Learn how to challenge a denied workers’ comp claim for an idiopathic injury and secure
the benefits you deserve
Work injuries are always stressful, but they can be even more so when your employer denies your rightful workers’ comp benefits because they claim your injury is “idiopathic.” This term might sound complicated, but it essentially means that the injury is believed to have originated from a personal medical condition rather than an incident at work.
This distinction can make the difference between receiving compensation for your medical bills and lost wages or being left to cope with your injuries on your own. Understanding the nuances of idiopathic injuries and how they relate to workers’ compensation claims is crucial for any employee facing this challenge.
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What is an idiopathic injury?
An idiopathic injury refers to an injury resulting from an individual’s internal, personal medical condition unrelated to the work environment or duties. This type of injury arises spontaneously or from an obscure or unknown cause that is peculiar to the individual and not induced by any external factors associated with their employment.
What is an example of an idiopathic injury?
Idiopathic injuries may stem from unknown causes or pre-existing conditions unrelated to workplace activities or environments. Below are a few examples:
- Epileptic seizures. If an individual has a history of epilepsy and experiences a seizure while at work, resulting in injury, this could be considered an idiopathic injury as the condition pre-exists and is not caused by work conditions.
- Heart attacks. A worker with a pre-existing heart condition might suffer a heart attack not induced by workplace stress or exertion but due to underlying cardiovascular issues.
- Strokes. Similar to heart attacks, if a stroke is caused by pre-existing medical conditions such as high blood pressure or atherosclerosis rather than work-related factors, it would be classified as idiopathic.
- Syncope (fainting). If an employee faints due to a condition unrelated to work, like dehydration, low blood sugar, or a pre-existing fainting condition, the resulting injuries would be considered idiopathic.
- Vertigo or dizziness. Workers with a pre-existing balance disorder or certain infections or diseases that affect balance may experience falls leading to injuries, classified as idiopathic if these episodes are not triggered by work-related factors.
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What is an idiopathic fall?
An idiopathic fall in the context of workers’ compensation refers to a fall that occurs due to a spontaneous internal condition unique to the employee, such as a medical or physical condition unrelated to the work environment.
Unlike unexplained falls, where the cause is unknown and might be presumed to be related to employment, idiopathic falls are not automatically assumed to arise out of employment.
For an injury resulting from an idiopathic fall to be compensable under workers’ compensation, there must be evidence that the injury was exacerbated or contributed to by a work-related risk or condition, such as the employee being on an elevated surface or in a situation that increased the risk of injury beyond normal levels.
How can an idiopathic injury affect a workers’ comp claim in NC?
In North Carolina, an idiopathic injury can significantly impact a worker’s compensation claim due to the nature of these injuries being unrelated to the work environment.
Workers’ compensation is designed to cover injuries or illnesses that arise out of or in the course of employment. If an injury is deemed idiopathic, meaning it stems from a personal medical condition or factor not related to the job, it may not be covered under workers’ compensation.
For instance, if a teacher suffers a fall while sitting at their desk due to a seizure related to a pre-existing epileptic condition and not due to any work-related hazard or activity, this might be considered an idiopathic fall. In such cases, the workers’ compensation claim could be denied on the basis that the injury did not arise out of employment activities or conditions.
However, if the work environment exacerbates the risk of injury from the idiopathic condition—for example, if the worker falls from a ladder or crashes while driving a vehicle for work during a seizure—then the injury might still be considered compensable under North Carolina workers’ compensation laws. The key factor is whether the employment conditions contributed to the risk or severity of the injury.
It’s important for workers facing such circumstances to consult with a workers’ compensation attorney to navigate the complexities of these cases and to help establish the connection between their work and the injury, if applicable.
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Who’s responsible for proving an injury is or isn’t idiopathic in a workers’ comp case?
In a workers’ compensation case, the burden of proof generally lies with the employee to establish that an injury or illness is work-related and, therefore, compensable under workers’ compensation laws. This means the employee must demonstrate that the injury occurred in the “course and scope” of employment and was caused by employment-related activities or conditions.
However, when an injury is alleged to be idiopathic—arising from internal conditions unrelated to work—the employer or their insurance carrier may argue this point to challenge the compensability of the claim.
In this situation, while the initial burden is on the employee to show the injury arose out of employment, if the employer contends the injury is idiopathic, the burden may shift to the employer to prove that the injury indeed resulted from an idiopathic condition rather than from a work-related hazard or activity.
Ultimately, in workers’ compensation cases involving idiopathic injuries, it can become a matter of presenting medical and factual evidence to demonstrate whether the injury was caused by employment or by a personal medical condition. The decision then rests on the North Carolina Industrial Commission to determine the compensability based on the evidence presented.
How can a workers’ comp attorney help prove an injury isn’t idiopathic?
An experienced workers’ compensation attorney may be able to help you take steps to appeal a denied claim and prove an injury isn’t idiopathic. Here’s how they can assist with your claim:
- Gathering and presenting medical evidence. They can compile medical records, expert testimonies, and other relevant medical information to establish a clear link between the injury and workplace conditions or activities, demonstrating that the injury was due to work-related factors rather than a pre-existing condition.
- Investigating the workplace environment. The attorney can examine the workplace to identify any hazardous conditions or job duties that could have contributed to the injury, thereby refuting the claim that the injury was solely due to an idiopathic condition.
- Collecting witness statements. The attorney can gather statements from coworkers, supervisors, or other witnesses who can attest to the circumstances surrounding the injury, providing context and evidence that supports a non-idiopathic cause.
- Consulting with experts. They might engage medical experts or occupational specialists to provide opinions on the nature of the injury, how workplace conditions could have contributed, and why the injury should not be considered idiopathic.
- Reviewing case law and legal precedents. An experienced attorney will be familiar with similar cases and legal standards, allowing them to argue effectively against the idiopathic injury classification based on established law and previous rulings.
- Advocating during hearings and appeals. The attorney can represent the injured worker in workers’ compensation hearings and appeals, arguing the case and challenging any assertions that the injury was idiopathic.
By addressing these aspects, a workers’ compensation attorney can help strengthen the case that an injury is work-related and therefore compensable under workers’ compensation laws, rather than resulting from an idiopathic condition.
Get help from an experienced Charlotte workers’ compensation attorney
Are you facing a denied claim because your employer’s workers’ compensation insurer says you have an idiopathic injury?
You still may have legal options!
At Wilder Pantazis Law Group, our knowledgeable work injury attorneys have more than 85 years of experience helping injured workers in Charlotte recover the compensation they deserve. If your claim was rejected on the grounds that your injury is idiopathic but you believe it was caused by your work environment or duties, we’re here to help.
Our team will investigate your case thoroughly, gathering the necessary evidence to challenge the insurer’s decision and prove your injury is work-related.