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What Is an Idiopathic Injury? How Does it Affect Workers’ Compensation?

construction-worker-569149_1920 An idiopathic injury is an injury from an unexplained origin or with an unknown cause. It may or may not have anything to do with a person’s place of employment. This makes it difficult to determine whether a worker’s pain is eligible for compensation under workers’ compensation laws. Some states have also broadened the definition of idiopathic injury to include an injury in the workplace brought on by a personal condition.

The biggest issue with idiopathic injuries is how they relate to workers’ compensation. In order to receive compensation for an idiopathic injury, the individual has to prove something or someone at the workplace caused the injury, not that it merely happened on its own. The law reads the injury must “arise out of and in the course of employment” Idiopathic injuries do not meet this definition as they do not “arise out of” the employment.

Workers’ Compensation

It is typically up to the employer to provide compensation coverage to their employees. Your employer will inform you whether or not it provides insurance coverage and what it includes, such as medical expenses or lost earning capacity. Your employer will also outline the specifics about compensation. Some states have a coming and going rule which states injuries sustained while driving to and from work are not eligible for compensation.

Other specifics such as, the access doctrine has a two-part test to determine whether or not the injury sustained qualifies for compensation. Under this rule, to be eligible for compensation, you must prove your employer encouraged you to take that particular route to and/or from work, or that your employer considers the location where your injury occurred to be part of the premises.

It may appear to offer little flexibility when it comes to your workers’ compensation, but keep in mind, for example, if you already have a weak back and hurt your back further while working you are eligible for workers’ compensation. This because despite a bodily flaw, the injury occurred in the course of the employment. This is different if an employee has an idiopathic episode while at work but the pain has no relationship to the work.

When Are Idiopathic Injuries Compensated?

It is possible to receive compensation for an idiopathic injury. The bottom line is if the employment significantly contributes to the injury by placing the employee in a position which increases the likelihood of the idiopathic incident, then the employee is eligible for compensation for the injury.

Workers’ compensation claims are very fact specific. For example, falls are only compensable under very specific circumstances. If an employee falls due to a non-work-related seizure, the claim could be compensable if the employee strikes a machine or other object at work while falling. The claim would not be compensable if the employee only falls to the ground.

If you feel you have an idiopathic injury that should be eligible for coverage by workers’ compensation, hire a legal expert in workers’ compensation and insurance. They will be able to evaluate your case and your injuries to see if your denial of compensation was wrongful.