"Idiopathic" Injuries And Georgia Workers’ Compensation Denials

An injured worker has the burden of showing that an injury was caused by his or her employment. Sometimes thorny issues come up in proving the causal connection.

The Georgia workers' compensation system covers a broad variety of injuries sustained in workplace accidents. In some cases, an employer or its workers' compensation insurer may deny a workers' compensation claim because it was "idiopathic" or did not arise from the employment.

Idiopathic or spontaneous injuries are due to something personal and not necessarily the workplace itself. A seizure is one example that could occur at work, but is likely not caused by the employment. A borderline injury such as a slipped disk after standing up from a desk could be spontaneous or work related.

The outcomes in these cases can be very unpredictable and it is a good idea to contact an experienced workers' compensation attorney for assistance. In this article, we will discuss a borderline case that highlights some of the complexity.

Georgia statute provides that "an accidental injury is compensable under the Workers' Compensation Act if the employee's injury arose out of and in the course" of employment.

"Arose Out Of" And A Claim Denial

In a recent Georgia Court of Appeals case, an employer denied a workers' compensation claim arguing that the employee failed to show a causal connection between her employment and an injury or that the injury arose out of her work.

The woman worked as a firefighter and EMT for Monroe County. She sat down to complete some paperwork after returning to the fire station from a call. Then she stayed at the desk watching television while on call. As the EMT got up to let a supervisor use the desk, she heard a "pop" in her knee. The pain increased to the point that she sought treatment at a local emergency room. She needed surgery and a possible knee replacement.

The employee applied for workers' compensation benefits. The administrative law judge granted benefits, because the EMT had needed to be in the location as a part of her work and suffered the injury when following direction from a supervisor. The employer appealed to the Appellate Division.

Because the employee simply rose from a seated position and did not slip, trip, fall or encounter "any object or hazard that increased her risk of injury," the Appellate Division held that the employee did not prove a causal connection between her work and the injury.

Georgia Court Of Appeals Decision

The Georgia Court of Appeals noted that the person requesting workers' compensation benefits has the burden to prove causation. The appeals court cited the peculiar to the work doctrine, meaning the risk was not causally connected to the employment and was a risk that the employee was equally exposed to outside of employment. The majority held that the EMT was unable to prove that her work caused the injury. Several examples they provided that would have met the causation test were a desk configuration that caused her to lose balance or a fire alarm that required her to jump up from the chair.

In a dissent, several judges cited Georgia case law that holds that employment need not be the only cause of an injury, but rather a "contributing proximate cause." The dissent argued that direction from a supervisor to move from the desk followed by an injury was enough to show a causal connection.

These cases are unpredictable and varied based on factual and legal complexities. A workers' compensation attorney can help build the strongest case possible. Obtaining the assistance of an experienced lawyer is crucial in responding to and obtaining benefits after a claim denial.

Keywords: Work comp claim denial, spontaneous injury, work-related knee injury