Understanding Personal Risks and the Idiopathic Defense
First, practitioners must understand it is the employer’s burden of proof to demonstrate a medical condition is idiopathic in nature. Idiopathic injuries are those medical conditions that arise spontaneously or stem from a trait personal to the injured employee.
The difficulty in demonstrating an injury is idiopathic in nature, stems from the fact our Courts continue to recognize the “egg shell theory” of causation. The New Jersey Workers’ Compensation Act states, in pertinent part, that employers must “[t]ake their employees as they find them, with all of the pre-existing disease and infirmity that may exist.” N.J.S.A. § 34:15-1. On its surface, the Act’s language lead practitioners to believe the employer and its workers compensation insurance carriers are responsible to provide workers compensation benefits to those employees that suffer a worsening of a pre-existing condition. The Act, however, requires the traumatic event to have arisen out of and in the course and scope of the injured person’s employment, or in other words, have “some” connection to the employment. There are three (3) types of risks potentially responsible for or contributing to an injury.
- Those distinctly associated with the employment or the “but for” test (i.e. finger amputation while using a deli slicer);
- Neutral risks, consisting of uncontrollable circumstances not originating in the employment but occurring during the course of employment (i.e. Act’s of God, such as employee being struck by lightning); and
- Those personal to the employee, in which the connection between the accident and injury is minimal and the injury itself is the result of a character personal to the injured employee (i.e. employee involved in physical altercation stemming from a domestic dispute, commentary involving employee’s disabled children, etc).
For purposes of our discussion on idiopathic claims, we can focus our analysis to the third category of risks, or those that are personal to the injured employee. It is well-established in New Jersey Workers Compensation that an injured employee need not necessarily be engaged in a work activity to have sustained a compensable injury; rather, the injury must have some connection to the employment. In other words, an injury can be compensable even when the employment is not the sole or proximate cause of the injury. To more thoroughly review “personal risks,” we can look to our Court’s analysis in Verge v. County of Morris, 272 N.J. Super 118 (App.Div. 1994).
In Verge, the injured employee with a long-standing pre-existing knee condition was walking in the Morris County Courthouse when she slipped on a rug and twisted her left knee in the process. The Judge of Compensation determined the event was idiopathic in nature and denied compensation benefits, on the premise the event could have occurred anywhere, and at any time in the course of walking. On appeal, however, our Appellate Courts reversed and remanded with instructions for the Compensation Court to make additional findings if Verge’s episode of slipping on a rug was the proximate cause of her accident. If the Judge of Compensation determined her act of slipping on a rug was the cause for her condition and need for additional medical treatment, the event would have been considered a compensable accident. Let’s assume for a moment that the circumstances were different. Instead of slipping on a rug, assume the injured employee was walking down a hallway when her knee suddenly buckled without any precipitating event, but thereafter experienced a popping within the knee joint, causing her to further twist and aggravate the knee condition. Those facts would be distinguishable, such that a sudden episode of knee buckling would be personal to the injured employee and not connected to the employment in any way, as the buckling episode in all probability could have occurred at any point, both during and outside of her employment.
There is an important distinction with idiopathic claims that we cannot ignore. While the employer may not be responsible for an idiopathic injury, they are responsible for the effects or consequences of the idiopathic event. Case in point is the New Jersey Supreme Court’s decision in George v. Great Eastern Food Products, Inc. 207 A.2d 161 (N.J. 1965). In George, the injured employee suffered a cardiovascular event and dizzy spell, causing him to fall on a concrete floor. The cardiovascular episode itself was not compensable, as the condition was not connected to his employment responsibilities. In George, however, the injured employee unfortunately struck his head on the concrete floor and died as a consequence. The skull fracture and death were deemed compensable, as the possibility of striking his head on the concrete floor were viewed as a risk of the employment.
In summation, the New Jersey Workers Compensation laws continue to recognize the “egg shell” theory of causation by way of an aggravation. There must be, however, some contribution from the employment for a pre-existing injury to suddenly become the responsibility of an employer and its workers compensation insurance carrier.
By: Eric E. Fingerman, Esquire
Associate at Brown & Connery, LLP