element.  See Bohlin, 61 W.C.D. at 72; Duchene v. Aqua City Irrigation, 58 W.C.D. 223 (W.C.C.A. 1998), summarily aff’d (Minn. Feb. 19, 1998).  The “increased risk” test requires a showing of exposure to some risk or hazard having its origin or source in the employment that the employee would not have been exposed to if pursuing his or her personal affairs.  See Duchene, 58 W.C.D. 223 (W.C.C.A. 1998), summarily aff’d (Minn. Feb. 19, 1998) (citing Nelson v. City of St. Paul, 249 Minn. 53, 81 N.W.2d 272, 273-74, 19 W.C.D. 120, 123 (1957); Olson v. Trinity Lodge No. 282, A.F. & A.M., 226 Minn. 141, 32 N.W.2d 255, 15 W.C.D. 251 (1948); Brusven v. Ballord, 217 Minn. 502, 14 N.W.2d 861, 13 W.C.D. 211 (1944); 1 Larson, § 6.30).  In other words, an employee is exposed to a risk of harm greater than that of the general public because of the nature, obligations, or incidents of the employment.  Id.

Courts have also applied a “positional risk” test, under which the employee must show that the obligations or incidents of the employment placed the employee in the particular place at the particular time that the employee was injured by some “neutral” risk or hazard.  Duchene, 58 W.C.D. at 228 (citing United Fire & Cas. Co., 510 N.W.2d at 244; Lange, 257 Minn. 54, 99 N.W.2d 915, 21 W.C.D. 61; 1 Larson, § 6.50).  An employee is not required to show that his or her risk or exposure is different from the kinds of risks encountered in daily living or involves a hazard peculiar to the employment.  Duchene, 58 W.C.D. at 231-32 (citing Breimhorst v. Beckman, 227 Minn. 409, 35 N.W.2d 719, 15 W.C.D. 395 (1949) (holding that the hazard need not be peculiar to or exclusively associated with employment); Snyder v. General Paper Corp., 227 Minn. 376, 152 N.W.2d 743, 24 W.C.D. 255 (holding that ordinary risks of life, when they occur in the course of employment, are compensable, and the term is not restricted to injuries caused by anticipated risks of the employment); Ferrell, 42 W.C.D. 1129; Okerstrom, 41 W.C.D. 23).  Therefore, according to Duchene, “[w]hen the general public and the employee are equally subject to the injury-causing risk, Minnesota has applied a positional risk test.”  58 W.C.D. at 228-29 (citing United Fire & Casualty Co., 510 N.W.2d at 244).

In Duchene, the employee sustained an injury to his knee while standing up after lunch.  58 W.C.D. at 223-24.  He had been sitting on the grass to eat lunch at a worksite, and the injury occurred as he stood.  Id.  The employee could not recall twisting or turning his knee, slipping, stepping on a rock, or anything similar, as he was getting up.  Id.  The employee’s injury fell within the purview of the personal comfort doctrine, and the parties ultimately did not dispute that the employee’s fall occurred the “in the course of” his employment.  Id. at 226-27.  Therefore, the focus of the dispute in Duchene concerned the “arising out of” element.  Id. at 227-28.  As this court noted, “if the employee could have testified that he had tripped over something, or had slipped on a rock, or had stepped wrong and twisted his knee as he got up, a sufficient work connection would have existed” in order for him to satisfy the increased risk test.”  Id. at 230 n.7.  However, the employee could not explain what had happened, and the cause of the injury was simply unknown.  Id. at 230-31.

As this court explained in Duchene, an unknown injury will “give rise to peculiar problems of proof” because the injury cannot be attributed to anything distinctly associated with the employment or with the employee personally.  Id.  The arising out of and in the course of requirements, however, “are not clearly separable, but are expressed similarly in the ‘circumstances’ of the injury.”  Id. at 232.  There was no evidence that the employee’s injury arose from a non-occupational condition or activities personal to him.  Id.  The fact that the employee could not explain exactly how the knee injury occurred did not make the fact of its occurrence during work hours, at the work site, while engaged in activities incidental to the employment, any less work-related.  Id.  On the facts of Duchene, this court held that the employee had satisfied the requirement that the injury have its “origin” or “source” in the employment and reversed the denial of benefits.  Id. at 232-33.

