This issue came up recently and I thought I would share it with you:

Claimant has a desk job in a large corporation.  In the office, during normal working hours, walking between a conference room and her desk, her ankle suddenly gives out and she falls to the carpeted floor.  Her injuries are serious as she fractured the ankle and suffered a possible torn shoulder labrum when her arm braced the fall. 

The question left to me was: is this an accident?  Your answer after the jump.

First, in a case like this, the claims professional should look to see if Claimant has a pre-existing condition that caused this “accident.”  This pre-existing condition, or idiopathic condition, must exist for the E/C to deny compensability.  As we all know, ankles do not just cave in without some external or internal forces acting upon it.  Often, through investigation, you will find Claimant has a history of ankle problems; perhaps a previous fracture or reconstruction or even a history of arthritis.

But, if there is no idiopathic condition, if the ankle just caved in randomly with no trauma, is it an accident?  The answer is yes.  Any exertion connected with the injury (including walking) as a medical fact satisfies the legal test of causation.  It is not necessary that Claimant show an actual slip and fall, or other mishap for this case to qualify as an “accident.”   Therefore, a case like this one would be compensable.

However, even if Claimant has an idiopathic condition of the ankle, the claim could still be compensable if she shows that her workplace conditions present an increased hazard unique to employment.  The courts decide what is an increased hazard on a case by case basis.   A standard carpeted floor might not be an increased hazard, while a bare concrete floor might be or an elevated ramp. 

I know this is a subjective evaluation and not a hard fast rule, so when there is an idiopathic condition the best an E/C can do is to ask if anything about the workplace environment is unusual as compared to Claimant’s home environment. 

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