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Idiopathic Claims and Georgia Workers’ Compensation

Generally, an employee in Georgia must prove that they sustained an accidental injury that arose out of and occurred in the course of their employment in order to have a compensable workers’ compensation claim. One defense to a workers’ compensation claim is that the injury was idiopathic in nature and therefore, it did not arise out of the worker’s employment. If an injury is truly idiopathic, then it is not work-related.

Georgia Workers’ Compensation Attorneys for Disputed Work Comp Claims

Injured workers with disputed or denied workers’ compensation claims should speak to an experienced Georgia workers’ compensation attorney right away. Attorney Beth Gearhart and her team at the Gearhart Law Group understand the frustration injured workers experience when their claims are denied or disputed.

After you hire us, our legal team will jump right into action to assess the facts of your case and review your medical records to help build the strongest case possible in your favor. We will make every effort to turn a disputed or denied claim into an accepted claim—but, if necessary, we will take your case to trial to fight for your legal rights. Contact us today to learn more about what we can do to help you secure workers’ compensation benefits for your work injury.

What Is an Idiopathic Injury?

In the context of workers’ compensation claims, the Georgia Court of Appeals has defined the term “idiopathic injury” as an injury that was sustained at work but either was unrelated to the work, or did not occur while engaged in the work. Simply put, just because an injury happened at work does not automatically make it a work-related injury covered under workers’ compensation. An injury that occurred at the workplace but happened due to either an unknown cause or for reasons that are personal to the injured worker, is not compensable under workers’ compensation.

One example of an idiopathic injury is an injury suffered by someone with epilepsy who happened to suffer an epileptic seizure while at work. Another example of an injury that is (in most cases) considered an idiopathic injury is an injury suffered by an employee who suddenly experienced a heart attack while at work. While there are some situations in which this could ultimately be found to be a work-related injury—a heart attack typically is considered idiopathic and not related to the work.

Do I Need to Hire a Georgia Workers’ Compensation Attorney for My Case?

If your Georgia workers’ compensation claim is denied because your employer’s insurance company believes that your injury was idiopathic in nature and not work-related, your next step should be speaking with a knowledgeable workers’ compensation attorney. Hiring a Georgia workers’ compensation lawyer can make a big difference in your case—even turning a denied claim into an accepted claim, allowing you to receive workers’ compensation benefits.

Are Falls at Work Considered Idiopathic Claims?

Generally, Georgia courts require a causal connection to be found between the condition of employment and the worker’s injury. If the injured worker’s injury would have happened regardless of where they were located at the time, and the work of the employee did not increase their risk of injury in any way, the claim will usually not be compensable.

One of the most common types of injuries that can result in a dispute regarding whether or not the injury was idiopathic in nature is a fall. Whether or not an injury from a fall at work is considered compensable under workers’ compensation depends on the specific facts and circumstances involved.

In the state of Georgia, there have been a few different significant workers’ compensation cases dealing with fall injuries and evaluating whether they are compensable workers’ compensation claims. These cases have helped to establish the standards used by judges and the courts to determine whether an injury is compensable under Georgia’s workers’ compensation laws.

Georgia Workers’ Compensation Cases Involving an Idiopathic Injury Defense

Since workers’ compensation cases involving an idiopathic injury defense can be complex, many of these cases have gone to trial and have even gone up to the Georgia Court of Appeals for further review. The recent case of Stoker v. Walker County Board of Education was heard by the Georgia Court of Appeals in 2021.

In this case, the claimant seeking benefits was a substitute teacher. The claimant suffered an injury due to a fall that occurred while she was leading the class down a straight, flat hallway to the cafeteria.

Stoker also testified at the hearing that she did not trip over anything in the hallway and that she did not fall as a result of slipping in any type of substance on the floor. Additionally, she testified that she did not know why she fell or what caused her to fall.

Since it is the responsibility of the claimant (the injured worker) to prove that their workers’ compensation claim is compensable under Georgia’s workers’ compensation laws, the Georgia Court of Appeals ruled that the claimant did not meet her burden and was therefore, not entitled to workers’ compensation benefits. The Court concluded that when an employee falls on an employer’s premises but not due to any discernible hazard present in the work environment, the injury may not be compensable.

How Can I Prove that My Injury Was Work-Related, and Not Idiopathic?

Your medical records and reports are some of the strongest tools that you can use to prove that your injury did arise out of and occur in the course of your employment. Medical records and chart notes often contain important details that were discussed at the time of the appointment. In many cases, you might find later on that your doctors or nurses noted certain things down in your records that you forgot later on or did not realize the importance of at the time.

Witnesses to the work incident, along with any accident reports made following the work accident, can also be helpful in proving that your injury was not idiopathic in nature. For a workers’ compensation claim denied or disputed based on a finding that the injury is idiopathic in nature, it is crucial to contact an experienced workers’ compensation lawyer right away to assess your case and help you move forward.

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