Lane v. Avis Budget Group, Inc

Opinion

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Electronically Filed Supreme Court SCWC-XX-XXXXXXX 30-DEC-2025 12:03 PM Dkt. 52 OP

IN THE SUPREME COURT OF THE STATE OF HAWAIʻI

---o0o---

ROXANNE K. LANE, Petitioner/Claimant-Appellant-Appellant,

vs.

AVIS BUDGET GROUP, INC., Respondent/Employer-Appellee-Appellee,

and

GALLAGHER BASSETT SERVICES, INC., Respondent/Insurance Adjuster-Appellee-Appellee.

SCWC-XX-XXXXXXX

CERTIORARI TO THE INTERMEDIATE COURT OF APPEALS (CAAP-XX-XXXXXXX; CASE NO. AB 2017-006; DCD NO. 2-14-48809)

DECEMBER 30, 2025

McKENNA, ACTING, C.J., EDDINS, GINOZA, AND DEVENS, JJ., AND CIRCUIT JUDGE NICHOLS, ASSIGNED BY REASON OF VACANCY

OPINION OF THE COURT BY DEVENS, J. *** FOR PUBLICATION IN WEST’S HAWAIʻI REPORTS AND PACIFIC REPORTER ***

I. INTRODUCTION

This appeal arises from a workers’ compensation claim filed

by Roxanne Lane (Lane) with her employer Avis Budget Group Inc.

(Avis or Employer). The dispositive question in this

controversy is whether Lane sustained a nasal fracture as a

result of a vehicle collision that occurred at work. The

Director of the Department of Labor and Industrial Relations

(DLIR Director) determined that Lane’s nasal injury was a

compensable work-related injury. 1 On appeal to the Labor and

Industrial Relations Appeals Board (LIRAB), the LIRAB reversed

the DLIR Director’s determination as to the nasal fracture,

concluding that the injury did not result from the collision.

The Intermediate Court of Appeals (ICA) affirmed the LIRAB.

We hold that the Employer did not meet its initial burden

of production in adducing substantial evidence to rebut the

legal presumption of compensability for Lane’s nasal injury.

Lane was at work operating an Avis van when another vehicle

reversed into the front of the van while Lane was at a full

stop. The evidence indicated that during the collision, Lane’s

body “went forward and backward, and her nose hit the steering

wheel.”

As a consequence of the collision, Lane sustained several

1 The DLIR Director denied compensability for Lane’s claimed left ankle injury.

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injuries and pursued a claim for workers’ compensation benefits.

In the Employer’s WC-1 “Employer’s Report of Industrial Injury”

(WC-1 report), the Employer identified Lane’s neck, low back,

and right shoulder as injuries sustained in the collision. The

Employer accepted liability for those injuries under Hawai‘i

Revised Statutes (HRS) Chapter 386. By accepting compensability

for those injuries, the Employer implicitly conceded that the

subject collision was of sufficient force to have caused Lane

bodily injuries.

The only injury at issue in this appeal is a right-sided

non-displaced nasal fracture, which Lane contends resulted from

the collision, but was omitted from the Employer’s WC-1 report.

The Employer argues there was substantial evidence that Lane’s

nasal fracture was not caused by the collision, including a

doctor’s opinion that the force of the collision was

insufficient to have caused Lane to strike her nose against the

steering wheel, thus rebutting the statutory presumption of

compensability. In opposition, Lane points to the medical

records documenting her complaints and symptoms affecting the

“right side of [her] face,” “[p]ain along right side of nose,”

“sinus pain,” “nasal congestion,” and “facial pressure” that she

reported to her doctors within hours and days after the

collision, and which the LIRAB did not discredit. X-ray imaging

taken seven days after the collision confirmed that Lane had

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sustained a “[n]ondisplaced right-sided nasal bone fracture.”

In support of its decision, the LIRAB relied on a

biomechanics opinion provided by the Employer’s medical doctor,

who opined that the “force involved in the accident” was low and

could not have caused Lane to hit her nose on the steering

wheel. However, there was no evidence in the record that this

doctor was qualified to offer such an opinion in that field of

expertise.

We hold that the LIRAB’s decision was, in part, clearly

erroneous, and vacate the ICA’s September 27, 2024 Judgment on

Appeal, vacate in part the LIRAB’s November 26, 2019 Order and

January 22, 2020 Order Denying Reconsideration as they relate to

the finding that Lane did not sustain a compensable work-related

injury to her nose, affirm the DLIR Director’s December 30, 2016

decision finding Lane’s nasal injury was compensable, and remand

the case to the LIRAB for further proceedings consistent with

this opinion.

II. BACKGROUND

A. Lane’s Injuries

Lane was employed with Avis as a transporter who delivered

cars between the airport and hotels on Oʻahu. On October 26,

2014, Lane was operating an Avis van when she was involved in a

motor vehicle collision in the airport parking lot. Lane was at

a complete stop when a customer from another car rental agency

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reversed their vehicle into the front of her van. Lane

testified that at the time of the impact, she was restrained by

a seat belt and was “popping [her] horn.” She further testified

that when the car hit the van’s front bumper, her nose hit the

steering wheel “hard.” Lane described the situation as a

“commotion,” as the other driver blamed her for causing the

collision.

Later that same day, Lane was seen at the emergency room at

Pali Momi Medical Center, which charted Lane’s injuries and

complaints, including “discomfort to the right side of [her]

face” and “pain to [her] right neck[.]” (Emphasis added.)

Tenderness to her cervical back and right trapezius muscle was

also entered in the emergency room records. The records noted

that Lane “[d]enie[d] head injury.” X-rays were taken of Lane’s

spine but not her nose.

The following day, on October 27, 2014, Lane was examined

by Dr. Darwin Chan at Concentra Medical Centers. Lane’s ear,

nose, and throat were “[r]eviewed and found to be negative.”

However, Dr. Chan reported that Lane was experiencing “facial

pressure,” lightheadedness, headache, and dizziness, along with

neck and back pain. Dr. Chan also indicated no “erythema or

edema of the external ears or nose.”

Two days after the collision, on October 28, 2014, Lane was

seen by Dr. Rae Teramoto who noted in the medical records that

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Lane was complaining of “[s]inus congestion and headache since

yesterday[.]” Significantly, Dr. Teramoto reported that Lane

was experiencing “[p]ain along right side of [her] nose.”

(Emphasis added.)

The same day, Lane also saw Dr. Ronald Kienitz at Concentra

Medical Centers. Lane complained of sinus pain and congestion,

joint pain, muscle pain, right shoulder pain, back pain, neck

pain, joint stiffness, night pain, and headache. Notably,

Dr. Kienitz wrote in his records that Lane “[f]eels that the

impact in [the motor vehicle accident] caused [sinus pain and

congestion] to flare up.” Dr. Kienitz prescribed nasal sprays,

and with respect to Lane’s ear, nose, and throat exam, he

reported “nasal congestion, sinus pain w/ percussion, sl large

SM nodes[.]”

