When the Initial Version of Events Determines the Contingency Classification
The determination of contingency is a particularly sensitive issue in employment and Social Security matters. Classifying medical leave as an occupational accident or as a common illness is not a minor distinction.
It affects the employee’s financial protection, the responsibility of the mutual insurance company, the employer’s position and the legal treatment of the temporary incapacity process.
However, not every injury suffered by an employee can automatically be classified as an occupational accident. Even when the condition is later linked to a work-related task, courts require a sufficient connection between the employment activity and the injury.
Judgment No. 320/2026 of the High Court of Justice of the Valencian Community, dated 30 January 2026, addresses precisely this issue.
The case concerns an employee who began medical leave due to a condition affecting her left shoulder. The INSS initially declared that the process derived from an occupational accident, but the mutual insurance company challenged that decision.
The High Court upheld the mutual insurance company’s appeal and concluded that the medical leave did not have an occupational origin, but rather corresponded to a common contingency.
The key factor was the lack of sufficient evidence establishing a connection between the injury and the work activity, together with the existence of an initial medical statement that was inconsistent with the later version presented to support the occupational origin.
Background of the Case
The employee worked for Rajenal, S.L. as a stock replenishment employee.
On 30 May 2019, she attended ASEPEYO medical services claiming that she had injured her left shoulder the previous day.
The mutual insurance company carried out medical examinations and concluded that the condition did not originate from an occupational accident.
On the same day, the public healthcare services issued a medical leave report.
The employee remained on temporary incapacity leave until 31 July 2021.
Subsequently, she was declared permanently and totally incapacitated for her usual occupation, with financial effects from 1 August 2021.
The employee had informed the public healthcare services that, on 29 May 2019, while handling and moving a goods cage, she had pulled and turned it, at which point she felt a cracking sensation and tingling from her left shoulder to her hand.
Based on this version of events, she requested that the INSS declare that the temporary incapacity process beginning on 30 May 2019 derived from an occupational accident.
The Initial Decision of the INSS
The INSS issued a decision on 26 October 2021.
In that decision, it declared that the temporary incapacity process initiated by the employee derived from an occupational accident.
This classification attributed the contingency to a professional origin, with the corresponding financial and legal consequences.
ASEPEYO, as a mutual insurance company collaborating with Social Security, disagreed with this conclusion.
Therefore, it filed a claim against the INSS, the General Treasury of Social Security (TGSS), the company and the employee.
Decision of the Labour Court
Labour Court No. 4 of Alicante dismissed the mutual insurance company’s claim.
The first-instance judgment confirmed the INSS decision and declared that the temporary incapacity process beginning on 30 May 2019 derived from an occupational accident.
Consequently, ASEPEYO was ordered to comply with and accept that classification.
The mutual insurance company appealed before the High Court of Justice of the Valencian Community.
The Mutual Insurance Company’s Arguments
ASEPEYO argued that the first-instance judgment had incorrectly applied the presumption of occupational origin established in Article 156.3 of the Spanish General Social Security Law (LGSS).
Its argument was that there was no occupational accident report and no employer communication to the mutual insurance company.
Furthermore, the process had never initially been treated as an occupational contingency.
The mutual insurance company also argued that the employee had previous medical conditions affecting the same area of the body for several years.
According to ASEPEYO, the first-instance judgment had incorrectly reversed the burden of proof.
In its view, the employee’s later statement alone could not be sufficient to activate the presumption of occupational accident.
What Is the Presumption of Occupational Origin?
Article 156.1 of the Spanish General Social Security Law defines an occupational accident as any bodily injury suffered by an employee as a result of or in connection with work performed on behalf of an employer.
This definition requires three elements:
- The existence of an injury.
- The existence of employment carried out for another party.
- A connection between the injury and the work activity.
Furthermore, Article 156.3 LGSS establishes a presumption of occupational origin for injuries suffered during working time and at the workplace.
This presumption is relevant because it shifts the burden of proof. If it is established that the injury occurred during working time and at the workplace, the occupational origin is presumed unless evidence to the contrary is provided.
However, this presumption does not apply automatically in every situation.
