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Idiopathic Falls and Workers' Compensation in West Virginia

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How do courts decide whether injuries that result from on-the-job falls are compensable under the West Virginia workers' compensation system? Workplace falls are common and can lead to serious, even fatal injuries. In fact, in the construction industry, falls are known as one of the "fatal four" because they are the leading cause of worker deaths. No industry is free from this common hazard. In fact, most nonfatal falls occur in health services, wholesale, and retail work.

One of the quirkier issues in workers' compensation law is that of the "idiopathic fall." This subject continues to confuse and frustrate in West Virginia and elsewhere. Fortunately, recent decisions from the West Virginia Supreme Court of Appeals and the state's workers' compensation system shed some light on this difficult question.

Earlier this year, the West Virginia Supreme Court of Appeals issued a memorandum decision in the case of Sellers v. West Virginia University Board of Regents. In Sellers, the claimant, a professor, fell in a hallway, injuring her elbow, shoulder, knees, and head. She had a history of "transient ischemic attack and/or syncope." She denied that she had any such episode at work on the date of her injury. Instead, she argued that she fell for no known reason.

The employer argued that the professor's fall resulted from one of her idiopathic losses of consciousness. In the alternative, the employer argued that even if the fall did not result from an idiopathic loss of consciousness, her employment did not cause the fall. The employer prevailed below, and the claimant appealed.

The Court unanimously affirmed the rejection of the claim, finding that claimant fainted and therefore her fall was not work-related. Interestingly, the Court did not address whether the employment environment posed any increased risk of injury.

Our firm recently litigated a case involving a claimant who fell while walking down a hall at a hospital. She admitted that she did not slip or trip. The floor was in pristine condition, and there were no spills or other hazards that could have caused a fall. The claimant was not running or hurrying. She was not carrying any work-related material. Her vision was unobstructed. She simply fell and had no idea why. As a result of her fall, the claimant suffered a fractured patella and filed a workers' compensation claim. The claim administrator denied the claim as an idiopathic fall. Citing a previous decision of the West Virginia Supreme Court, Cox v. Fairfield Inn, the Office of Judges held the claim compensable.

In the Cox case, the claimant, a front desk clerk, twisted her ankle when she walked around a corner at work. She also had a history of "pseudo seizures," but the Court held that there was no evidence that her fall resulted from one of these episodes. Instead, she had fallen for no known reason. In that case, the Court held that the "[w]orkers' [c]ompensation system is a no fault system, meaning [the claimant] is not required to prove unsafe working conditions in order for an injury to be held compensable."

The difference between Sellers and Cox is that the Court found in Sellers that the professor's fall resulted from a preexisting, unrelated health condition. In Cox, the clerk's fall did not result from any preexisting condition, even though the claimant did suffer from a condition that could have caused her fall.

What are the take-away points for West Virginia employers?

1. If a claimant falls at work while performing work-related duties, the resulting injuries will be compensable unless the fall resulted from a specific non-occupational factor.

2. If a claimant cannot identify an environmental or work-related cause for a fall, the claim will be compensable if there are no contributing non-occupational factors.

3. Even if there is a history of a preexisting condition that could have caused or contributed to a fall, if there is no direct evidence that this was what caused the fall, the claim will likely be compensable. 

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