Sorting out the difference between "idiopathic," purely personal, and compensable workplace accidents in New York.

What types of injuries are compensable?

To be compensable under the Workers’ Compensation law, an accidental injury must have arisen both out of and in the course of employment.  See WCL § 10.  Accidents arising “in the course of employment” are presumed to arise out of the employment, and this presumption must be rebutted by “substantial evidence to the contrary” for the employer to succeed in denying a claim.  See WCL § 21. 

Are idiopathic injuries compensable?

The term “idiopathic” means “spontaneous injuries or injury whose cause is unknown” but we use this term to refer to injury likely arose from something “personal” to the employee – not a common or shared workplace risk.

Are purely personal injuries compensable?

No. For example, injuries arising from diabetic collapse or fainting in the workplace are sometimes referred to as “idiopathic” injuries. More commonly, the employee who alleges that their leg “just gave out” causing them to fall to the ground. In one memorable case, a claimant stated that her ankle twisted, and testified that she did not trip or fall – her ankle simply twisted while she was walking. In these types of injuries, the employer has to decide whether to accept the claim or deny it as “did not arise out of or in the course of the employment.”

When can an injury caused by an idiopathic or purely personal risk be compensable?

In a recent case (Manhattan Psychiatric Center, 113 NYWCLR 86, N.Y.W.C.B. Full Board 2013, Decided March 28, 2013) a claimant passed out and fell to the ground as a result of a personal health condition. he claimant fell while exiting a bathroom at work. She testified that “she did not trip over anything.” A co-worker testified that about an hour before the fall, the co-worker had called the nursing office about the claimant, telling them that he was throwing up and feeling sick. It was determined that the underlying health condition (a vasovagal reaction due to pregnancy) had nothing to do with the employment. The trial judge found that the claimant had blacked out and fell at work due to a condition not connected to her work activity. 

However, the Board ruled that while falling due to her purely personal condition, she stuck her head on the wall of the bathroom she was exiting. The Board ruled that even though the fall was precipitated by a reason purely personal to the employee, the fall was “impeded by the work environment” and the resulting injuries were therefore compensable.

The application of these rules to decisions is very fact specific.

For example, in the cases of epileptic seizures occurring in the workplace, where the claimant was injured not by the seizure but by coming in contact with the employer’s premises during the thrashing episode, the Board has previously ruled that the claim was not compensable, because “in any epileptic fit anywhere the ground or floor would end the fall.”  In other words, there is nothing uniquely impeding about the employer’s workplace floor that distinguishes it from any other which would have been encountered by the epileptic during a fit.

In the recent case, the claimant’s head struck a bathroom wall – not the floor. The Board ruled that the it was the wall that interfered with the fall – not the floor – and that therefore the claim was compensable. This decision is based on the longstanding line of cases (going back to 1932) in which the Board finds that objects such as a table or the employer’s building itself “impede” the fall and therefore render a claim for injury compensable.

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Greg Lois is the managing partner of LOIS LLC, a 19-attorney law firm dedicated to defending employers and carriers in New York and New Jersey workers' compensation claims. Greg is the author of a popular series of "Handbooks" on workers' compensation, and is the co-author of the 2016 Lexis-Nexis New Jersey Workers' Compensation Practice Guide. Greg can be reached at 201-880-7213 or glois@lois-llc.com