Lane was referred to physical therapy. The October 29,

2014 therapy records documented continuing complaints of sinus

pain and congestion along with neck pain.

That same day, Lane was seen by Dr. Jack Hsieh.

Dr. Hsieh’s records noted a frontal headache as well as neck

pain, right shoulder pain, and low back pain. The doctor’s exam

and assessment indicated that Lane was experiencing a cervical

strain, right shoulder strain, lumbar spine strain, myofascial

pain, and headaches with pain levels reaching 10/10 in

intensity, with ten indicating the worst pain. Dr. Hsieh’s

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“external inspection” of Lane’s nose and ears was reported as

“normal.” 2

Lane’s therapy records from October 30, 2014 documented

ongoing complaints of neck and mid-to-low back pain.

On November 2, 2014, seven days after the work accident,

Lane went to the emergency room at Kapiʻolani Medical Center for

Women and Children (Kapi‘olani Medical Center). Lane initially

went to the emergency room because her daughter was sick. While

at the hospital, Lane “registered to see why [she] was getting

these headaches non stop and couldn’t focus, couldn’t

concentrate on anything.” She was seen by Dr. Jaimie Tom, who

recorded in the clinical notes that Lane’s primary complaint was

“persistent nasal pain that has been ongoing now for the past

week.” Dr. Tom ordered x-ray imaging of Lane’s nose which

“show[ed] a nasal bone fracture.” Consistent with Lane’s

earlier complaints of pain along the right side of her nose,

documented by Dr. Teramoto two days after the collision, the

x-rays revealed a “[n]ondisplaced right-sided nasal bone

fracture.” (Emphasis added.) Dr. Tom diagnosed Lane with a

nasal fracture, but also noted that there was no significant

swelling, obvious deformity, septal hematoma, or septal

deviation, with only “faint ecchymosis over the nasal bridge.”

2 Dr. Hsieh’s examination of Lane’s ears, nose and throat noted “no hearing loss and no sore throat,” but mentioned nothing about her nose other than the “external” inspection was normal.

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Dr. Tom’s records further reflected that Lane experienced facial

pain after the collision and had “quite a bit of epistaxis, but

that has resolved.” 3

On November 7, 2014, Lane was seen by Dr. Hsieh whose

diagnosis included cervical spine strain, right shoulder strain,

lumbar spine strain, lumbar radiculitis, headache, nasal

fracture, and myofascial pain.

On November 24, 2014, Lane returned to Kapiʻolani Medical

Center where she saw Dr. Anthony Dumpit, who diagnosed Lane with

blurred vision, chest pain, nausea, dizziness, and headaches,

and documented that Lane was experiencing tenderness in the

sinuses but no nosebleeds.

The Employer’s WC-1 report noted that Lane had sustained

cervical, lumbar, and right shoulder injuries related to the

subject motor vehicle collision. The Employer accepted

compensability for those injuries. Lane later filed a WC-5

“Employee’s Claim for Workers’ Compensation Benefits” (WC-5

claim) seeking coverage for the additional injuries to her

“head, brain, face, blurred vision, nose (fracture), neck, right

shoulder, back, ribs [and] left ankle, [c]oncussion, [h]eadaches

and dizziness,” and dysphagia along with psychological injuries

including depression, anxiety, and mental distress, which the

3 “Epistaxis” refers to nasal bleeding.

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Employer denied. (Emphasis added.)

B. Employer’s Medical Examiner Reports

Pursuant to HRS § 386-79 (2015) (Medical examination by

employer’s physician), Lane was examined by two medical doctors

designated by the Employer.

1. Dr. Leonard Cupo

The first doctor, Dr. Leonard Cupo, examined Lane on

January 13, 2015, over two months after the collision. Lane’s

chief complaint at the time of the exam was nasal pain and pain

to her cervical spine, right shoulder, and lumbosacral spine.

a. No Acute Symptoms

Dr. Cupo concluded that Lane’s nasal fracture was not

caused by the collision. Dr. Cupo opined that Lane’s nasal

fracture “bears no relationship to and was not caused,

aggravated, or accelerated by the motor vehicle accident[.]”

Dr. Cupo based his opinion on Lane’s medical visits from

October 26, 2014 to November 2, 2014, explaining that Lane did

not complain of nasal pain or demonstrate an “abnormality”

during the physical examination on October 26, 2014 such as

“edema, ecchymosis, or tenderness.” That is to say, Dr. Cupo’s

opinion rested in part on the purported absence of acute

physical symptoms. Dr. Cupo explained that if Lane sustained a

nasal fracture during the collision, she “would have been

acutely and markedly symptomatic” when she was evaluated at the

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emergency room on October 26, 2014.

Dr. Cupo wrote that Lane’s first clinical notes relating to

nasal pain were reported to Dr. Teramoto on October 28, 2014,

but that Dr. Teramoto’s report did not document that the nasal

pain was related to the collision. Further, Dr. Cupo stated

that the medical records from the day of the collision did not

indicate any nasal bleeding despite Lane later reporting that

she experienced nasal pain associated with epistaxis at the time

of the collision. Dr. Cupo did not opine as to an alternative

cause of Lane’s nasal fracture.

b. Opinion on Biomechanics

Of particular significance, Dr. Cupo opined that the

“intensity of force” from the impact was “low and thus could not

have caused [Lane] to strike her nasal bridge on the steering

wheel,” especially if she was restrained by her seatbelt and

beeping the horn with her right hand.

After viewing the video of the collision, Dr. Cupo

supplemented his initial report stating that there was “no

indication that the employee was in pain on the surveillance

videotape of 10/26/14” and that the “intensity of the force”

noted in his earlier report was confirmed by his review of the

video.

Dr. Cupo did not quantify or otherwise explain the level of

force required for Lane to strike the steering wheel and sustain

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a nasal fracture, nor did he cite to any biomechanical, accident

reconstruction, or engineering findings or calculations made in

support of his opinion that the force generated by the impact

was insufficient for Lane to have sustained a nasal injury.

Dr. Cupo’s report also did not reflect that he had any relevant

qualifications, training, or expertise in these fields.

2. Dr. Vern Sasaki

Over two-and-a-half years after the collision, the Employer

had Lane examined by a second medical doctor, Dr. Vern Sasaki,

on July 6, 2017. Dr. Sasaki concluded that Lane’s nasal

fracture did not result from the impact. Dr. Sasaki opined that

Lane’s nasal fracture was first apparent on November 2, 2014,

and that the prior medical examinations on October 26, 2014,

October 27, 2014, and October 29, 2014 “did not reveal any

findings of a nasal fracture or complaints of nose pain or

swelling,” including Dr. Hsieh’s examination on October 29,

2014, which “revealed a normal nose examination.” Dr. Sasaki

advanced that Lane’s nasal fracture occurred “sometime after

10/29/14 and before 11/02/14 when her nasal fracture was

diagnosed in the Emergency Room,” but provided no opinion as to

an alternative cause of Lane’s nose injury. Dr. Sasaki

acknowledged that Lane reported facial pain on the right side of

her face along with neck and back pain at the emergency room on

the day of the collision, as well as sinus pain and headaches

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during her follow-up visits at Concentra Medical Centers.