First, there must be a sufficient factual basis allowing the injury to be objectively located within the workplace context.
The Injury Must Have an Objective Connection With the Work Activity
The High Court recalls that an occupational accident is not limited only to sudden or violent events.
Certain illnesses or alterations in physiological processes that arise during work and may be caused by internal or external factors can also qualify as occupational accidents.
However, even in these situations, there must be a connection between the injury and the work activity.
In the case analysed, the Court considers that this connection was not proven based on the established facts.
The employee later stated that the injury occurred while handling a goods cage. However, this version did not coincide with the first medical account recorded by the mutual insurance company.
The Importance of the First Medical Examination
One of the decisive elements of the judgment is the first medical examination.
The employee was treated by ASEPEYO’s medical services on 30 May 2019, one day after the alleged incident.
According to the High Court, the first medical record did not include the version later provided to the public healthcare services.
Instead, the emergency report indicated that the pain had appeared while lifting her arms in the shower to wash her hair.
This fact was considered decisive.
The Court considers that the first statement made before the mutual insurance company’s medical services weakened the later version regarding the occupational origin of the condition.
Therefore, the employee’s subsequent statement was not sufficient to activate the presumption of occupational origin.
The Absence of an Occupational Accident Report
The judgment also considers the fact that there was no occupational accident report known to the mutual insurance company.
This factor is not necessarily decisive by itself.
Some occupational accidents may not initially be processed correctly.
However, in this case, it was considered together with other elements:
- The first medical version did not refer to a workplace incident.
- The mutual insurance company rejected the occupational origin.
- There was no employer communication identifying the event as work-related.
Therefore, the overall evidence did not allow the Court to conclude that the injury occurred as a result of or in connection with work.
Why the Presumption of Occupational Origin Did Not Apply
The High Court concludes that the only element supporting the application of the presumption was the employee’s later statement before the public healthcare services.
However, this statement was contradicted by the first version provided to the mutual insurance company on 30 May 2019.
Therefore, there was insufficient factual evidence to apply Article 156.3 LGSS.
The Court considers that the first-instance judgment had incorrectly applied the presumption without prior evidence establishing that the injury had actually occurred during working time and at the workplace.
The Burden of Proof
The issue of evidence is at the centre of the case.
When the presumption of occupational origin applies, the party denying the professional nature of the injury must prove that the condition is not related to work.
However, when it has not been established that the injury occurred during working time and at the workplace, the presumption does not apply.
In that situation, the party claiming the occupational origin must prove the causal relationship between the injury and the work activity.
The High Court considers that this relationship was not proven.
Therefore, it upholds the appeal filed by the mutual insurance company.
Decision of the High Court of Justice of the Valencian Community
The High Court of Justice of the Valencian Community upholds the appeal filed by ASEPEYO.
It overturns the judgment issued by Labour Court No. 4 of Alicante.
Furthermore, it upholds the mutual insurance company’s claim and declares that the medical leave initiated on 30 May 2019 did not derive from an occupational contingency, but rather from a common contingency.
The judgment does not impose costs.
The Key Legal Principle of the Judgment
The judgment establishes a clear principle: the presumption of occupational origin requires a sufficient factual basis.
It is not enough for an employee to later state that the injury occurred while performing a work-related task.
If the first medical examination records a different version and there is no occupational accident report or employer communication, the presumption may not apply.
Therefore, classifying a medical leave as an occupational accident requires more than an allegation.
It requires consistency between the timeline, medical evidence and objective connection with the work activity.
Practical Impact for Companies
This judgment is relevant for companies managing medical leave and potential occupational accidents.
First, it confirms the importance of immediately documenting any workplace incident.
If an employee reports an injury occurring during working hours, the company should activate internal procedures and record the circumstances surrounding the event.
Second, it highlights the importance of consistency between the initial medical statements and any later version of the accident.
The first medical assessments often have significant evidentiary value.
Third, it confirms that companies should preserve communications, internal reports, witnesses’ information, working time records, assigned tasks and any other evidence that may help reconstruct what happened.
