Compensability In Workers’ Compensation
Not every injury at work is work-related, and some claimed injuries don’t involve any specific accident. Attorneys at Peterson White can help determine whether someone is an employee and whether a claimed injury is actually a compensable work injury.
First, the injured worker must be an employee. Although this may sound simple, some companies may be surprised to find out that people they consider independent contractors or even owners are deemed employees by state law. Further, other parties may be deemed employers based on up-the-ladder liability in subcontractor situations.
Generally, an injury or condition is a compensable work injury only if it both occurs “in the course of” the employment and “arises out of” the employment. The “course of” employment generally refers to the time, place, and circumstances. “Arising out of” employment generally refers to the cause or source of the accident. A person might be injured at work while on the clock (in the course of employment) but while doing an activity that isn’t part of their job (not arising out of employment), such as doing something that is for their own benefit, not for their employer’s benefit. However, these definitions are not consistent state to state, and there are exceptions. For example, under the personal comfort doctrine, reasonable activities for attending to one’s own personal comfort, such as going to the bathroom or taking a lunch break on the work premises, are considered incidental to the employment.
Next, several defenses are available to employers, depending on the state and the specific facts of the claim. Possible defenses include drug or alcohol intoxication, intentional self-inflicted injury, misconduct, safety violations, misrepresentation on the employment application, failure to follow medical advice, lack of notice to the employer that an injury has occurred, and the statute of limitations (when an employee does not file litigation within a certain timeframe).