Fall at Work in Illinois: When Workers’ Comp Covers Explained, Unexplained and Idiopathic Falls

Is a Fall at Work Covered by Illinois Workers’ Compensation?

A compensable Illinois workers’ compensation injury must generally arise out of and occur in the course of employment.

“In the course of employment” generally concerns the time, place, and circumstances of the accident. Was the employee working, on the employer’s premises, completing an assigned duty, taking an authorized break, traveling for work, or doing something reasonably connected to the job?

“Arising out of employment” concerns why the accident happened. Did a work duty, workplace condition, or employment-related risk cause or contribute to the fall?

Illinois Workers’ Compensation Is No-Fault—but the Fall Must Still Be Work-Related

Illinois workers’ compensation is generally a no-fault system. An employee usually does not need to prove that the employer negligently caused the accident.

The worker may still qualify for benefits even if the worker was distracted, misjudged a step, moved too quickly, used imperfect technique, or made an ordinary mistake.

No-fault does not mean automatic coverage. The employee must still establish a sufficient connection between the fall and the employment.

Our guide to Illinois no-fault workers’ compensation explains the difference between fault and work-relatedness.

Explained Falls: When a Workplace Condition Caused the Accident

An explained fall has an identifiable cause. These are often the strongest fall claims because the worker can identify a physical condition or work activity that caused or contributed to the accident.

Examples include slipping or tripping because of:

• Water, condensation, grease, oil, soap, wax, or another slippery substance;
• Snow, ice, slush, or tracked-in moisture;
• Uneven pavement, raised concrete, potholes, cracked tile, or damaged flooring;
• Broken steps, worn stair treads, missing handrails, or defective ramps;
• Loose mats, cords, straps, pallets, boxes, shrink wrap, tools, or debris;
• Poor lighting or an obscured change in elevation;
• A ladder, scaffold, platform, loading dock, or piece of work equipment;
• Carrying materials that obstructed the worker’s view or affected balance;
• Pushing or pulling a cart, patient, pallet jack, container, or equipment;
• Moving quickly in response to a patient, customer, resident, emergency, or supervisor; or
• Being struck, bumped, startled, pulled, or redirected by another person.

The employee does not ordinarily have to prove that the employer knew about the condition. Notice and negligence may matter in a separate personal injury case, but workers’ compensation generally focuses on whether the employment condition caused or contributed to the injury.

What If the Employee Did Not See the Hazard Before Falling?

Many people do not look directly at the floor while walking. A worker may first see water, ice, a crack, or debris after the fall. That does not necessarily make the claim unexplained.

Evidence may include:

• Water on the floor, shoes, or clothing after the fall;
• A shoe that was wet, oily, or contaminated;
• A crack, elevation change, loose mat, or object at the point of the fall;
• Witness testimony about the condition immediately before or after the accident;
• Surveillance video showing the foot catch, slide, or change direction; and
• Consistent accident reports and medical histories.

The fact that an employee did not see a transparent or unexpected condition before stepping on it does not prove that the condition was absent.

For immediate reporting, medical, and evidence-preservation steps, read what happens after a slip and fall at work in Illinois.

What Is an Unexplained Fall at Work?

An unexplained fall occurs when the evidence does not establish why the employee fell. The worker may remember walking and then being on the ground, or may have no memory of the accident because of a head injury or loss of consciousness.

A truly unexplained fall can be difficult to prove because the employee bears the burden of connecting the accident to employment.

An unexplained fall is not necessarily the same thing as an idiopathic fall. In a genuinely unexplained case, the cause remains unknown. In an idiopathic case, the evidence identifies a personal medical condition or internal weakness as the cause.

Evidence That May Explain an Initially Unexplained Fall

• Surveillance video;
• Photographs of the area;
• Witness accounts;
• Damage to shoes or clothing;
• Weather records and snow or ice conditions;
• Maintenance, cleaning, or inspection records;
• Evidence concerning what the employee was carrying, pushing, or pulling;
• The employee’s required route and work destination;
• Medical evidence excluding a seizure, fainting episode, or other personal cause; and
• The employee’s statements before memory was affected by medication or a head injury.