Finally, when there is uncertainty regarding the correct contingency classification, companies should coordinate with the mutual insurance company and obtain appropriate legal advice.
Impact for Mutual Insurance Companies and Social Security
For mutual insurance companies, this judgment reinforces the importance of the initial medical assessment and proper clinical documentation.
The medical report issued during the first consultation may become decisive when determining whether a condition has an occupational origin or not.
The judgment also confirms that mutual insurance companies may challenge an INSS decision regarding the determination of contingency when they consider that the medical leave does not result from an occupational accident.
However, such challenges must be supported by sufficient evidence.
In this case, the key elements were:
- The employee’s first medical statement.
- The absence of an occupational accident report.
- The initial medical assessment rejecting the professional origin of the condition.
Together, these elements were sufficient to challenge the classification initially made by the INSS.
Impact for Employees
For employees, the judgment also provides an important practical lesson.
When an injury actually occurs during work, it is essential to report it immediately and consistently.
The employee should explain from the first medical examination:
- How the accident occurred.
- What task was being performed.
- When the injury happened.
- Where the incident took place.
A late or inconsistent version of events may weaken a claim for recognition of an occupational contingency.
This does not mean that every discrepancy automatically prevents recognition of an occupational accident.
However, when the only evidence supporting the occupational origin is a later statement contradicted by the first medical assessment, the evidence may be considered insufficient.
Best Practices When a Workplace Injury Occurs
When an injury occurs during working hours, companies should have a clear internal protocol.
First, the company should immediately record the employee’s report of the incident.
Then, it is advisable to identify:
- The exact location where the incident occurred.
- The time of the event.
- The task being performed.
- Any potential witnesses.
The corresponding internal report or communication should also be completed whenever there are indications of a workplace accident.
The employee should be referred to the mutual insurance company when appropriate, and all documentation relating to the incident should be preserved.
For their part, employees should accurately describe the mechanism of injury from the first medical examination.
Finally, where previous medical conditions exist, they should be carefully assessed in order to determine whether the injury represents a new condition, an aggravation of an existing condition, or a common illness unrelated to work.
The Presumption of Occupational Origin Does Not Replace Proof of the Event
Judgment No. 320/2026 of the High Court of Justice of the Valencian Community confirms that the presumption of occupational origin cannot be applied without sufficient objective evidence.
In the case analysed, the employee later claimed that the injury occurred while handling a goods cage.
However, during the first medical examination before the mutual insurance company, a different version was recorded: the pain appeared while lifting her arms in the shower to wash her hair.
Furthermore, there was no occupational accident report and no employer communication to the mutual insurance company.
For these reasons, the High Court upheld ASEPEYO’s appeal and declared that the medical leave beginning on 30 May 2019 resulted from a common contingency, not an occupational accident.
The practical lesson is clear: in contingency determination procedures, initial evidence matters.
Consistency between the accident report, medical records and company documentation may determine the final classification of the process.
At Suárez de Vivero, we advise companies, mutual insurance companies, organisations and Human Resources departments on contingency determination procedures, occupational accidents, temporary incapacity, Social Security matters, occupational risk prevention and legal defence in employment proceedings.
Frequently Asked Questions About Occupational Accidents and the Presumption of Occupational Origin
What is the presumption of occupational origin?
It is the legal rule under which injuries suffered during working time and at the workplace are presumed to be occupational accidents, unless evidence proves otherwise.
Does the presumption apply whenever an employee says that the injury occurred while working?
No.
There must first be sufficient objective evidence allowing the injury to be placed within the context of working time and the workplace.
Who must prove the occupational origin of the injury?
If the presumption of occupational origin applies, the party denying the professional nature of the injury must rebut it. Does not apply, the party claiming that the injury is work-related must prove the causal relationship with the employment activity.
Can a mutual insurance company challenge an INSS decision?
Yes. A mutual insurance company may judicially challenge a decision determining that a medical leave derives from an occupational accident if it considers that the legal requirements are not met.
What should companies do when a workplace injury may have occurred?
Companies should document the incident, record the employee’s initial explanation, identify witnesses, communicate the event correctly and coordinate with the mutual insurance company.