IDIOPATHIC INJURY | SC WORKERS COMPENSATION
Idiopathic Injury Under SC Workers Compensation Law
In most work-related accidents, the question of whether the claim is compensable is clear. However, in idiopathic injury cases, clever defense lawyers try to cloud the issue by arguing the injury had nothing to do with the employment, and therefore, should be denied. The defense bar was so effective in creating this legal mayhem that the appellate courts recently released two clarifying opinions (Nicholson v. SCDSS and Barnes v. Charter 1 Realty) that return workers’ compensation standards to where they were intended from inception. First, let’s start with some of the basic precepts of South Carolina workers’ compensation law. Here are some of the often-quoted principles in the case law:
- For an accidental injury to be compensable, it must “arise out of and in the course of employment.” S.C. Code Ann. § 42-1-160(A) (Supp. 2013).
- An injury arises out of employment if it is proximately caused by the employment.
- It must be apparent to the rational mind, considering all the circumstances, that a causal relationship exists between the conditions under which the work is performed and the resulting injury.
- The claimant has the burden of proving facts that will bring the injury within the workers’ compensation law, and such award must not be based on surmise, conjecture, or speculation.
- Workers’ compensation law is to be liberally construed in favor of coverage to serve the beneficent purpose of the Workers’ Compensation Act.
- Exceptions and restrictions on coverage are to be strictly construed.
Idiopathic injury claims represent an exception from the general rule that a work-related injury is compensable. As an exception, the idiopathic doctrine should be strictly construed in favor of inclusion. One definition of an idiopathic injury is one that is “brought on by a purely personal condition unrelated to the employment, such as heart attack or seizure, that can manifest anywhere. For example, if an employee becomes ill while at work from natural causes, that state or condition is not accidental. If someone faints due to a high fever, is that injury compensable? It could depend on a number of potential facts. If the employee were called into work by the employer knowing the person was ill, that fact might bring an otherwise non-compensable claim within workers’ compensation protection. As you will see, these cases are very fact-specific, and details will make a critical difference.
In Nicholson, an employee fell on the carpet while on her way to a meeting and was injured. There was nothing wrong with the carpet itself. The employee simply tripped and fell. There was no dispute that Nicholson’s injuries occurred within the course of her employment, but the challenge was whether they arose out of her employment. In the previous ruling, the South Carolina Court of Appeals held “the causative danger must be peculiar to the work and not common to the neighborhood.” The court reasoned that because the carpet was a “common danger not peculiar to Nicholson’s employment,” there was no causal connection between the injury and the job. An injury is not compensable unless there is some causal connection to the workplace. The rule does not require a claimant to prove an injury is entirely unique to the employment. Any other interpretation would seriously undermine the basic premise and reason for workers’ compensation.
The Court of Appeals also found that Nicholson failed to show a causal connection between her employment and injury because she could not establish her fall was the result of a “hazard or special condition.” In effect, the Court was now requiring a claimant to demonstrate some danger or hazard caused the fall. The South Carolina Supreme Court reversed and commented “…this constrained view of recovery is directly contrary to our workers’ compensation jurisprudence, which has consistently allowed recovery for accidents that could occur under circumstances not related to employment.” South Carolina has never required an injury to result from a particular hazard or risk of the job. The court of appeals ruling erroneously injected fault into workers’ compensation law which was specifically designed as a no-fault system. For an accidental injury to be compensable under South Carolina workers’ compensation law, there must simply be a causal connection between the employment and the injury. The claimant needs to prove nothing more. Because the circumstances of her employment required her to walk down the hallway to perform her responsibilities and because Nicholson’s fall was not caused by a condition peculiar to her, it was deemed to be causally related to her employment.
By contrast, in Barnes, the Court of Appeals denied benefits because the claimant could not how she fell while she was going to check emails. There was no substance, object, debris, or anything else in her path that caused her to trip. The surface she walked on in the hallway was level without any bubbling or other alterations in the carpet. In short, there was no evidence presented that her fall was caused by any hazards at her workplace. Therefore, the Court found that the Claimant’s injuries were caused by an idiopathic fall and were not compensable. The Supreme Court again reversed and reaffirmed that a fall is not idiopathic simply because the claimant is unable to articulate a specific cause of her fall. Unless there is evidence that her leg gave out or she suffered some other internal breakdown or failure, it is irrelevant whether the carpet or hallway was defective. Whether she tripped because she was hurrying or she tripped over her own feet makes either scenario an idiopathic injury. There is no legal authority under SC workers compensation law that clumsiness is an exception to the Act. Because Barnes was performing a work task when she tripped and fell, those facts alone establish the causal connection between her employment and the injuries sustained. As admitted during oral arguments, if Barnes had been on the way to the bathroom or to get a cup of coffee, her injuries would still be compensable under the “personal comfort doctrine.” Our courts have established that acts necessary to the life, comfort, and convenience of the servant while at work, though strictly personal, are incidental to service, and any injury sustained while engaged in same will be deemed to have arisen out of the employment.
There are many examples where these rules come into play. Here in Fort Mill and Rock Hill, we are located in close proximity to I-77. Many of our citizens are on the road making deliveries or travel to different locations. They are exposed to the same inherent hazards of interstate driving as anyone else, just to a greater degree. Had the Supreme Court, not re-clarified idiopathic injury claims, any accident while on the road could have been determined to be non-compensable. However, if a person has a heart attack or seizure while driving, that is a closer question and subject to challenge. In Indian Land, we are even closer to Charlotte and have experienced significant growth in construction traffic and the increased danger that results. For anyone who is involved in a traffic-related accident, whether a driver or pedestrian, workers compensation benefits are still available as long as what you are doing at the time furthers your employer’s business. Details and specifics matter here. For questions, it would be best to consult experienced SC workers compensation attorney Robert J. Reeves to get answers and more information about your potential claim. You can reach him directly at 803-554-4157 or email
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