We hear the term “idiopathic claim” quite frequently in workers' compensation, but what does it really mean? To begin with, “idiopathic” is a combination of two Greek words: “idio” relating to “one's own” and “pathic” suggesting suffering or disease. It has come to mean any disease or condition of unknown cause. Lawyers and practitioners have borrowed this term to argue in workers' compensation that if a condition is idiopathic, it must be considered not causally related. Yet the word “idiopathic” does not appear anywhere in the New Jersey Workers' Compensation Act, and there are precious few New Jersey cases that even refer to it.
A more useful way to understand the defense is to think about the two fundamental requirements for any workers' compensation claim: the injury must occur during the course of employment, and the injury must arise from employment. So a police officer is walking down steps at work and feels sudden pain in his knee. He does not fall; he does not strike the ground. A piece of bone broke off in the knee spontaneously for no known reason. Is this compensable? No, according to Meusev.Egg Harbor Township Police Department, No. A-4553-90 (App. Div. May 6, 1992). It is idiopathic, or more precisely, the injury did not arise from the employment.
Another way of restating this is that for an injury to be work related, it must occur during work and the premises at work must contribute to the injury. In the above Meuse case, work had nothing to do with the injury. It could have happened anywhere and it was pure accident that the bone broke off while walking at work. The act of walking which the officer was doing was no different than his walking anywhere else.
Another example: Iesha is getting ready to go home on a snowy winter day. Her shoulder has been painful for weeks from heavy shoveling at home. She puts on her winter coat, and as she raises her right arm, she feels a tear in the shoulder. She is diagnosed with a rotator cuff tear. This happened at work, but did work cause the injury to occur? Arguably no, because Iesha puts on her winter coat all the time, whether at home or at work. She did not slam into a door or bump into another employee when she was putting on the coat. The shoulder just spontaneously tore while she was putting her coat on. This is similar to the Meuse case. The injury did not arise from work and would be considered idiopathic.
What about an employee who wears three inch platform heels to work. While walking down the corridor, she turns right to go to the cafeteria for a cup of coffee. As she turns right, her right foot falls out of the platform shoe and she badly sprains her ankle at that very moment. She does not fall and hit the ground. Defense would concede that this meets the first test: it happened at work. But did it arise from work? Arguably no. Work did not cause this to happen at all. The bad sprain was produced by the act of walking with three inch platform heels.
Suppose in the above example that the employee with the platform heels slips and falls as her shoe is coming out. She braces herself with her right hand, and she fractures the hand in two places while trying to protect herself from the fall on a tile floor. Is the hand injury compensable? Well, the injury occurred during work hours, and employees are generally covered while going for a cup of coffee on premises. The act of falling and striking the hard ground caused the employee to fracture her hand. This not only happened during work but the work premises – the hard tile floor – caused the hand to fracture in two places. The floor is part of the work premises, and this hand injury is likely to be found work related.
In short, when we think of idiopathic claims, the better analysis is whether the injury arises from work or just from personal activities that could have happened anywhere.
John H. Geaney, Esq., is an Executive Committee Member and a Shareholder in Capehart Scatchard's Workers' Compensation Group. Mr. Geaney concentrates his practice in the representation of employers, self-insured companies, third-party administrators, and insurance carriers in workers' compensation, the Americans with Disabilities Act and Family and Medical Leave Act. Should you have any questions or would like more information, please contact Mr. Geaney at 856.914.2063 or by e?mail at email@example.com.
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