In Bohlin, the employee’s claimed injury occurred while her vehicle was parked on the employer’s parking lot before work.  61 W.C.D. at 69-70.  The employee testified that as she turned to exit her vehicle, she felt a pain in her back.  Id. at 70.  The employee did not recall whether she had actually stepped onto the parking lot prior to feeling the pain, and she did not slip or fall on the parking lot.  Id. at 72.  There was no evidence the parking lot was a possible cause of or contributed in any manner to the employee’s injury.  Id. at 72-73.  This court noted that the only connection between the employment and the injury was the fact that the employee’s vehicle was parked on the employer’s parking lot, stating that “It is clear from the employee’s testimony, however, the parking lot was not the source of the injury-producing risk.”  Id.  Therefore, this court held that the employee failed to prove the employment was the source of any injury-producing risk or hazard whatever and under the increased risk test, the employee failed to prove her injury arose out of her employment.  Id.  However, this court went on to state that the employee could try to establish compensability under a different test or theory.  Id.

Thus, pursuant to Bohlin, the increased risk test may be the starting point of the analysis for the arising out of element, but even if an employee cannot establish compensability under the increased risk test, compensability may be analyzed under a different test or theory.  Id.  Even in Bohlin, this court opined that the “positional risk test” may be applied in situations where the specific circumstances of an injury, including an unexplained fall onto a flat floor, are unknown.  61 W.C.D. at 76 (citing Larson, § 7.04).  The positional risk test may support compensation in “situations in which the only connection of the employment with the injury is that its obligations place the employee in the particular place at the particular time when he or she was injured by some neutral force, meaning by ‘neutral’ neither personal to the claimant nor distinctly associated with the employment.”  Id. at 73-74 (discussing Larson, § 3.05).  Bohlin also discussed the outcome in the Duchene case, and clarified that Duchene does not stand for the unqualified application of the positional risk doctrine.  Id. at 78.

Bohlin, by the same token, does not stand for the unqualified application of the increased risk test.  Rather, the proper analysis of compensability requires the balancing of both the “arising out of” and “in the course of” elements to determine whether, on the facts of each case, there is a sufficient “work-connection.”  See Id. at 79-80.  A “positional risk” or “unexplained fall” case may have a so-called “weak” arising out of element, but it must still be considered in conjunction with the in the course of element in that particular case.  Id.  Bohlin goes on to explain that:

Bohlin analyzed the facts of that case under both the increased risk and positional risk test.  In the end, this court held that both the in the course of and arising out of elements were weak.  Id. at 80-81.  The only connection to the employment was the fact that the injury occurred while the employee was in her car, parked on the employer’s parking lot, shortly before the start of her work shift.  Id.  The arising out of element was weak because the mechanism of injury was completely unknown.  Id.  The “in the course of” element was also weak because, although the requirements of time and space were met, the “circumstances” provided only “the most attenuated nexus” between the injury and the employment.  Id.  The employee was injured before even setting foot onto the employer’s parking lot, while coming to or going from work, and such injuries are generally not compensable.  Id. (citation omitted).

Whether the requisite causal connection exists is generally a question of fact for the compensation judge.  See Bohlin, 61 W.C.D. at 78 (citations omitted).  However, “no absolute rule can be derived, since there are too many factual variables that could affect the result.”  Id. at 81.  No comprehensive definition can be fashioned to fit all cases, and, to a great extent, each case stands on its own facts.  Id. at 79 (citing Gibberd, 424 N.W.2d at 780, 40 W.C.D. at 1047).  Thus, the compensation judge must give appropriate consideration to the “work-connection” of each injury, and the judge must consider the balance between the arising out of and in the course of elements.  Id. at 78-81.

An employee is covered by the workers’ compensation act “while engaged in, on, or about the premises where the employee’s services require the employee’s presence as a part of such service at the time of the injury.”  See Duchene, 58 W.C.D. at 227 (citing Minn. Stat. § 176.011, subd. 16 and discussing the “in the course of” requirement).  The parties do not dispute that the employee’s fall happened in the employer’s headquarters building when she was there specifically for the purpose of attending a required training session.  As such, the “in the course of” element is strong.

