In August 2011, a 67-year-old woman from North Carolina was in Maryland conducting field interviews when she fell upon returning to her car after an unsuccessful interview. She was taken to the hospital and was treated for a broken left arm, and the doctors attempted to find out the reason for the fall. Medical records indicated that the woman fainted briefly, but that there was "no medical reason." Upon returning home, the woman consulted with her primary physician who reviewed her medical records and examined her, and gave the opinion that the fall may have been due to heat exhaustion, since there were no underlying medical conditions. This opinion directly contradicted a note from the emergency room that the woman "was not overheating."
A workers' compensation claim was filed for the August fall, but was denied in October 2012 on the basis that the injury was due to factors that were not job related.
The decision was appealed to the full Industrial Commission, and the decision was reversed, with temporary total disability benefits being awarded.
When an injury is compensable
To receive workers' compensation, an injured employee must prove that: (1) the injury was caused by an accident; (2) the injury happened during employment; and (3) the injury happened because of the employment. In this decision, Philbeck v. University of Michigan, the court's decision centered upon the third issue. Here, the facts as disclosed by the emergency room report indicated that the reason for the claimant's fall was unknown. In this circumstance, when the facts presented by the claimant show underlying reason for a fall and the Commission has made no finding that the fall was caused by a force separate from employment, then the court will infer that the fall happens because of the employment.
The claimant's employer argued that the fall was due to an idiopathic condition of the claimant, that is, a condition due to the physical or mental condition of the individual employee. A fall due to an idiopathic condition will not give rise to an inference; if the fall is solely due to the idiopathic condition, no compensation is given. Only where the fall is due to the risks of employment is compensation awarded.
Prior to this appeal, the Commission made a finding of fact that the claimant's fall was not due to an idiopathic condition.
Looking to other facts found by the Commission, there was no evidence of objects on the ground causing the fall; the medical evidence was that the claimant was not overheated; a witness reported no obvious reason causing the claimant to fall; the treating emergency room doctor stated that dehydration predisposed her fainting spell; and her primary physician concurred that dehydration contributed to her fainting. In all, the Commission determined that evidence supporting that the claimant's fall was the result of dehydration or heat exhaustion was speculation and entitled to little or no weight; the appellate court decided that there was no remaining evidence as to the origin or cause of the fall. Thus, the fall was unexplained; the presumption arose; and the claimant was entitled to compensation.
Workers' compensation was enacted to protected both employees and employers, but it is a complex area of law. If you are injured at work, you should contact a lawyer experienced in workers' compensation law to help you navigate the complexities and help you receive full and fair compensation.