The path to better understanding of idiopathic work injuries
An idiopathic injury occurs when either the cause of an accident is unknown or when it is due to a personal condition of the employee with no relationship to a workplace risk or hazard. For an injury to be compensable under O.C.G.A. § 34-9-1(4), it must “arise out of” and occur “in the course of” employment.
In the realm of workers’ compensation, the difference between idiopathic and other injuries is an important one, as it can be the deciding factor in whether a claim is compensable or not.
An idiopathic injury occurs when either the cause of an accident is unknown or when it is due to a personal condition of the employee with no relationship to a workplace risk or hazard. For an injury to be compensable under O.C.G.A. § 34-9-1(4), it must “arise out of” and occur “in the course of” employment.
While idiopathic injuries may occur in the course of employment due to their timing, they are not compensable as they don’t arise out of the employment. It should be noted that claiming an injury is idiopathic is not an affirmative defense for an employer or insurer. Rather, the employee must meet his or her burden of proof with respect to proving the injury arose out of the employment.
Let’s look at some examples of idiopathic injuries. If an employee faints, suffers a seizure or blacks out due to a personal condition, the resulting injury could be an idiopathic injury. An employee’s leg giving out while merely walking or standing at work might also result in an idiopathic injury. Additionally, if an employee slips and falls while on the job, where there is no object, residue or liquid on the floor causing the slip, the employee might have sustained an idiopathic injury, which would not be compensable.
Where did the concept of idiopathic injuries originate?
The origin is not from statutes and legislation but rather from the courts, starting with the Supreme Court of Georgia’s decision in Fried v. United States Fidelity & Guarantee Co., 192 Ga. 492 (1941). The court found that an injury does not arise out of employment when 1) the employment could not be determined as the proximate cause of the injury, and 2) the injury came from a danger or hazard the employee was equally exposed to apart from the employment.
There is a great need for factual analysis in evaluating potential idiopathic injuries. Look at the comparison of U.S. Casualty v. Richardson, 75 Ga. App. 496 (1947) and Borden Foods v. Dorsey, 112 Ga. App. 838 (1965). In Richardson, an employee with a personal epileptic condition had a seizure brought on by excessive work and struck his head on a worktable before hitting the floor. This resulted in a compensable injury, as the worktable was unique to his employment.
However, in Borden, the injury sustained by an employee who fell when walking in an employer’s plant, where no contributing cause for the fall was noted other than the floor itself, was found to be idiopathic and not compensable. The reasoning in Borden was that the injury was no worse than if the employee fell similarly and landed on any hard surface outside of the employer’s premises.
The definition of idiopathic injuries has been changed and molded as other cases involving fact patterns with slight deviations have emerged. In Prudential Bank v. Moore, 219 Ga. App. 847 (1996), an employee’s injury was found idiopathic, and thus not compensable, when she fainted and hit her head on a baseboard at work. Unlike the worktable in Richardson, the baseboard was determined to be a hazard the employee was equally exposed to outside of work.
However, with the decision in Johnson v. Publix Supermarkets, 256 Ga. App. 540 (2002), there appeared to be the signaling of the end of idiopathic injuries. In Johnson, a cashier sustained a compensable injury when she fell while rushing down an aisle to do her job. Johnson held that the “positional risk doctrine,” rather than the previously used “peculiar risk doctrine,” should be used to determine if an injury arises out of employment. This brought about the opposite result to the one reached in Borden, as discussed above.
The idiopathic injury defense was resurrected in Chaparral Boats v. Heath, 269 Ga. App. (2004), which found Johnson erroneously construed the principles underlying prior case law. In Chaparral Boats, an employee’s knee injury sustained when speed-walking to work was found not to be compensable. She was found to be equally exposed to the risk of walking quickly outside of work, meaning it was not caused by any risk peculiar to the employment.
Using a consistent approach but reaching a different outcome, in Harris v. Peach County Board of Commissioners, 296 Ga. App. 225 (2009), a custodian sustained a compensable knee injury when bending to pick up a pill off the floor while at work. Although the pill was hers, her job duties as a custodian specifically involved picking objects up off the floor, which provided the requisite causal connection between the accident and injury.
In a contrast to the Harris case, in St. Joseph’s Hospital v. Ward, 300 Ga. App. 845 (2009), the employee’s injury was found to be idiopathic. Although the employee nurse in Ward was injured when twisting to get a glass of water for a patient, which was part of her job duties, the act of twisting to obtain a glass of water was not a unique risk associated with her job.
In similar fashion, a firefighter injuring her knee when standing up from her desk, even though asked to do so by her supervisor, was also found to be an idiopathic injury in Chambers v. Monroe County Board of Commissioners, 328 Ga. App. 403 (2014). The same train of thought in Ward was used in Chambers. Simply standing from a seated position is a common and ordinary daily action not unique to a firefighter’s job.
The consideration of an idiopathic injury was addressed in 2018 with Cartersville City Schools v. Johnson, 345 Ga. App. 290. In this case, a teacher was found to have sustained a compensable injury when she fell and injured her knee walking to the front of her classroom after placing an image on a smartboard. The reason for the finding of compensability was that her duties of instructing her students required swift movements to maneuver through the classroom configuration.
Determining If an employee has an idiopathic Injury
These cases are all fact specific. First, find out if the employee had a fall or injury with no clear cause and no work-related objects contributing to the injury. Investigate if the employee has a personal condition (such as seizures) unrelated to work, causing or contributing to the accident. Along similar lines, if a personal condition is not involved, determine if the employee has had prior treatment to the same body part claimed to be injured in the work accident.
The investigation can involve obtaining statements quickly following the accident. These statements should be from the injured employee, witnesses, supervisors and/or investigators. If there are any videos or pictures of the scene of the accident, a review can identify if there are any work-related objects or causes of the accident depicted.
In addition, a review of the medical records of the employee before and after the accident can reveal information about the cause of the employee’s injury and uncover pre-existing personal conditions that may have contributed to or caused the accident and resulting injury.
While the definition of idiopathic injuries and case results may have changed somewhat throughout the years, the idiopathic defense is still alive in workers’ compensation. As noted, claims involving potential idiopathic injuries are fact intensive and fact specific.
The quicker an investigation can be conducted, the easier it is for employers and insurers to decide whether to accept or deny a claim. Part of the investigation will hinge on the credibility of the employee and any witnesses. It is important to document all evidence in a claim by recording statements of the employee and witnesses, and by preserving any documents, photos or video surveillance.
Thus, make certain to investigate and uncover all facts to ensure a proper compensability determination and prepare for an idiopathic defense, if available.
M. Ann McElroy is a senior attorney at Swift, Currie, McGhee & Hiers, who defends employers and insurers in workers’ compensation claims. Her clients include county governments, insurance companies and large-scale claims management companies.