Dr. Sasaki stated that with a nasal fracture, he would expect

acute clinical symptoms to appear “almost immediately,” and that

the “amount of force” required to cause a nasal fracture would

have to be “significant.”

Dr. Sasaki also cited Dr. Cupo’s review of the video

footage of the collision, noting that Dr. Cupo’s observations

“validated that the collision was a low-speed collision[.]”

Dr. Sasaki did not indicate that he personally reviewed the

C. Injuries Accepted by Employer

The Employer accepted Lane’s neck, back, and right shoulder

injuries as compensable workers’ compensation injuries but

denied liability for Lane’s nasal injury.

D. DLIR Director’s Decision

The DLIR Director reviewed the Employer’s denial of Lane’s

nasal injury and the additional injuries claimed in Lane’s WC-5

claim. HRS § 386-73 (2015).

In a decision issued on December 30, 2016, the DLIR

Director credited various medical reports, including the reports

from the Pali Momi emergency room, Dr. Teramoto, Dr. Kienitz,

and Dr. Hsieh, and noted that the Employer did not present an

alternate explanation for Lane’s nasal injury. The DLIR

Director reviewed the surveillance video of the collision from

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two angles and observed an “obstruction from both angles in the

form of tinted windows of the claimant’s vehicle and a large

umbrella.”

The DLIR Director determined that Lane’s nasal injury and

the injuries to her neck, back, right shoulder, head, ribs, and

vision were compensable work-related injuries caused by the

collision, but did not find that Lane’s left ankle injury was a

compensable consequence of the collision. 4

E. LIRAB’s Decision

Lane appealed the DLIR Director’s decision on her left

ankle to the LIRAB. HRS §§ 386-73, -87 (2015). As is relevant

to this appeal, one of the issues raised before the LIRAB was

whether Lane’s nasal injury was caused by the subject collision.

At the LIRAB trial, Lane testified and described how the

collision occurred: “So I reversed back, stopped completely.

They’re reversing back. Popped my horn. He just completely hit

me by the right side of the bumper.” In describing the impact,

she testified, “It was like a [sic] impact. It was like

[everything] just hit,” with the impact causing a “dent in the

rear of [their] car.” Lane further testified that she hit her

nose “hard” on the steering wheel, and explained that when it

4 On December 1, 2015, Lane suffered a left ankle injury while exiting a bus after a doctor’s appointment. Lane was diagnosed with a left ankle “sprain.” Lane sought workers’ compensation for the ankle injury as the result and consequence of her compensable work-connected injuries related to the vehicle collision.

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happened, it was “like a flash at the moment the car hit[.]”

Lane also testified that she was “complaining the next day every

day” about her nose to her doctors, who told her it was a sinus

infection and only gave her nose spray and prescription

medication that “wasn’t working.” As a result of hitting the

steering wheel, Lane testified that she “[f]elt pain to [her]

whole face,” but did not tell the doctor at the emergency room

that she hit her head on the steering wheel “because I just felt

funny like I wanted to pass out after . . . the whole commotion.

After I had to take the car back . . . just felt like fainting.”

The Employer did not call Dr. Cupo or Dr. Sasaki, or any

other witness to testify at the trial.

Following the trial, the LIRAB issued its decision

affirming in part and reversing in part the DLIR Director’s

decision. Relevant to this appeal, the LIRAB affirmed the

compensability of Lane’s injuries to her head, ribs, and vision

after determining that the Employer had not met its burden of

producing substantial evidence to rebut the presumption of

compensability. However, the LIRAB reversed the DLIR Director’s

decision as to Lane’s nasal fracture, determining that it was

not a work-related injury. As to Lane’s nasal injury, the LIRAB

concluded that the Employer: (1) “met its burden of producing

substantial evidence to rebut the presumption for

compensability”; and (2) “met its burden of persuasion to rebut

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the presumption of compensability.” The LIRAB’s determination

was based primarily on the reports from Dr. Cupo and Dr. Sasaki.

The LIRAB issued the following pertinent findings of fact

(FOFs):

7. With regard to Claimant’s nose, Dr. Cupo opined that Claimant’s nose fracture was not caused, aggravated, or accelerated by the October 26, 2014 accident. He explained that Claimant did not complain of nasal pain or abnormality when seen at the emergency room and that the force involved in the accident could not have caused her to strike her nasal bridge on the steering wheel, specially [sic] if she had her right hand on the steering wheel to beep her horn.

8. To Dr. Sasaki, Claimant reported that her head and face hit the steering wheel in the October 26, 2014 accident, but she did not have a bloody nose. Dr. Sasaki opined that Claimant’s nasal fracture occurred between October 29, 2014 and before November 2, 2014.

9. The foregoing is substantial evidence that, if true, would be sufficient to rebut the presumption of compensability with regard to Claimant’s nose.

10. Employer met its burden of production to initially present substantial evidence that if true, could rebut the presumption that Claimant’s nose fracture was not related to the October 26, 2014 accident.

11. The October 26, 2014 collision was not “extreme,” as stated by PA Acree.

12. Dr. Cupo’s description that the collision did not even move the van, is more accurate, in that the video showed that it only caused a slight quiver.

13. Upon exiting the vehicle a short time after the collision, Claimant did not attend to her face or nose.

14. Claimant did not complain of any issues with regard to her nose when she visited the emergency room on October 26, 2014.

15. The Board credits Dr. Chan’s October 27, 2014 examination of Claimant’s nose to have no erythema or edema present.

16. The Board credits Dr. Hsieh’s October 29, 2014 examination of Claimant’s nose to be normal.

17. The Board does not credit Claimant’s November 2, 2014 representation to emergency personnel that she had “quite a

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bit of epistaxis.”

18. The Board credits her representation to Dr. Sasaki that she did not have a bloody nose.

19. The Board also credits Dr. Cupo’s opinion that the force of the collision was low and could not have caused Claimant to strike her nasal bridge on the steering wheel, particularly because she was beeping her horn.

20. Weighing the evidence elicited by Employer against the evidence elicited by Claimant, Employer met its burden of persuasion to rebut the presumption of compensability.

(Emphases added.)

The LIRAB also issued conclusions of law (COLs). Relevant

here, COL 4 provided, “Claimant did not sustain a personal

injury to her nose on October 26, 2014, arising out of and in

the course of employment.”

