I have a claimant who says while walking to the break room, she tripped and fell on the carpet. The client checked where she fell – no snags. It was confirmed by the supervisor that nothing on the carpet was present that caused her to fall at that time. I haven’t got her statement yet. Apparently, after she got up, she fell right back down. It sounds to be idiopathic. She would not have been carrying any type of work product, only walking to break room. We can deny, correct?
In Kentucky workers’ compensation, there are three kinds of falls: (1) work-related fall; (2) nonwork-related fall; and (3) unexplained fall. The only type of fall that is not compensable is the nonwork-related fall – these are “idiopathic” falls. The use of the term “idiopathic” can be confusing, because in medicine, “idiopathic” means “no known cause”.
However, in Kentucky workers’ compensation, “idiopathic” means there is a known cause, and it is nonwork-related. An unexplained fall while the employee is in the course and scope of employment is compensable. The fact situation you have described sounds as though is it probably either a work-related fall [she tripped on the carpet] or an unexplained fall [she was clumsy]. There are no facts here that would support a conclusion that this was an idiopathic fall. There was no mention of a pre-existing disease or physical weakness that caused her to fall. Unsuitable clothing that is inherently dangerous can be considered an idiopathic fall, but wearing high heels has been ruled insufficient to establish an idiopathic fall when the employer’s dress code allowed high heel shoes. Kentucky cases addressing unexplained and idiopathic falls involve a back condition, heart attack, an epileptic seizure, an allegation of syncope, and a pre-existing weakness in the ankle.
The facts you have provided do not give you a reasonable basis upon which to deny the claim. However, the fact that she fell again immediately after standing up is probably a good reason to investigate further. You will find that it is almost always going to require a medical opinion to prove that the fall was idiopathic. A doctor would need to examine the employee to determine whether she had any pre-existing physical or mental disease, condition or weakness that resulted in the fall. Let me know if you have questions about this. I have attached the Kentucky Supreme Court’s Opinion in Vacuum Depositing, Inc. v. Dever, which is the most recent discussion of this issue.