Two recent state court decisions have highlighted the complexities of workplace falls and whether unexplained “idiopathic” causes can eliminate a claimant’s rights to workers compensation.
Falls, among the most common types of injuries in the workplace, can be triggered by the work itself or the condition of the premises.
They can also be considered idiopathic, or caused by some unknown factor. Such falls often lead to litigation with often unpredictable outcomes, legal experts say, adding that the so-called idiopathic fall defense of claims is usually a best practice.
J. Bradley Young, a shareholder with Chesterfield, Missouri-based Harris Dowell Fisher & Young LC who practices in Illinois and Missouri, said the issue is fraught with “gray areas” and that sometimes pre-existing physical conditions – such as a bad knee that buckles — can bar such claims in some states.
In many states, “the question is always going to be, did the employment place them at greater risk of injury? If the answer is no, the idiopathic injury is not considered to be compensable because the employment did not place them at greater risk of injury,” said
Then there’s the burden-of-proof requirements, which differ among states.
In Grafton Correctional Facility v. BWC, the Ohio Supreme Court on Sept. 23 reversed a trial court ruling in favor of the worker, stating instead that the prison case manager’s unwitnessed fall in a hallway may not be compensable, as the “injured worker bears the burden of eliminating idiopathic causes for the injury,” and, once the claimant has done so, “an inference arises that the fall is traceable to some ordinary risk, albeit unidentified, to which the employee was exposed on the employment premises.”
The Utah Court of Appeals on Aug. 22 ruled in Ackley v. Labor Commission that a Lowe’s Home Improvement store worker can receive benefits for injuries she suffered from an idiopathic fall while she was working — if the injuries were made more severe by the environment in which she worked.
The appellate court explained that potential workplace hazards “must actually contribute to the injuries sustained” for an increased risk to be present. This means idiopathic falls to level ground on a hard floor might be compensable, “but only if the employee can show, as a factual matter, that the hardness of the floor made the resulting injuries worse,” the court said.
Applying an idiopathic defense “is challenging from a practical level, depending on which state you’re in,” said Emily Truitt, a senior attorney in the Atlanta office of Swift, Currie, McGhee & Hiers LLP, which defends employers.
Ms. Truitt said many claims call for investigations and medical records and that the lag time in obtaining information can put the employer at a disadvantage. Also, many states — such as Georgia — have case law that allows for the compensability of idiopathic falls if certain standards are met.
Other factors unrelated to the cause of a fall can push a claim forward, according to John Ruocchio, partner at Raleigh, North Carolina-based Lewis & Roberts PLLC, which also defends employers.
“It’s highly fact-specific,” he said, adding that parts of injuries that occur in conjunction with an idiopathic fall could be compensable. One example he gave is if a worker hits his or her head on a desk as a result of an idiopathic fall. It’s likely the head injury would be compensable because the desk is related to the work.
This article was first published in Business Insurance.