Nonetheless, the compensation judge relied solely on the increased risk test and found that, due to the condition of the floor, the employee did not establish that her injury arose out of employment.  The Minnesota Supreme Court has addressed falls onto flat floors or other injuries involving conditions personal to an employee, but, as discussed in detail in Bohlin, the Supreme Court has not decided the issue of compensability in a situation where the accident is truly unexplained.  61 W.C.D. at 76-77 (citing Stenberg v. Raymond Coop. Creamery, 209 Minn. 366, 296 N.W. 498, 11 W.C.D. 415 (1941); Barlau v. Minneapolis-Moline Power Implement Co., 214 Minn. 564, 9 N.W.2d 6, 12 W.C.D. 531 (1943); Miller v. Goodhue-Rice-Wabasha Citizens Action Council, Inc., 197 N.W.2d 424, 26 W.C.D. 187 (Minn. 1972); O’Rourke v. North Star Chemicals, Inc., 281 N.W.2d 192, 31 W.C.D. 672 (Minn. 1979)).  Each of those cases involved a condition personal to the employee, which contributed to the injury.  In O’Rourke, for example, the employee was found lying face down in a boxcar from which he had been removing bauxite.  However, the employee suffered a cerebral hemorrhage causing him to fall into the boxcar.  The Court noted that the employee’s “fall itself was caused by an idiopathic condition not shown to have any relation to his employment.”  Since the employment placed the employee in a position that aggravated the effect of his fall, the Court held his resultant death was causally related to and arose out of his employment.  In Barlau, the employee fell onto a flat floor surface.  Although a personal condition contributed to the fall, the Supreme Court upheld an award of compensation.

Here, there is nothing to suggest that any type of personal condition was involved with the employee’s fall.  The employer argues that the employee sustained an idiopathic injury, which it maintains is not compensable.  There is, however, a difference between “unexplained” injury cases and “idiopathic” injury cases.  Duchene, 58 W.C.D. at 232 (citing 1 Larson, § 10.31(b)).  “[U]nexplained-fall cases begin with a completely neutral origin of the mishap, while idiopathic fall cases begin with an origin which is admittedly personal and which therefore requires some affirmative employment contribution to offset the . . . showing of personal origin.”  Id.  (citing 1 Larson, §§ 12.11 and 12.14).

The employer relies on Koenig v. North Shore Landing, 54 W.C.D. 86 (W.C.C.A. 1996) for the position that the employee sustained an idiopathic fall, which should not be compensable.  In Koenig, the employee fell on a flat, level floor covered with slate tiles.  Id. at  92.  The employee had no recollection of why he fell, but he had a history of epileptic seizures and alcohol abuse, and the compensation judge commented that the likely cause of the employee’s fall was due to a seizure caused by alcohol abuse.  Id. at 91-92.  On appeal, a divided panel of this court adopted the majority position described by Professor Larson and held that injuries resulting from idiopathic falls onto flat surfaces do not arise out of the employment.  Id. at 93-94.  The majority stated:

The compensation judge applied the increased risk test to deny benefits, and the employer argues that this was the correct analysis.^[1]  However, the facts of this particular case illustrate the shortcomings of the exclusive application of the increased risk test.  Ultimately, we are left with an employee who sustained an injury as a result of a fall at work, and she has been denied compensation because she could not prove that the floor was slippery.  Compare this potential outcome with Starrett v. Pier Foundry, 488 N.W.2d 273, 47 W.C.D. 176 (Minn. 1992).  There, the employee’s foot became entangled in a cord on the floor of a coworker’s vehicle, and he fell out of the truck and onto the employer’s parking lot.  This court held that the employee’s activities were reasonably incidental to his employment.  The employee was still on his way in to work, and he happened to trip on something that was in the vehicle.  The Supreme Court affirmed and held that because he was on the employer’s premises and injured while engaged in activities reasonably incidental to his employment (going into work), the injury was compensable.

