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  1. #1
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    Apr 2013
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    Default Worker's Comp Benefits for an Idiopathic Fall

    We have a school custodian who fell while unlocking a gate, she turned right foot and fell on both knees. I have one person telling me this would be a idiopathic fall and is not covered under WC, then another telling me that any fall on school grounds would be covered.

    Any thoughts on this?

  2. #2
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    May 2010
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    358

    Default Re: Idiopathic Fall in Tennessee

    Quote Quoting andrea31419 View Post
    We have a school custodian who fell while unlocking a gate, she turned right foot and fell on both knees. I have one person telling me this would be a idiopathic fall and is not covered under WC, then another telling me that any fall on school grounds would be covered.

    Any thoughts on this?
    If she was on the clock.............its workmans comp!

  3. #3
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    Apr 2013
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    Default Re: Idiopathic Fall in Tennessee

    That's what I needed to know, thanks.

  4. #4
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    Default Re: Idiopathic Fall in Tennessee

    Sounds like you are the "employer"... simply file the claim with your WC carrier. It's not up to you whether or not this injury is compensable. The IC makes that decision for you, thats what WC ins premiums provide, legal advice. No one on a message board can answer your question definitively.

  5. #5
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    Oct 1971
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    3,639

    Default Re: Idiopathic Fall in Tennessee

    An idiopathic injury is one that has an unexplained origin or cause. See Shearon v. Seaman, 198 S.W.3d 209, 214 (Tenn. Ct. App. 2006). An alternative definition is an injury “caused by a purely personal condition” as opposed to an employment condition. See 20 Tenn. Workers’ Comp. Prac. & Proc. 10:7 (2009-2010). As a general rule, idiopathic injuries are not compensable under the Tennessee Workers’ Compensation Act. The determinative issue in such cases is often whether the injury arose out of employment.
    See: Idiopathic Injuries under the Tennessee Workers' Comp Act
    http://www.martindale.com/workers-co...le__921366.htm

    Idiopathic Falls

    Idiopathic falls are a confusing subject in compensation claims.
    Three ideas can explain most such claims:
    A fall to the work surface causing injury precipitated by an underlying condition such as epilepsy or syncopy will not normally be awarded coverage, and will be deemed an idiopathic fall.
    An idiopathic fall which produces an injury because the employee struck an instrumentality of work while falling, such as a table, railing, machine, lamp, or other object not directly on the work surface, will be covered due to the intervention of the work instrument.
    Finally, a fall of unknown cause should be covered because its idiopathic nature is unproven.
    Confused? The ECAB decisions which follow explain the differences.
    See pg 3:
    http://owcp.lettercarriernetwork.inf...eve%20Burt.pdf

    Tony
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
    http://www.workerscompensationinsura...inks/index.htm

  6. #6
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    Oct 2006
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    9,108

    Default Re: Idiopathic Fall in Tennessee

    if she twisted her ankle on the work surface causing the fall then it's not idiopathic and it should be covered. she should file the claim and appeal any denial of benefits.

  7. #7
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    Default Re: Idiopathic Fall in Tennessee

    Generally speaking, an "unexplained fall" and an "idiopathic fall" are mutually exclusive. An "unexplained" fall is the same as one with an "unknown cause."

    If it is "idiopathic" then it is "explained" (known to have fallen due to an idiopathic reason) and therefore not an "unexplained" fall. I just won a case in NC on this very issue. It is possible that TN case law contains a highly divergent opinion on these things but I would doubt it.

    Generally, idiopathic means for some personal reason with no connection to the work. It is usually a medical condition. Epilepsy, prior knee injury that gives out for no work-related reason, etc. I see nothing in the description posted by the OP to suggest idiopathic fall. Sounds like the person just lost his or her balance while managing the gate. Here in NC that would be an injury by accident, and I suspect that is also true in TN. But a TN work comp lawyer could give you a more reliable opinion than I.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  8. #8
    Join Date
    Apr 2013
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    10

    Default Re: Idiopathic Fall in Tennessee

    In talking with the employee, she was rushing to open the gate, turned her foot, lost her footing and fell. My colleagues are telling me it would be idiopathic, but the more I think about it, the fall may be due to her rushing and losing her balance, which would not be idiopathic. Would this be a correct view on this?

  9. #9
    Join Date
    Oct 2006
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    Default Re: Idiopathic Fall in Tennessee

    yes.
    the fall maybe directly linked to an on-the-job event/incident.
    trip falls are a common on-the-job injury in almost every industry/occupation and are covered by workers comp.

  10. #10
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    Default Re: Idiopathic Fall in Tennessee

    Quote Quoting andrea31419 View Post
    In talking with the employee, she was rushing to open the gate, turned her foot, lost her footing and fell. My colleagues are telling me it would be idiopathic, but the more I think about it, the fall may be due to her rushing and losing her balance, which would not be idiopathic. Would this be a correct view on this?
    Probably the correct view.
    However, as the ER you are required to file the claim with your WC carrier.
    It's not up to you, or your colleagues to determine whether or not the injury is work related, or the claim compensable.

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