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Morgan’s Tip of the week- What does Idiopathic mean now?

Greetings,

Well maybe I don’t know what I thought I knew.

Since the 1989 Grimes case, the law on idiopathic accidents had been fairly well settled.   Idiopathic accidents are when  a claimant is just walking and their knee gives way, or they pass out, suffer a seizure etc… These types of accident do not “arise out of” employment, as they could have happened anytime or anyplace, and the worksite was simply the fortuitous place where it happened to occur.  For years, the burden of proof was on the Employer/Carrier to prove that the accident could have happened anywhere by showing a pre-existing or non-work related condition.

In Grimes, a Florida Supreme Court case, the claimant, who had suffered from polio,  stood up from her desk, and her knee brace gave way causing her to fall and breaking her leg on a carpeted floor.  Her knee brace lock had broken before at home, causing her to fall.   The carpeted floor was not an  increased hazard of work. The Court developed the two part test:

  • Did a non-work related condition cause the fall?  And if so..
  • Did the employment create any increased hazard?

The subsequent caselaw, including the Caputo case, stated that if the cause of the fall was unknown, then it is work related, and arises out of employment because there is no other known cause.

And then came the 1st DCA’s  2019 Valcourt-Williams case.   In this case, an adjuster working from home tripped over her dog while getting coffee on a break.   It is undisputed if a claimant tripped over a chair in the break room at the office that this would be compensable.  The issue, the court decided, is that the dog does not arise out of an employment risk.  The same result would have happened if she tripped over her dog on a Saturday. The DCA stated:

“To be sure, a handful of our earlier cases have overlooked or ignored the statutory “arising out of” limitation, and we have not always been consistent in our application of that limitation.”

The DCA further stated:

“If any ambiguity remains, we hope to remove it now: For any injury to be compensable, it must “arise out of” the employment; there must be—as the statute says—”occupational causation.” § 440.02(36), Fla. Stat.”  The dissenting opinion in Valcourt-Williams noted “Today, a majority of this court reverses decades of precedent regarding the compensability of workplace injuries under Florida workers’ compensation law.”

Does this put the burden back on the claimant to show the accident DOES arise out of employment, not on the E/C to show it DOESN’T?

Following Valcourt-Williams, the JCC’s have been mixed in their opinions as to whether this was a one-off type of opinion dealing with working from home or does it overturn all the prior caselaw on the burden of proof on idiopathic cases.

Earlier this week, the 1st DCA affirmed a JCC decision without a written opinion in Rogers v. Winn-Dixie.  In this case, the claimant had an unexplained syncopal episode at work and fell.  The JCC stated in accordance with Valcourt-Williams, the claimant has the burden of proving the fall arose out of employment.  The claimant testified even he didn’t know why it happened.  The JCC ruled the claimant failed to prove it arose out of employment, and the 1st DCA, without writing an opinion, affirmed.

So, where does that leave us on idiopathic?   It’s still a little unclear as to how far this caselaw goes to me, but it’s certainly bears watching further decisions.  Hopefully the 1st DCA will address whether this rational applies to all idiopathic claims in a written opinion.

Maybe I don’t know what I thought I did.

Sincerely,

Morgan Indek | Managing Partner