Ordinary Walking, Level Floors and Neutral Risks

Employers sometimes argue that walking on a level floor, standing up, turning, or using stairs is an ordinary activity faced by the general public and therefore a neutral risk.

That does not automatically end the claim.

An activity should not be treated as neutral when the employee was performing a specific work duty or an act the employer could reasonably expect the employee to perform.

Walking to retrieve supplies, checking a patient, delivering materials, carrying equipment, or responding to a supervisor may be directly connected to the job.

Even a neutral risk may become compensable when the employment exposes the worker to that risk more frequently or in a meaningfully different way than the general public.

Relevant facts may include:

• How often the employee had to use the route;
• Whether the route was required or selected by the employer;
• Whether the worker was carrying job materials;
• Whether the job required hurried or repeated movement;
• Whether the employee was using a restricted or employee-only area;
• Whether the surface contained a defect or hazard; and
• Whether the work environment increased the severity of the fall.

What Is an Idiopathic Fall?

An idiopathic fall originates from a condition personal to the employee rather than from the work environment.

Possible examples include:

• A seizure;
• Fainting or loss of consciousness;
• A sudden cardiac event;
• Vertigo or dizziness unrelated to work;
• Low blood sugar;
• A personal knee or ankle condition that suddenly gives way; or
• Another internal medical event unrelated to employment.

Employers and TPAs sometimes use the term too broadly. A fall is not idiopathic merely because no coworker saw it, the employee did not see the hazard beforehand, or the employer disagrees with the employee’s description.

There should be evidence that a personal condition actually caused the fall.

Can an Idiopathic Fall Still Be Covered?

Potentially. Even if a personal medical condition initiates the fall, workers’ compensation may apply when an employment condition significantly increases either the risk of falling or the harmful effects of the fall.

Examples may include falling:

• From a ladder, scaffold, elevated platform, or loading dock;
• Down a flight of stairs;
• Into machinery or industrial equipment;
• Against a sharp counter, fixture, tool, or work surface;
• While handling heavy or hazardous materials; or
• In another location where the employment created a danger beyond an ordinary level floor.

Are Falls on Stairs at Work Covered?

A fall on stairs may be covered when something about the stairs or the employment contributed to the accident.

Relevant facts include:

• Water, ice, worn tread, loose carpeting, poor lighting, or another stair defect;
• A broken or missing handrail;
• Carrying files, tools, products, food, medical equipment, or other work materials;
• Moving quickly to attend a meeting, respond to a patient, or complete another duty;
• Repeatedly using the stairs because of the job; and
• Using an employee-only or employer-required stairway.

Falls During Breaks or Lunch

A fall during a break is not automatically excluded. Coverage may depend on whether the break was authorized, where it occurred, whether the employee remained on the employer’s premises, and whether the activity was reasonably incidental to employment.

A worker may have a compensable claim after falling in an employer-provided break room, cafeteria, hallway, entrance, or another area the employee was reasonably expected to use.

Parking Lot and Entrance Falls

Falls in parking lots, sidewalks, and building entrances often depend on control and required use.

Important questions include:

• Did the employer own, lease, maintain, or control the area?
• Was the employee required or expected to park there?
• Was the employee using a required or customary route?
• Did snow, ice, a pothole, broken pavement, or poor lighting contribute?
• Did the employer direct employees through a particular entrance?
• Was the employee carrying work materials or performing an errand?
• Did a property owner or snow-removal company create or fail to correct the condition?

Falls Away From the Employer’s Main Workplace

Employees are often injured at customer properties, construction sites, patients’ homes, delivery locations, hotels, airports, temporary work sites, and other places away from the employer’s main facility.

The claim may still be compensable when the employee was traveling or present at the location for work. Delivery drivers, sales employees, home health workers, construction employees, service technicians, and other traveling employees may have broader coverage because travel and changing locations are part of their jobs.

Can You Sue After a Fall at Work?