Lane’s motion for reconsideration was denied by the LIRAB.

F. ICA Proceedings

1. Parties’ Arguments to the ICA

Lane appealed to the ICA contending that the Employer did

not present substantial evidence to overcome the presumption of

compensability and, thus, the LIRAB erred in determining that

her nasal injury was not a work-related injury.

Lane challenged the LIRAB’s FOFs 7-12, 14-17, 19 and 20 and

COL 4 relating to her nasal fracture. Lane argued that the

LIRAB erred because there was no substantial, reliable, and

consistent evidence to rebut the presumption of compensability,

including substantial evidence to meet the Employer’s initial

burden of production. Specifically, Lane pointed to the post-

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collision examinations by Dr. Chan and Dr. Hsieh, which did not

establish the absence of a fracture because no x-ray imaging was

administered.

Lane also argued that the LIRAB erred in crediting

Dr. Cupo’s opinion “regarding the force of the collision”

because: (1) the LIRAB ignored Dr. Cupo’s bias; (2) Dr. Cupo’s

conclusion that the van did not move after the collision was

inconsistent with the LIRAB’s finding that the van “quivered”;

and (3) Dr. Cupo was not qualified as a biomechanics expert or

accident reconstruction expert.

Lane further asserted that Dr. Cupo’s and Dr. Sasaki’s

reports contained general medical conclusions and failed to

identify the cause of Lane’s nasal fracture. Additionally, Lane

argued that neither Dr. Cupo nor Dr. Sasaki were qualified to

opine on the video of the collision.

Lane also contended that because the Employer had conceded

that the collision caused injuries to her neck, back, head,

ribs, and vision, the Employer could not at the same time claim

that the collision was too minimal for Lane to have injured her

nose. Lane asserted that any reasonable doubt as to whether an

injury is work-connected should be resolved in her favor, and

that the Employer failed to provide an alternative explanation

as to the cause of her nasal fracture other than the collision.

Lane further argued that the LIRAB erred in denying her

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motion for reconsideration.

The Employer countered that there was substantial evidence

to overcome the presumption of compensability. The Employer

noted that: Lane’s testimony about her experiencing nasal

bleeding was not credited; Dr. Chan and Dr. Hsieh reported that

Lane’s nose was normal; the collision did not move the van and

only caused a “slight quiver”; upon exiting her vehicle Lane did

not “attend to her face or nose,” or complain about her nose

when she went to the emergency room on the day of the collision;

and Dr. Cupo determined that the force during the collision

could not have caused Lane to strike her face on the steering

wheel while beeping the horn and restrained by a seatbelt. The

Employer emphasized that the LIRAB’s credibility determinations

should not be disturbed on appeal.

The Employer also asserted that the LIRAB did not abuse its

discretion in denying Lane’s motion for reconsideration because

no new evidence or arguments were presented.

2. Summary Disposition Order

The ICA affirmed the LIRAB’s decision, concluding that

substantial evidence supported the LIRAB’s findings and that the

Employer met the “high burden” of rebutting the presumption of

compensability for Lane’s nasal injury. The ICA cited

Dr. Cupo’s and Dr. Sasaki’s opinions that Lane would have been

symptomatic had she sustained a nasal fracture in the collision,

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and that she did not report a nasal injury nor were there

clinical symptoms of bruising, swelling, or nose bleeding on the

day of the collision and the few days thereafter. The doctors’

reports, the ICA found, supported the Employer’s position that

the nasal fracture was not caused by the collision.

The ICA concluded:

[T]he LIRAB did not clearly err in crediting the doctors’ opinions, which specifically, directly, and expressly address the presumption that Lane injured her nose in the October 26, 2014 workplace accident. Accordingly, we further conclude that the LIRAB did not err or abuse its discretion in entering the November 26, 2019 Order.

The ICA also concluded that the LIRAB did not abuse its

discretion in denying Lane’s motion for reconsideration because

Lane did not make any argument in support of this point of

error.

G. Supreme Court Proceedings

1. Application for Writ of Certiorari

We accepted Lane’s application for writ of certiorari. 5

Lane’s primary contention is that the ICA erred in affirming the

LIRAB’s decision because the Employer did not meet its heavy

burden of producing substantial evidence to overcome the

presumption of compensability for her nasal injury, i.e., the

Employer failed to disprove that the injury is work-connected.

Lane notes that the medical records reflected that she

5 Lane timely filed an amended application for writ of certiorari.

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complained of discomfort to the right side of her face during

the initial Pali Momi emergency room visit and complained of

nasal pain and congestion to Dr. Teramoto and Dr. Kienitz, which

neither Dr. Cupo nor Dr. Sasaki addressed.

Lane also contends that the ICA decision is inconsistent

with this court’s prior decisions regarding the evidence

necessary to overcome the presumption of compensability, citing

primarily to our decision in Cadiz v. QSI, Inc., 148 Hawaiʻi 96,

468 P.3d 110 (2020).

2. Employer’s Response

The Employer counters that the LIRAB properly credited

Dr. Cupo’s and Dr. Sasaki’s medical opinions rather than Lane’s

testimony. The Employer asserts that it carried its burden of

rebutting compensability because both Dr. Cupo and Dr. Sasaki

concluded that the collision was low-impact and that if Lane had

sustained her nasal fracture during the collision, she would

have immediately experienced symptoms. The Employer further

contends that Dr. Cupo’s and Dr. Sasaki’s opinions were properly

credited by the LIRAB, the ICA correctly upheld the LIRAB’s

weighing of the evidence, and the LIRAB was not required to

resolve any conflicts in the evidence in Lane’s favor.

III. STANDARDS OF REVIEW

“Appellate review of a LIRAB decision is governed by HRS §

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91-14(g).” 6 Skahan v. Stutts Constr. Co., Inc., 148 Hawaiʻi 460,

466, 478 P.3d 285, 291 (2021) (citations and brackets omitted).

Under those provisions, the reviewing court “may affirm the decision of the agency or remand the case with instructions for further proceedings.” The reviewing court also “may reverse or modify the decision and order if the substantial rights of the petitioners may have been prejudiced because the administrative findings, conclusions, decisions, or orders” (1) violate provisions of the constitution or a statute, (2) are beyond the agency’s statutory authority or jurisdiction, (3) used “unlawful procedure,” (4) were “[a]ffected by other error of law,” (5) were clearly erroneous, or (6) were arbitrary or capricious “or characterized by abuse of discretion or clearly unwarranted exercise of discretion.”

Ihara v. State Dep’t of Land & Nat. Res., 141 Hawaiʻi 36, 41, 404

P.3d 302, 307 (2017) (citing HRS § 91-14(g)(1)-(6)) (cleaned

up).

