Idiopathic Fall to Level Floor May Be Compensable in Iowa

Divided Court Adopts Minority Rule for Idiopathic Falls

Adopting the minority American rule that all work-related risk factors must be considered in determining the compensability of an idiopathic fall—even the hardness of the floor—the Supreme Court of Iowa, in a divided decision, held that a worker’s idiopathic fall to a level floor could be compensable, depending upon the facts of the particular case [Bluml v. Dee Jay’s Inc., 2018 Iowa Sup. LEXIS 101]. Accordingly, the majority of the Court reversed a decision of a state district court that (along with the deputy commissioner and the commissioner) had concluded, as a matter of law, that idiopathic falls onto level floors were not compensable. Quoting extensively from Larson’s Workers’ Compensation Law, the majority also provided a sweeping overview of the status of the law across the United States.


The employee began to suffer seizures in 2007 and was prescribed anti-seizure medication. In the months leading up to February 2012, he had not regularly taken his anti-seizure medication and, according to the majority’s opinion, also had some issues with alcohol abuse. On February 15, 2012, while working at a Long John Silver’s restaurant as shift manager, the employee experienced a full-body seizure, fell straight backward onto the ceramic tile floor of the restaurant, striking the back of his head. The fall resulted in a serious closed head injury.

Determination by the Iowa Workers’ Compensation Commission

The deputy commissioner determined that the employee had failed to carry his burden of proof that he had sustained an injury that arose out of and in the course of employment. Specifically, the deputy that it appeared clear that idiopathic falls to level surfaces were not compensable under Iowa law. The commissioner affirmed, commenting that while there was no dispute that the injuries sustained by the employee were rendered more serious because his fall occurred on a ceramic tile floor inside the restaurant, the majority rule was that an idiopathic fall on a level floor was not compensable, irrespective of the hardness of the floor. The state district court also affirmed.

Increased-Risk Rule for Idiopathic Falls

Initially, the majority noted that here there was no dispute that the fall was idiopathic in nature. The majority observed that there was but one published precedent in Iowa on idiopathic falls. In that case, compensation was awarded to a worker who fell from a ladder to a cement floor. In that case, the Supreme Court of Iowa had articulated use of the “increased-risk” rule—that to recover for an idiopathic fall, the claimant needed only prove that a condition of his or her employment increased the risk of injury. In that earlier decision, the Court had added that the risk of injury is greater when one falls from a height of four to five feet onto a concrete floor than when one falls on level ground.

Supreme Court Majority Continued

Quoting extensively from Larson and citing and quoting from a host of decisions in other states, the majority acknowledged that a distinct majority of jurisdictions denied compensation in level-fall cases. There was some support, albeit a minority of jurisdictions, that compensation should be awarded where the hardness of the floor was an important risk factor.

The majority concluded that in idiopathic-fall cases, the claimant should have both the burden and the opportunity to meet the increased-risk test. In Iowa, there was no hard-and-fast rule that idiopathic falls onto level floors are never compensable. Alternatively, there was also no legal principle that idiopathic falls to hard floors are always compensable. Rather, the claimant may recover if he or she proves that a condition of his or her employment increased the risk of injury. The issue was factual, not legal. The district court (and the commissioner) had erred in determining the issue as a matter of law.

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