An injury is not compensable under Wisconsin’s worker’s compensation system merely because it happened at work. A worker’s compensation insurance company may deny an injured worker’s claim by asserting that the cause of the claimed injury is “idiopathic.” An idiopathic injury is an injury that arises from a worker’s personal condition and which cannot be attributed to any work-related incident or hazard. Some examples include fainting due to a medical condition that causes seizures, heart attacks, tripping over one’s own shoes, or asthma attacks.
When is it compensable?
Although it is legal for the insurance company to deny a claim when the cause of an injury is purely idiopathic, there are certain circumstances that can turn what seems like an idiopathic injury into a compensable worker’s compensation claim.
An idiopathic injury may be compensable if employment exposes a worker to a special or increased hazard that contributes to an injury at work. For example, a worker may be asthmatic and working in a factory setting that exposes them to smoke or chemicals that increase the risk of an attack. If that worker has an asthma attack and their worker’s compensation claim is denied, an attorney may be able to prove that the work exposure caused or contributed to the attack and show that, although asthma is a preexisting idiopathic condition, the asthma attack itself is a compensable work injury.
Another illustrative example is the “trip and fall” at work. In this scenario a factory worker is walking on a flat surface that is free of any hazard. The worker trips over their own shoes and lands hard on the ground, suffering a broken tailbone. Here, the fall is purely idiopathic and the broken tailbone is not a compensable work injury. However, if that same worker had tripped over their own shoes while they were climbing a flight of stairs, causing that worker to tumble down ten steps and suffer a broken tailbone, the injury would be compensable because the flight of stairs constitutes a work hazard that contributed to the broken tailbone.
Should I trust the worker’s compensation insurance company went it tells me that my injury is not work-related?
No. Sometimes, worker’s compensation insurance companies erroneously claim that a work injury is “personal” or “idiopathic” when it is clearly untrue. For example, a firefighter may suffer heatstroke while engaging in mandatory physical training on a hot day, pass out, and suffer a concussion when they hit the ground. In this case, the insurance company may deny the claim by asserting that heat exhaustion is a personal condition or otherwise idiopathic. Such denial would be inappropriate because heat exhaustion, unlike asthma, is not a preexisting health condition personal to the firefighter. Instead, the heatstroke is an injury caused by exposure to high temperature and physically demanding work-related activity. In other words, there is
nothing idiopathic about the injury and the worker’s compensation insurance company is just plain wrong.
What does all this mean?
The main takeaway here is that, if you receive a denial letter from a worker’s compensation insurance company where it is claimed that your injury was “personal” or “idiopathic” and not compensable, do not just take the insurance company at its word. CALL AN ATTORNEY!
Here at Hawks Quindel, S.C., we have decades of experience in identifying wrongful denials of workers’ compensation claims. We can help you understand if your injury is work-related and obtain the worker’s compensation benefits you are owed.