Furthermore, exclusive application of the increased risk test seems to result in decisions where compensation may be allowed if there is a personal condition contributing to the fall, (see Barlau), but denied in cases such as this where there is no personal condition involved and an employee is not able to show some nominal defect with the employer’s floor.

The employee in Bohlin had not even set foot onto the employer’s premises when her unexplained injury occurred.  Awarding benefits in that situation would have meant that all an employee would need to prove is that a completely unexplained injury occurred while the employee was on the work premises.  61 W.C.D. at 78.  “Such a result would remove from the employee proof of the ‘arising out of and in the course of’ requirement of Minn. Stat. § 176.011, subd. 16, and place the burden of proof on the employer.”  Id.  By definition, however, application of the increased risk test prevents compensation for every unexplained injury because increased risk can not be shown in those situations.  But if increased risk related to the employment can be shown, the injury would no longer be unexplained.

To require that increased risk must be found in every case is to hold as a matter of law that an unexplained injury is never compensable.  While the increased risk test may be the test that is used primarily,^[2] it is not the only test that may be used.  See Sorenson v. Carr Co., 71 W.C.D. 133 (W.C.C.A. 2011) (discussing Bohlin).  “No one comprehensive definition can be fashioned to fit all cases addressing whether an injury arises out of and in the course of employment,” and “each case stands on its own facts.”  Bohlin, 61 W.C.D. at 79.  See also Gibberd, 424 N.W.2d at 780, 40 W.C.D. at 1047; Anderson v. Smead Mfg. Co., 69 W.C.D. 32 (W.C.C.A. 2009).  As such, neither the increased risk test nor the positional risk test will be applicable in every case.  Rather, the proper test is the “work-connection” analysis laid out in Bohlin, and the “arising out of” element must be balanced with the “in the course of” element to determine compensability.  It is insufficient, as a matter of law, to award or deny benefits based solely on application of the increased risk test, as the compensation judge did here.

The compensation judge found that the employee was not able to prove that the floor was slippery, and we will not disturb that factual finding.^[3]  However, whether or not the floor was slippery, the fact remains that the employee fell on the employer’s floor while in the course of her employment, and she sustained an injury as a result.  Ultimately, then, there must be a legal analysis of the balance between both the “arising out of” and “in the course of” elements.  Because both were so weak in Bohlin, this court reversed the award of benefits.  Here, the facts are much different than those in Bohlin.  First and foremost, the in the course of element is very strong.  The employee was not coming or going from her employment at the time of the injury, and she sustained her injury in the employer’s headquarters where she was obligated to be for a training session.  The fall happened on the employer’s premises, and the floor was involved with the injury, as opposed to the parking lot in Bohlin.^[4]  Thus, there is much more of a work connection in this case.

Although the “arising out of” element may have been relatively weak here under the increased risk test, the “in the course of” element was stronger than in cases such as Bohlin and Lester, and it was actually stronger than many cases in which benefits were granted, including Starrett and Duchene.  The work-connection balancing test discussed in Bohlin does not require that an employee be able to prove that there was some defect in the employer’s floor.  To do so would impose an inappropriate burden of proof on the employee in what is supposed to be a no-fault system.^[5]  In addition, neither Bohlin nor any of the other cases discussed above require unqualified application of the increased risk or positional risk tests.  Rather, each case must stand on its own facts and must include a consideration of both the arising out of and in the course of elements.

The particular facts of this case show that the employee had arrived inside the employer’s headquarters, and she was preparing for a training session she was obligated to attend by the employer.  Therefore, the in the course of requirement is strong.  While the compensation judge may not have found that the floor was slippery or that the employee was required to wear the wooden-heeled shoes, the floor was certainly a contributing factor in her injury, as opposed to the parking lot in Bohlin.  The arising out of element may not be as strong as it would be in a case that clearly passes the increased risk test, but the in the course of element is strong enough to outweigh any deficiencies here.  The compensation judge did not apply the work-connection balancing test because she did not give consideration to the strength of the “in the course of” element.  Where, as here, the strength of the in the course of element outweighs any deficiencies in the arising out of element, the injury is compensable.  Therefore, we reverse the compensation judge’s determination that the injury did not arise out of and in the course of the employment.