- Idiopathic Conditions: Are These Types of Claims Compensable?
- August 30, 2017
It can be difficult to determine whether a claim is compensable when the petitioner suffers from an idiopathic condition that may have caused or contributed to the alleged injury. An idiopathic condition is a condition or trait that is unique or personal to the injured worker, is not related to the worker’s employment, and exposes the injured worker to risk of injury. The New Jersey Workers’ Compensation Act states 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. However, there is a legal standard that must be met before these claims are considered compensable.
In order for a claim to be compensable, the injury must arise out of and in the course of the petitioner’s employment. An injury arises out of employment when the injury is caused by a risk that is incidental to employment. Case law clarifies the legal standard when making the determination of whether a claim is compensable.
Although an employer is not responsible for a petitioner’s idiopathic condition, the employer is responsible for the effects of an injury that occurs at work even if the accident was initially caused by the idiopathic condition. In George v. Great Eastern Food Products, Inc., 207 A.2d 161 (N.J. 1965), the petitioner became dizzy from an unknown cardiovascular condition and fell on the concrete floor while working. George states that if a fall occurs by or was the result of a disease or physical seizure and did not involve the employee’s work responsibilities, it is not compensable. On the other hand, if the fall “[w]ould not have occurred but for the services rendered in the employment, it is covered by the statute.”
The court found that the idiopathic incident by itself was not compensable. However, it noted that when an injury is caused by a condition of the employment, it would be compensable. In George, the petitioner’s injury was caused when the employee’s head hit the concrete floor, which the court found to be a risk of employment. The skull fracture caused the petitioner’s death. Therefore, the claim was found to be compensable.
The positional-risk test gives clarification to the legal standard when determining if a claim is compensable when dealing with idiopathic conditions. The Sexton v. County of Cumberland, 962 A.2d 1114 (N.J.Super. App.Div. 2009) case sets forth the positional-risk test. The petitioner alleged an aggravation of her pre-existing condition, chronic obstructive pulmonary disease (COPD), when she inhaled perfume sprayed in the air by a co-worker. To apply the positional-risk test, the question is “[w]hether it is more probably true than not that the injury would have occurred during the time and place of employment rather than elsewhere.”
Along with the positional-risk test, one must also consider the nature of the risk that caused the injury. There are three categories of risk that must be considered:
1. Those distinctly associated with the employment (Example: Employee’s fingers getting caught in gears or excavations caving in);
2. Neutral risks, consisting of uncontrollable circumstances not originating in the employment environment (Example: Employee being struck by lightning or blinded by a flying beetle); and
3. Those personal to the employee, in which the employment connection with the injury is minimal and it is the personal proclivities or contacts of the employee that give rise to the harm (Example: Employee attacked while working by an enemy motivated by vengeance stemming from personal contact with the employee).
The first two types are compensable. The third is not.
In Sexton, the court found that the petitioner’s alleged exposure arose out of her employment. The positional-risk test was satisfied because she would not have been exposed to the perfume had she not worked that day. Furthermore, the nature of the risk was neutral as the circumstances were not controllable by the employer and were not work related. The risk still existed that a co-employee might do something that could injure the petitioner. Currently, this case remains the legal standard for these types of claims and is cited in several recent cases, namely, Pulejo v. Middlesex County Consumer Affairs, 2016 N.J. Super. Unpub. LEXIS 1626 (N.J. Super. App.Div. July 14, 2016); Pereira v. Oasis Foods, 2017 N.J. Super. Unpub. LEXIS 1456 (N.J. Super. App.Div. June 13, 2017).Overall, idiopathic conditions are not compensable. The carrier would not be responsible for treatment associated with the underlying idiopathic condition. However, any aggravation of an idiopathic condition or an injury sustained at work because of this condition might be compensable. Resolution of the issue will rely heavily on a factual analysis of the petitioner’s idiopathic condition and the alleged work accident. Therefore, it is essential to obtain all the necessary information and facts of a petitioner’s injury to make a proper argument against compensability with these types of claims.