Idiopathic and unexplained accident cases are on the rise as more employees are taking medications for a myriad of health issues. An idiopathic accident is one where the injury is caused by a preexisting personal disease of the employee (diabetes, seizures, etc.) and can be compensable if the employment increases the dangerous effects of the condition. Typically, compensable idiopathic injuries are found in motor vehicle accident and fall from ladder cases.
Unexplained injuries are not compensable because the claimant cannot prove that the injury arose out of the employment.
In an unpublished decision, Burney-Vivens v Community Corrections Administration, the Court of Appeals addressed the idiopathic v. unexplained injury issue.
In Burney-Vivens the claimant had a history of migraines. She had also sustained a compensable back injury in 2012 for which she was still taking medication. She was driving an employer provided car while on assignment for her employer. Because she was driving she did not take her back pain medication that day.
She was involved in a single car accident in which her car left the road and went down an embankment. She testified that at a certain point in time on the trip, after driving past a sign for the Town of Boones Mill her vision diminished and started blurring. The next thing she remembered was crawling out of the car. She did not remember what caused her to run off the road.
At the hearing, the claimant alleged that her accident was caused by an idiopathic condition of blurred vision due to her pre-existing migraine headaches. In the alternative, she alleged that she blacked out because of her back pain.
The Deputy Commissioner ruled against the claimant, finding that the accident was unexplained. On review, the Full Commission rejected the claimant’s argument that she suffered visual problems as a result of the idiopathic condition. The Full Commission reasoned that even if visual problems developed before the accident it could not infer that those problems played a causative role in the accident. The accident could have been caused by another vehicle running the claimant off the road, the claimant attempting to avoid a deer, a mechanical issue, or some other factor independent of the blurred vision. Because the claimant had no memory of the events which caused the accident and the evidence introduced failed to establish the cause, she could not prevail.
The Full Commission also rejected the claimant’s testimony as not credible that she experienced visual problems, for any reason, prior to the accident. [1] The Full Commission noted that the claimant had significant memory problems and did not recall anything between driving past the Boones Mill sign and being in her wrecked car off the road. In other words, how could she testify that while she remembered nothing after passing the Boones Mill sign until crawling out of the car she could remember have a migraine after passing the Boones Mill sign?
The Court of Appeals affirmed the Full Commission’s Opinion because credible evidence supported the Commission’s findings. The Court could not reweigh the evidence.
In so finding, the Court rejected the claimant’s argument that the loss of vision from the idiopathic condition caused the wreck. The medical providers were unable to identify any idiopathic condition at the time of the accident. The ER physician noted only a possible headache prior to the crash. The medical evidence also failed to establish if she lost consciousness prior to, during, or after the collision.
Based upon this evidence, the Full Commission found, and the Court of Appeals affirmed the finding that the medical providers: (1) could find no cause for visual problems; (2) never indicated that the claimant experienced a migraine at the time of the accident; (3) could not determine that the cause of the accident was a migraine.
It may have been a closer case had a medical provider opined that the claimant had suffered a migraine which caused visual impairment prior to the accident. However, it probably would not have been enough to prevail since the claimant could not prove that any visual problems caused the accident.
The practice pointer to take from this case is that when taking a claimant’s statement in a potential idiopathic injury case, you should ask the claimant what happened and let them tell you sequentially what happened. After the entire story is told, you might need to clarify with questions such as: (1) why did the accident occur? (2) what symptoms did you suffer? and (3) when did you suffer the symptoms?
It is critically important to get the statement prior to the claimant retaining an attorney and being coached against testifying to an unexplained accident.
However, as is often the case, the best evidence is likely ER notes immediately after the accident. Those intake notes generally indicate the claimant’s unvarnished impressions of the mechanism of the accident and are given great weight by the Commission.
[1] The Full Commission also gave the claimant the benefit of the doubt, stating that even if she did recall having visual problems at some time around the time of the accident it could not infer that the symptoms were caused by a migraine because the claimant testified that while she had blurred vision prior to the accident she could not remember if she was having a migraine.