The LIRAB’s conclusions of law are reviewed de novo, under the right/wrong standard. Its findings of fact are

6 HRS § 91-14(g) (Supp. 2016) provides:

(g) Upon review of the record, the court may affirm the decision of the agency or remand the case with instructions for further proceedings; or it may reverse or modify the decision and order if the substantial rights of the petitioners may have been prejudiced because the administrative findings, conclusions, decisions, or orders are:

(1) In violation of constitutional or statutory provisions;

(2) In excess of the statutory authority or jurisdiction of the agency;

(3) Made upon unlawful procedure;

(4) Affected by other error of law;

(5) Clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record; or

(6) Arbitrary, or capricious, or characterized by abuse of discretion or clearly unwarranted exercise of discretion.

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reviewable under the clearly erroneous standard to determine if the agency decision was clearly erroneous in view of reliable, probative, and substantial evidence on the whole record. Like any agency findings, the LIRAB’s findings should be sufficient to allow the reviewing court to track the steps by which the agency reached its decision.

Cadiz, 148 Hawaiʻi at 107, 468 P.3d at 121 (cleaned up).

A finding of fact “is clearly erroneous when (1) the record

lacks substantial evidence to support the finding, or (2)

despite substantial evidence in support of the finding, the

appellate court is nonetheless left with a definite and firm

conviction that a mistake has been made.” Est. of Klink ex rel.

Klink v. State, 113 Hawaiʻi 332, 351, 152 P.3d 504, 523 (2007)

(citation omitted).

“In the workers’ compensation context, substantial evidence

means a high quantum of evidence which, at the minimum, must be

relevant and credible evidence of a quality and quantity

sufficient to justify a conclusion by a reasonable person that

an injury or death is not work connected.” Borrson v. Weeks,

155 Hawaiʻi 490, 496, 567 P.3d 195, 201 (2025) (citing Panoke v.

Reef Dev. of Hawaii, Inc., 136 Hawai‘i 448, 462, 363 P.3d 296,

310 (2015)) (quotations and brackets omitted). Substantial

evidence “must be evidence such as a reasonable mind might

accept as adequate to support a claim.” Acoustic, Insulation &

Drywall, Inc. v. Labor & Indus. Relations Appeal Bd., 51 Haw.

312, 314, 459 P.2d 541, 543 (1969).

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IV. DISCUSSION

The crux of Lane’s contention is that the Employer failed

to produce substantial evidence to overcome the statutory

presumption that her nasal fracture was a work-related injury. 7

Even with full regard and due deference to the LIRAB, we hold

that the Employer did not adduce substantial evidence to meet

its initial burden of production to rebut the presumption of

compensability. The evidence relied upon by the LIRAB,

particularly the biomechanics opinion from Dr. Cupo, lacked

foundation to be considered and thus lacked probative value.

“Hawaii’s workers’ compensation statute is to be accorded

beneficent and liberal construction in favor of the employee, to

fulfill the humanitarian purposes for which it was enacted.”

Respicio v. Waialua Sugar Co., 67 Haw. 16, 18, 675 P.2d 770, 772

(1984). HRS Chapter 386 entitles employees injured in the

course of employment to compensation. HRS § 386-3 (2015).

HRS § 386-85 creates a rebuttable presumption that an

employee’s claim is compensable. A claim for compensation is

presumed to be a work-related injury in the absence of

substantial evidence to the contrary. HRS § 386-85 (2015). The

presumption is that the claimed injury is causally related to

7 In her points of error, Lane appears to argue that the ICA applied the incorrect standard of review; however, Lane does not present any argument to support this assertion and, further, the ICA correctly applied the clearly erroneous standard of review to the LIRAB’s FOFs and right/wrong standard to the LIRAB’s COLs. See Skahan, 148 Hawai‘i at 468 n.7, 478 P.3d at 293 n.7.

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the employment activity. Korsak v. Hawaii Permanente Med. Grp.,

94 Hawai‘i 297, 307, 12 P.3d 1238, 1248 (2000); Cadiz, 148

Hawai‘i at 107, 468 P.3d at 121 (citing HRS § 386-85) (“The

workers’ compensation statute rests on the presumption that a

claimed injury is work-connected and therefore compensable.”).

This presumption is one of the “keystone principles” of our

workers’ compensation system. Flor v. Holguin, 94 Hawaiʻi 70,

79, 9 P.3d 382, 391 (2000) (citation omitted). “That

presumption is paramount, in part, because the workers’

compensation statute provides an injured employee’s exclusive

remedy for an injury arising out of and in the course of

employment.” Cadiz, 148 Hawaiʻi at 99, 468 P.3d at 113 (cleaned

The presumption of compensability places a “heavy burden on

the employer to disprove that an injury is work-related.”

Korsak, 94 Hawai‘i at 307, 12 P.3d at 1248. This presumption “is

not a mere procedural device that disappears upon the

introduction of contrary evidence.” Id. (citing Akamine v.

Hawaiian Packing & Crating Co., 53 Haw. 406, 408, 495 P.2d 1164,

1166 (1972)). To rebut the presumption of compensability, the

employer has the burden of going forward with the evidence,

which is the burden of production; and once the burden of

production is met, the employer then has to meet the burden of

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persuasion. Cadiz, 148 Hawai‘i at 99–100, 468 P.3d at 113–14

The burden of production requires the employer to initially

introduce substantial evidence that rebuts the presumption that

the injury is work-related. Id. (citation omitted). “After the

trier of the facts first makes the determination as to whether

the evidence adduced by the employer is substantial[,] then

[they are] to weigh and consider the evidence offered by the

employer against the evidence offered by claimants supportive of

the claim.” Acoustic, Insulation & Drywall, Inc., 51 Haw. at

316, 459 P.2d at 544.

“Substantial evidence” signifies a high quantum of

evidence that is, at a minimum, relevant and credible of a

quality and quantity sufficient to justify a conclusion by a

reasonable person that the injury is not work connected.

Korsak, 94 Hawai‘i at 307, 12 P.3d at 1248 (citation omitted).

“In evaluating whether the burden of producing substantial

evidence has been met, ‘the slightest aggravation or

acceleration of an injury by the employment activity mandates

compensation.’” Cadiz, 148 Hawai‘i at 108, 468 P.3d at 122

(quoting Panoke, 136 Hawai‘i at 461, 363 P.3d at 309). If

substantial evidence is not adduced, the “claimant must

prevail.” Chung v. Animal Clinic, Inc., 63 Haw. 642, 650, 636

P.2d 721, 726–27 (1981). If substantial evidence is adduced,

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the LIRAB must then weigh and consider the evidence offered by

the parties with any reasonable doubts as to whether an injury

is work-related resolved in favor of the claimant. Akamine, 53

Haw. at 409, 495 P.2d at 1166.

Here, the Employer did not meet its initial burden of

compensability. Therefore, we need not reach the burden of

persuasion. See id. at 413, 495 P.2d at 1169.

