Idiopathic Condition


Nothing is as frustrating to an Employer/Carrier as when an employee suffers an accident and cannot explain how the accident took place.   This occurs often in slip and falls where the employee readily admits she does not know (or sometimes remember) how she fell.  She was walking down and a hallway at work one minute.  The next minute, she was on the ground and in pain.

Many E/C’s view these type of injuries as “idiopathic” and deny the claim because the accident could have occurred anywhere (at home or in public) and the fact it occurred at work was just a coincidence.  None of the physical aspects of the job caused the accident.

The problem is this thinking is wrong.  Even the definition of “idiopathic” is misinterpreted by many E/C’s.  All “idiopathic” means (as defined by Webster’s Dictionary)  “arising spontaneously or from an obscure or unknown cause.”   So, when an E/C cries out “idiopathic!” and denies the claim, all they are saying is they have no idea what happened.  And, that has no bearing to proving the claim is non-compensable.

The truth of the matter is that if no one (not even the Claimant) knows how an accident happened, the courts are going to favor the Claimant and award compensability.   And, we have a couple of new cases from the First DCA that proves this point. (more…)

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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. (more…)