“Idiopathic” defense to workers’ comp claims is still viable in Georgia, court rules

The “idiopathic defense” to workers’ compensation claims is still a viable one, according to a recent decision from the Georgia Court of Appeals.

“Idiopathic,” as defined by the Georgia Court of Appeals, means “injuries sustained at work that are unrelated to, or do not occur while engaged in, work.” In Stoker v. Walker County Board of Education, the Court of Appeals said that a workplace injury resulting from a fall that occurred for no apparent work-related reason was not compensable.

Background

As most know, a compensable claim in Georgia requires the employee to prove that he or she sustained an injury by accident which arose out of and in the course of employment. When it comes to a fall at work, the question of compensability usually turns on whether the fall and resulting injury “arose out of” the employment. An injury arises out of employment when a reasonable person, after considering the circumstances of the employment, would perceive a “causal connection” between the conditions under which the employee must work and the resulting injury.

Examples of falls at work that were compensable can be seen in two recent cases, Cartersville City Schools v. Johnson and Frett v. State Farm Employee Workers’ Compensation.   The Cartersville claimant, Celia Johnson, was a teacher who had walked to the back of her classroom to load a picture onto her smart board during her lesson. After uploading the picture, she turned from her computer and desk to quickly maneuver around the desks and walk back to the front of her classroom to resume her lesson. In doing so, she fell and injured her knee.

During the workers’ compensation hearing, the evidence showed that these necessary swift movements and the configuration of Ms. Johnson’s classroom contributed to the acute stress on her knee, resulting in the injury. As a result, her knee injury was determined to have arisen out of her employment and was compensable.

In Frett, claimant Rochelle Frett was an insurance claims associate. She decided to take her lunch break (during which she was allowed to leave the premises and use her scheduled break time as she saw fit), in the employer’s break room. While preparing her lunch, she slipped in some water on the floor and was injured. Although the injury occurred during a break and the fall was not related directly to work activities, her injury was found to be compensable. According to the Court, preparation of Ms. Frett’s lunch was reasonably necessary to sustain her comfort at work and therefore incidental to her employment, and therefore the injury was compensable.

The Stoker decision

Given the erosion of the “break” defense, and the finding in Cartersville that “walking and falling” is compensable,  Georgia employers began to wonder whether there was still a viable idiopathic defense to workers’ compensation claims based on falls that occurred at work but not due to any work hazard.

In Stoker, the Georgia Court of Appeals has now made clear that where an employee has fallen while on the employer’s premises but not because of any discernable hazard in the work environment, the injury may not be compensable.

The claimant in Stoker was a substitute teacher who was injured while leading her class down a flat straight hallway to the cafeteria. Ms. Stoker testified that she did not trip over anything, did not slip in any substance on the floor, and did not know why she fell. She testified that she went from performing her job duties to being on the floor.

The burden is on the claimant to present evidence linking the alleged work injury to the work. It is not enough to show that the injury occurred while the claimant was at work. The Court of Appeals found that Ms. Stoker failed to meet her burden of proving by a preponderance of evidence that her injury arose out of her employment. The Court went on to explain that an injury that is peculiar to the individual or arises spontaneously from an obscure or unknown cause, and has no causal connection to workplace activity or conditions, is idiopathic and not an injury arising out of employment.

The Stoker decision sends a clear message that workers’ compensation claimants in Georgia must prove that their falls and resulting injuries arose out of the employment. And that is good news for employers.