A. Employer did not meet its burden of producing substantial evidence to rebut the presumption of compensability.

The LIRAB found, and the ICA affirmed, that the Employer

met its initial burden of producing substantial evidence to

rebut the presumption of compensability with respect to Lane’s

nasal injury. The LIRAB’s determination was premised on two

FOFs. The first finding, FOF 7, relied on Dr. Cupo’s opinions

that: (1) the nasal fracture was not caused by the impact; (2)

Lane did not complain of nasal pain or abnormality at the

emergency room; and (3) the “force involved in the accident

could not have caused her to strike her nasal bridge on the

steering wheel, specially [sic] if she had her right hand on the

steering wheel to beep her horn.” The second finding, FOF 8,

was based on Dr. Sasaki’s opinion that Lane did not have a

bloody nose and that “Claimant’s nasal fracture occurred between

October 29, 2014 and before November 2, 2014.”

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Standing on these two FOFs, the LIRAB concluded that these

FOFs constituted “substantial evidence” to rebut the presumption

of compensability with respect to Lane’s nose injury, and that

the “Employer met its burden of production[.]”

The LIRAB then weighed Lane’s medical records generated

from October 26, 2014 through October 29, 2014 together with

Dr. Cupo’s and Dr. Sasaki’s reports, concluding that the

Employer met its burden of persuasion to overcome the

presumption of compensability. Lane cites Cadiz for the

contention that the Employer did not meet its initial burden of

production. We agree with Lane.

1. The record lacks foundation for Dr. Cupo’s opinion pertaining to biomechanics.

This case rests on whether Lane struck her nose on the

steering wheel. And if Lane struck her nose on the steering

wheel, the pertinent question is whether that could have, in any

way, caused her nose injury. See Korsak, 94 Hawai‘i at 308, 12

P.3d at 1249.

As noted, in FOF 7, the LIRAB relied on Dr. Cupo’s opinion

in concluding that the “force involved in the accident” could

not have caused Lane to strike her nose on the steering wheel.

The LIRAB clearly erred because there is nothing in the

record to indicate Dr. Cupo was qualified to render such an

opinion. Dr. Cupo did not cite to any credentials that

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qualified him as a biomechanics or accident reconstruction

expert. Also, he only offered a “generalized” opinion as to the

force of the impact. See id. at 308, 12 P.3d at 1249 (affirming

that “generalized medical opinions do not constitute substantial

evidence”).

In concluding that the Employer met its burden of

production, the LIRAB relied on Dr. Cupo’s opinion that the

force involved in the collision was “low and could not have

caused [Lane] to strike her nasal bridge on the steering wheel,”

especially if she had her right hand on the steering wheel to

beep the horn. 8 This opinion was offered without any calculation

of the force generated by the collision or the amount of force

transmitted to Lane’s body; any determination as to whether Lane

was sitting completely back in the driver’s seat or leaning

forward at impact placing her body and face in closer proximity

to the steering wheel; or any discussion of whether Lane’s right

arm was bent at the elbow or fully extended as she was beeping

the horn.

This technical and complex subject matter is typically

reserved for experts in biomechanics, accident reconstruction,

8 Dr. Cupo opined that Lane’s right shoulder injury was not caused by the collision, specifically stating, “The right shoulder was not a body part injured at the time of the motor vehicle accident of 10/26/14.” However, not even the Employer deemed Dr. Cupo’s opinion to be credible, as the Employer “accepted liability” for Lane’s right shoulder as a compensable body part injured in the collision.

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engineering, and other disciplines who have the requisite

training and experience in these specialized fields. See Loren

Peck, How Sound Is the Science? Applying Daubert to

Biomechanical Experts’ Injury Causation Opinions, 73 Wash. & Lee

L. Rev. 1063, 1090-1110 (2016). Biomechanics experts analyze

motor vehicle collisions utilizing physics and engineering

principles, along with vehicle manufacturing information, to

assess the forces generated in a collision. The analysis

involves accident reconstruction, which examines factors such as

vehicle weights, impact velocities, impact angles, damage

patterns, vehicle crashworthiness, occupant dynamics, injury

tolerance thresholds, and environmental factors, along with

other relevant data to analyze the forces and energy transfers

involved in a collision. Cf. Udac v. Takata Corp., 121 Hawai‘i

143, 150, n.8, 214 P.3d 1133, 1140, n.8 (Ct. App. 2009) (Expert

Dr. Banks, who had a medical degree and engineering degree, and

taught courses in biomechanics and injury causation analysis,

“testified that he followed five steps in conducting his injury

causation analysis: (1) vehicle motion or vehicle dynamics, (2)

occupant motion or occupant kinematics, (3) biomechanics, (4)

injury potential/injury analysis, and (5) review of medical

records. Dr. Banks testified that ‘[b]iomechanics is the

application of the science of mechanics to biological

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systems.’”).

Thoens v. Safeco Insurance Co. of Oregon involved an expert

opinion on the biomechanics of a motor vehicle collision. 356

P.3d 91 (Or. App. 2015). There, the biomechanics expert opined

as to whether the forces associated with the collision were

sufficient to cause injury to the vehicle occupant. Id. at 101.

The expert testified to his education and training, which

included a bachelor’s degree in engineering, a master’s degree

in biomedical engineering, and a Ph.D. in biomedical

engineering. Id. He also described his significant work and

research background in biomechanics. Id. at 101.

The Court of Appeals of Oregon found the biomechanics

expert’s opinion scientifically valid. Id. at 110. The court

considered, inter alia, the expert’s calculation of the

collision force applied to the driver’s vehicle and “how that

force was transmitted to the driver’s seat, using principles of

physics and taking into account the construction of the car and

its components”; analysis of “how plaintiff's body would have

been affected by that force, given her ‘body habitus, her

height, weight, how she was seated inside the vehicle, [and]

what type of restraint’ was used”; and comparison of the forces

that plaintiff’s body had “experienced in the collision” to a

“‘known level of human tolerance’ based on studies of vehicle

collisions and crash tests as well as his own study of human

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tissues and how they respond to various stresses.” 9 Id. at 102.

