James McCaffery Cardinal Logistics Idiopathic Injuries
Many workers face falling injuries at work. A common reason that the Workers’ Compensation Insurance Carrier will deny the claim is that the Carrier will call the fall “idiopathic.” This is legal speak for stating that work had nothing to do with the cause of the fall. The case of James McCaffery Cardinal Logistics, No. 2015-08-0218, 2015 WL 8770402, at *6 (Dec. 10, 2015) discussed below details how you might fight the Carrier to show that a fall was not idiopathic. In particular it helps to show that some workplace hazard was faced. So, for example, a fall on stairs is not idiopathic because stairs create a falling hazard.Facts of the Case
On May 19, 2015, James McCaffery (“Employee”) was operating a truck for Cardinal Logistics (“Employer”). Employee was driving to Memphis, Tennessee when he sneezed as he entered a curve on the highway. This caused him to veer off the road and when he attempted to regain control of the truck he oversteered, causing the truck to roll over. This left Employee with many injuries. Employee immediately reported the incident to Employer and sought medical treatment.Procedural Background
Employer filed a Notice of Denial and stated that the reason for denial was the “injury occurred due to an idiopathic condition (sneeze).” Employee filed a Petition for Benefit Determination requesting medical and temporary disability benefits. After unsuccessful mediation, an expedited hearing took place. The trail court issued an order granting medical and temporary disability benefits. Employer was ordered to provide medical treatment for Employee’s injuries related to the work incident. Additionally, Employer was ordered to pay the outstanding bills for Employee’s medical treatment for the injuries as well as pay temporary disability benefits from the date of the accident through the date of Employee’s last visit with his doctor. Employer appealed.
After Employer filed a brief on appeal, Employee filed a brief along with a motion for expenses and attorney’s fees. Employee argued Employer’s appeal was frivolous and asserted Employer appealed to delay things. Employer responded with an objection and a motion to strike Employee’s brief on appeal, arguing Employee’s brief was not filed in a timely manner.Analysis
Judge Hensley delivered the opinion of the Workers’ Compensation Appeals Board. Employer presented the issues for review as “1. Whether Employee’s injuries are idiopathic in nature. 2. Whether Employee’s injuries resulted from and act of God. 3. Whether Employer’s affirmative defense based on the ‘imported risk doctrine’ bars Employee’s recovery. Two additional issues are presented by the motions filed on appeal: (1) whether the appeal is frivolous, and (2) whether Employee’s brief on appeal should be stricken as untimely.” James McCaffery Cardinal Logistics, No. 2015-08-0218, 2015 WL 8770402, at *6 (Dec. 10, 2015).
To be compensable under the workers’ compensation statutes, an injury must arise primarily out of and occur in the course of and scope of the employment. James McCaffery Cardinal Logistics, No. 2015-08-0218, 2015 WL 8770402, at *6 (Dec. 10, 2015). “Injury” is defined as “an injury by accident… arising primarily out of and in the course and scope of employment, that causes death, disablement or the need for medical treatment of the employee.” An accidental injury must be “caused by a specific incident, or set of incidents, arising primarily out of and in the course and scope of employment, and is identifiable by time and place of occurrence.” Tenn. Code Ann. § 50-6-102(13)(A) (2014).
“An idiopathic injury is one that has an unexplained origin or cause, and generally does not arise out of the employment unless ‘some condition of the employment presents a peculiar or additional hazard.’” James McCaffery Cardinal Logistics, No. 2015-08-0218, 2015 WL 8770402, at *6 (Dec. 10, 2015). In this case Employee was clearly acting within the scope of his employment when he sneezed and lost control of the truck. Employer argued that the injuries sustained by Employee did not arise primarily out of the employment, instead the injuries were the result of an idiopathic condition, Employee’s sneeze.
“An injury that occurs due to an idiopathic condition is compensable ‘if an employment hazard causes or exacerbates the injury.’” James McCaffery Cardinal Logistics, No. 2015-08-0218, 2015 WL 8770402, at *6 (Dec. 10, 2015). “Cause” in this context means that the accident began in the hazards to which the employee was exposed while performing employment duties. “Here, Employee’s act of driving the truck in the course of the employment constituted a hazard incident to his employment, which not only increased the risk of injury to Employee, but was the immediate cause of Employee’s injuries.” James McCaffery Cardinal Logistics, No. 2015-08-0218, 2015 WL 8770402, at *6 (Dec. 10, 2015). The causal link between the accident or injury and the employment should be the focus, not the causal link between the employment and the idiopathic condition. Employee had to prove that driving the truck caused or exacerbated his injuries to form a causal link between his injuries and his employment. He did not have to prove that some condition of the work caused him to sneeze.
Employer cited no authority to support the claim that Employee’s sneeze was an act of God, so it this argument was unpersuasive. Additionally, Employer’s use of the “imported risk doctrine” as defense to the compensability of Employee’s claim was unpersuasive as well.
Employee’s motion for expenses and attorney’s fees was denied and the assertion that Employer’s appeal was frivolous was found to have no merits. Employer’s motion to strike Employee’s brief as untimely was also denied.
If you have a Tennessee Workers’ Compensation case and the insurance company tells you that the claim is denied because the accident is idiopathic, make sure you call our Workers’ Compensation attorneys at (865) 691-2777.