An employee generally cannot sue the direct employer for ordinary negligence because workers’ compensation is usually the exclusive remedy against the employer.

A separate personal injury case may be possible when someone other than the employer caused or controlled the dangerous condition.

Potential third parties include:

• A building or property owner;
• A commercial tenant;
• A general contractor or subcontractor;
• A property-management company;
• A janitorial or floor-maintenance contractor;
• A snow-and-ice-removal company;
• A delivery customer or homeowner;
• A manufacturer of defective equipment; or
• Another business sharing or controlling the property.

Workers’ compensation and third-party claims can proceed at the same time. Workers’ compensation may provide medical care and wage-loss benefits without requiring proof of negligence.

A third-party lawsuit may permit recovery for pain and suffering, loss of normal life, and other damages that workers’ compensation does not ordinarily pay.

Read our guide to Illinois workers’ compensation and third-party injury claims. For claims involving negligent property owners or contractors, visit our Chicago premises liability lawyer page.

What Evidence Helps Prove a Fall at Work?

A Prompt and Accurate Accident Report

Identify the exact location, approximate time, hazard, witnesses, work activity, and body parts injured.

There is an important difference between saying, “I do not know what happened,” and saying, “I did not see the water until after I slipped.” Use the description that truthfully reflects the accident.

Photographs and Video

Photograph the hazard and surrounding area before it is cleaned, repaired, salted, moved, or blocked off. Include wider photographs showing the location and close photographs showing the condition itself.

Surveillance video should be requested quickly. Many systems automatically overwrite recordings.

Witnesses

A witness does not have to see the exact moment of the fall. A coworker who observed water, condensation, ice, damaged flooring, poor lighting, or the condition immediately afterward may provide important evidence.

Medical Histories

Tell each medical provider that the injury happened at work and describe how. Check discharge papers and work notes when possible.

Incorrect references to a fall at home, an unrelated medical event, or the wrong body part can become major issues later.

Maintenance and Inspection Evidence

Cleaning logs, maintenance requests, repair records, prior incident reports, inspection records, weather information, photographs, and contracts may help establish what happened and who controlled the property.

Common Reasons Fall Claims Are Denied

• The employee cannot explain why the fall happened;
• The accident resulted from a personal medical condition;
• No coworker saw the hazard;
• No one else reported water, ice, or defective flooring;
• The floor was dry when management inspected it later;
• The employee was on break or walking to a personal vehicle;
• Walking or using stairs was an ordinary activity;
• The employee had a pre-existing knee, ankle, back, or balance problem;
• The first medical note does not identify the hazard;
• The employee did not report the accident immediately; or
• Photographs were not taken on the accident date.

None of these arguments automatically defeats a claim. Each defense should be compared against the complete evidence.

Recent Trial Win in a Disputed State Employee Fall

McHargue & Jones recently represented an Illinois State employee after the State argued that her fall was idiopathic or otherwise unrelated to work.

Gallagher Bassett administered the claim as the State’s TPA, and the Illinois Attorney General’s Office defended it. We presented evidence that condensation and an uneven interior walking surface caused or contributed to the fall.

The State called four witnesses, but cross-examination established that none saw the accident or had first-hand knowledge of the condition at the precise time and place of the fall.

The arbitrator found the employee’s testimony, accident report, medical records, and photographic evidence more credible. The State sought Commission review, and the Illinois Workers’ Compensation Commission affirmed and adopted the central findings and award.

Read the confidential case summary: fall at work trial win for an Illinois State employee.

What Benefits May Be Available After a Compensable Fall?

• Payment of reasonable and necessary medical treatment;
• Temporary total disability benefits while the employee cannot work;
• Temporary partial disability benefits when the employee works at reduced earnings;
• Physical therapy, medication, injections, testing, and surgery;
• Vocational rehabilitation and maintenance benefits;
• Permanent partial disability compensation;
• Wage differential benefits; or
• Permanent total disability benefits in the most serious cases.

Our Illinois workers’ compensation benefits guide explains these categories in greater detail.