Here, there was no showing through testimony, curricula

vitae, or other relevant evidence that Dr. Cupo or Dr. Sasaki,

neither of whom testified at the LIRAB trial, possessed the

requisite expertise or were otherwise qualified to render

forensic biomechanics, vehicular accident reconstruction, or

engineering opinions relating to the collision. See State ex

rel. Jones v. Recht, 655 S.E.2d 126, 132 (W. Va. 2007) (A

medical doctor’s testimony “must be strictly restricted to

medical testimony” and “[i]ssues regarding the force of impact

must be redirected to experts qualified in accident

reconstruction or biomechanics.”). Nor was there any evidence

of scientific methods, studies, or analysis performed in

furtherance of Dr. Cupo’s opinion that it was “impossible” for

Lane to have struck her nose on the steering wheel based on the

9 See also Maines v. Fox, 190 So.3d 1135, 1142 (Fla. Dist. Ct. App. 2016) (holding that a medical doctor with expertise in biomechanical engineering should have been able to testify to forces involved in a motor vehicle collision and whether those forces were enough to cause claimant’s injuries); Johnston-Forbes v. Matsunaga, 333 P.3d 388, 391 (Wash. 2014) (biomechanics expert allowed to testify where the expert reviewed engineering data on both vehicles, bumper crash test information, and performed impact tests on both bumpers); Wilson v. Rivers, 593 S.E.2d 603, 604-06 (S.C. 2004) (finding that a medical expert with a degree in physiology and training in biomechanics who “conducted over 800 impact and injury causation analyses” and had been qualified as an expert in biomechanics in other states, was qualified to testify to forces involved in a motor vehicle collision).

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force involved in the collision. 10

In light of the foregoing, we find that the LIRAB erred in

relying on Dr. Cupo’s opinion on biomechanics, which lacks

foundation and does not justify a conclusion by a reasonable

person that Lane’s nasal injury was not work-related. See

Korsak, 94 Hawai‘i at 308, 12 P.3d at 1249.

Moreover, Dr. Cupo’s report represents the kind of

generalized opinion this court has previously warned against and

summarily rejected in Korsak and Akamine. Korsak, 94 Hawai‘i at

308, 12 P.3d at 1249 (“[P]ursuant to Akamine, generalized

medical opinions do not constitute substantial evidence.”); see

Akamine, 53 Haw. at 410, 495 P.2d at 1167–68. Thus, Dr. Cupo’s

opinions on biomechanics, which Dr. Sasaki relied on for his

opinions, cannot be sustained as substantial evidence. 11

Given the deficiency of the LIRAB’s findings, the critical

10 Although Dr. Cupo opined that it was “impossible” that Lane struck the steering wheel during the impact, the LIRAB found that the collision caused her a head injury. Upon review of the surveillance video, the LIRAB acknowledged that the video had “no clear visual of Claimant’s position or movement within the van[,]” yet that same video purportedly supported Dr. Cupo’s opinion that the collision did not cause Lane’s nasal fracture. And although the LIRAB found that the collision caused a “slight quiver,” it nevertheless credited Dr. Cupo’s opinion that the van did not move.

11 Lane also argues in conclusory fashion that Dr. Cupo is inherently biased because the Employer retained him to examine Lane. In support, Lane filed Dr. Cupo’s 1099 tax form and his testimony from an unrelated workers’ compensation case, in which Dr. Cupo testified that his average fee was “approximately $800 per [independent medical examination (IME)].” Dr. Cupo was retained by the Employer pursuant to HRS § 386-79 which allows an employer to designate a physician of their choice to examine a claimant at the expense of the employer. This is the employer’s statutory right. Neither the LIRAB nor the ICA addresses the argument regarding Dr. Cupo’s (continued . . .)

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question is whether striking the steering wheel could have, in

any way, fractured Lane’s nose with respect to medical

causation. Korsak, 94 Hawai‘i at 308, 12 P.3d at 1249

(concluding that IME reports failed to directly address whether

claimant’s physical therapy session could have exacerbated

claimant’s condition and were thus insufficient as substantial

evidence). Neither Dr. Cupo nor Dr. Sasaki answered that

question, nor did either doctor point to an alternative cause of

Lane’s injury.

2. Lane’s medical records documented clear and undisputed evidence of facial and nasal complaints from October 26, 2014 through October 29, 2014.

In FOFs 7 and 8, the LIRAB credited Dr. Sasaki’s opinion

that the nasal fracture occurred in the compressed window

between October 29, 2014 and November 2, 2014, and Dr. Cupo’s

opinion that Lane did not complain of any nasal related symptoms

at the emergency room. 12 Dr. Sasaki based his medical causation

opinion on the medical records generated between October 26,

2014 and October 29, 2014 in concluding that the records did not

reveal any “complaints of nose pain or swelling.”

Dr. Sasaki’s opinion misstates the undisputed evidence.

The medical records from Drs. Kienitz and Teramoto clearly

bias; however, on this record, we do not find this argument persuasive.

12 Dr. Sasaki stated that the nasal fracture occurred “after” October 29, 2014.

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documented Lane’s nasal symptoms, including persistent nasal

“pain,” before October 29, 2014, which Dr. Sasaki’s report

acknowledged but failed to address. Neither Dr. Sasaki nor

Dr. Cupo specifically explained or accounted for Lane’s right-

sided facial complaints in the emergency room 13 or the other

documented complaints Lane was experiencing before October 29,

2014, which included “facial pressure,” persistent “sinus pain

and congestion” since the collision, and “[p]ain along right

side of nose” that Lane attributed to the “impact in [motor

vehicle accident][.]”

The x-ray imaging taken on November 2, 2014 confirmed that

Lane sustained a right-sided non-displaced nasal fracture, the

same side she had been complaining about before October 29,

2014. While the medical records reflect that her neck pain had

improved from the date of the collision leading up to

November 2, 2014, the same records also document that “she

continues to have facial pain.” There was no evidence that Lane

was experiencing any ongoing or frequent nasal or facial

13 The record reflects that the collision occurred at approximately 1:52 p.m. on October 26, 2014, and that Lane was seen in the emergency room at 5:46 p.m., or within four hours of the incident. There is no indication in the emergency room report that Lane’s nose was ever examined on October 26, 2014, with the records showing that Lane seemed more preoccupied with her neck pain, which apparently prompted the doctors to order cervical x-ray imaging. The report references a physical examination of her head, ears, eyes, neck, cardiovascular system, pulmonary/chest, abdominal, musculoskeletal, neurological, and skin. However, the section pertaining to “HENT” (head, ears, nose, and throat) does not provide any information, as that section was left blank. No x-rays were taken of Lane’s face or nose.

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symptoms before the collision. 14 And although it is not required

that an employer provide evidence that definitively establishes

the cause of a claimant’s injury, neither Dr. Cupo nor

Dr. Sasaki explained why Lane would have started suffering

right-sided facial and nasal symptoms following the collision if

the impact had not caused the right-sided nasal fracture.

The Employer argued that the absence of acute external

physical symptoms, or what Dr. Cupo referred to as an

“abnormality,” in the medical records before October 29, 2014

ruled out the possibility that Lane sustained the nasal fracture

from the collision. But Lane did not exhibit such symptoms on

November 2, 2014 when x-rays revealed her nasal fracture. 15

Indeed, the Kapiʻolani Medical Center records from that date

indicated that Lane was not “acutely and markedly symptomatic”

any more than she was during the preceding days when she was

complaining of right-sided facial symptoms and pain along the

right side of her nose. 16 Dr. Cupo himself interpreted those

same records as documenting “no edema or deformity of the nasal

bridge” or “septal deviation or hematoma[,]” yet there is no

14 Both Dr. Cupo and Dr. Sasaki engaged in an extensive review of Lane’s prior medical records and history. Neither report alluded to any entries or doctor visits relating to nasal or sinus complaints predating the collision.

15 On October 29, 2014, Dr. Hsieh reported doing an “external inspection” of Lane’s ears and nose, which he indicated was “normal.”

16 Kapiʻolani Medical Center’s medical records from November 2, 2014--seven days after the collision--confirmed the absence of any “significant swelling,” “obvious deformity,” “septal hematoma,” or “septal deviation.”

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question that Lane’s nose was fractured.

As to Dr. Sasaki’s opinion that Lane did not have a bloody

nose, which the LIRAB relied on in FOF 8, the Employer did not

present any evidence suggesting that a person with a non-

displaced nasal fracture will necessarily experience bleeding.

Significantly, the medical records from Kapiʻolani Medical Center

advised Lane that with a “minor fracture,” “[s]ometimes, there

is also bleeding from the nose” and that it “may” cause

swelling. (Emphasis added.) That is to say, there may or may

not be any bleeding or swelling with a minor non-displaced nasal

fracture and, therefore, the absence of such symptoms is not a

definitive indicator to rule out that a person has suffered a

fracture.

In Panoke v. Reef Development of Hawaii, Inc., this court

held that two medical reports submitted by the employers’

doctors and the expert testimony of a third employer doctor did

not rebut the presumption of compensability because the doctors

did not address how Panoke, a construction worker injured while

maneuvering equipment on a worksite, was “asymptomatic” for a

shoulder injury prior to the workplace incident, “but then

started suffering from shoulder problems shortly afterwards.”

136 Hawaiʻi at 461, 363 P.3d at 309. The claimant in Panoke did

not exhibit “immediate symptoms” following the incident and did

not begin to complain of symptoms until “approximately two weeks

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after the work accident.” Id. at 463-64, 363 P.3d at 311-12.

This court concluded that the absence of symptoms following

a work accident was insufficient to overcome the presumption of

a covered work-related injury. Id. We held that an IME

doctor’s testimony that Panoke’s injury was not aggravated by

the accident because “[h]e would expect immediate symptoms given

the amount of tears” was “not sufficient to constitute

substantial evidence.” Id. at 463, 363 P.3d at 312 (quotations

omitted). We specifically noted, “[T]here is nothing in the

record to explain why Panoke would have started experiencing

serious shoulder pain approximately two weeks after the work

accident if the work accident had not caused the injury or

aggravated some pre-existing injury.” Id. at 464, 363 P.3d at

312. “As a result, the LIRAB erred in concluding that [the

employer] had adduced substantial evidence to overcome the

presumption that Panoke’s shoulder injuries were related to the

. . . work accident as he alleged.” Id.

Similar to the employer’s doctors in Panoke, neither

Dr. Cupo nor Dr. Sasaki explained why Lane was asymptomatic

prior to October 26, 2014 but then started experiencing right-

sided nasal and facial symptoms shortly after the collision

occurred and continuing through October 29, 2014. Panoke, 136

Hawaiʻi at 461, 464, 363 P.3d at 309, 312. Here, the LIRAB also

relied on Dr. Cupo’s and Dr. Sasaki’s opinions that Lane would

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have experienced immediate symptoms if the fracture were caused

by the collision. In contrast to the claimant in Panoke, who

began complaining of symptoms two weeks after the workplace

incident, Lane was diagnosed with a nasal fracture within a week

of the incident, after x-ray imaging revealed a fracture.

Contrary to Dr. Sasaki’s conclusions, the record reflects that

Lane did experience immediate and continuing right-sided facial

and nasal symptoms from the date of the collision, October 26,

2014, through October 29, 2014, as well as on November 2, 2014,

the date x-ray imaging revealed the fracture.

Dr. Cupo’s and Dr. Sasaki’s opinions that Lane could not

have sustained the nasal fracture before October 29, 2014 due to

the absence of immediate symptoms do not align with the

uncontroverted evidence, do not address the undisputed findings

charted in Lane’s medical records from October 26, 2014 through

November 2, 2014, and do not provide a sufficient degree of

specificity to constitute substantial evidence to rebut the

presumption that Lane’s nasal injury was work-related.

Accordingly, the Employer did not satisfy its initial burden of

production in rebutting the statutory presumption of

compensability.

B. Employer did not meet its burden of persuasion.

Assuming, arguendo, the Employer had met its burden of

production, the remaining evidence in support of the Employer’s

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burden of persuasion was, at best, conflicting. Any such doubts

would be resolved in Lane’s favor. Borrson, 155 Hawai‘i at 497,

567 P.3d at 202 (citing Akamine, 53 Haw. at 409, 495 P.2d at

1166); Chung, 63 Haw. at 652, 636 P.2d at 727 (Where the

evidence conflicts, “the legislature has decided that the

conflict should be resolved in the claimant’s favor.”). In

Cadiz, we held that “[i]n evaluating whether the burden of

persuasion has been met, the ‘broad humanitarian purpose of the

workers’ compensation statute read as a whole requires that all

reasonable doubts be resolved in favor of the claimant.’” 148

Hawai‘i at 108, 468 P.3d at 122 (citing Ihara, 141 Hawaiʻi at 41,

404 P.3d at 307). Here, since the Employer failed to produce

substantial evidence that expressly, directly, and specifically

rebutted the presumption that Lane’s nasal injury was work-

related, the LIRAB erred in concluding Lane’s nasal injury was

not a compensable injury. See Korsak, 94 Hawai‘i at 308, 12 P.3d

at 1249 (noting the ICA applied the correct analysis of whether

doctors’ reports expressly, directly and specifically rebutted

the presumption that an injury was causally related to the work

accident).

Based on the foregoing, we conclude that the LIRAB’s FOFs

7-10, 12, and 19-20 and COL 4 are clearly erroneous.

Accordingly, they are vacated.

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V. CONCLUSION

For these reasons, we vacate the ICA’s September 27, 2024

Judgment on Appeal; vacate in part the LIRAB’s November 26, 2019

Decision and Order and January 22, 2020 Order Denying

Reconsideration as they relate to the LIRAB’s FOFs and COL that

Lane did not sustain a compensable work-related injury to her

nose; affirm the DLIR Director’s December 30, 2016 decision

finding Lane’s nasal injury was compensable; and remand the case

to the LIRAB for further proceedings consistent with this

opinion.

Michael J.Y. Wong /s/ Sabrina S. McKenna for petitioner /s/ Todd W. Eddins Brian G.S. Choy and Keith M. Yonamine /s/ Lisa M. Ginoza for respondents /s/ Vladimir P. Devens

/s/ Steven R. Nichols