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In order to qualify for workers’ compensation benefits, you must be able to establish that your injury arose “out of and in the course and scope of employment.” The work activities must also be a substantial contributing factor to the injury.Arising Out of the Employment
The “arising out of” requirement is a legal causation standard. It basically means that there must be a causal connection between the employment and the injury. Generally, what this means is that you must show that a condition or incident of employment increased your exposure to potential harm beyond that of the general public or beyond your exposure to potential harm outside of work. In plain language, what this means is that the circumstances of your employment must have had something to do with the work injury.
Most on-the-job injuries satisfy this rule. There, are a few exceptions, however, where an on-the-job injury may not necessarily “arise out of’ the employment, including:
Injuries caused by “Acts of God.” Acts of God can include anything from injuries caused by disease or severe weather. There are many “exceptions” to this “exception,” however. If an employee’s work circumstances placed them at increased risk to exposure to the “Act of God,” or if an employee’s injuries sustained as a result of an “Act of God,” were worsened due to their work activities or circumstances, those injuries are generally compensable.
Injuries while “Coming or Going.” Generally speaking, if you sustain injury while on your way to work, or on your way from work, your injury is not covered for purposes of workers’ compensation. This is known as the “Coming and Going Rule.” Again, there are several exceptions to this exclusion. For example, employers are obligated to provide safe ingress to or egress from the employment premises. In plain language, that means injuries sustained on your way into or out of the workplace, such as walking to an employee parking lot, are generally covered.
Injuries due to the intentional acts of third parties. On the-job injuries that are the result of a violent act of a third party, totally unconnected with the employment, are not compensable. In most cases, however, there is at least some connection between the circumstances of the employment and the violent act, so these types of injuries are usually covered.
Idiopathic injuries. “Idiopathic” basically means spontaneous, or peculiar to the individual. Personal conditions that cause an injury at the workplace are not compensable. That being said, if the employment premises or activities aggravate or increase the risk of injury, these types of injuries can be compensable.
In the Course and Scope of Employment
To meet the second part of the legal causation test, you must also show that the injury occurred within the period of the employment, and at a place where you could reasonable expected to be, and while you were performing your duties or something incident thereto. In plain language, this means that typically your injury must have occurred on the employer’s premises, during working hours, while performing your job duties.
There are, however, a number of exceptions to these requirements, including:
Traveling employees. Employment that requires travel involves a special set of rules. Each case is very fact specific, and involves an analysis of where the employee was at the time of the injury, what the employee was doing, and if the employee was required to be traveling as part of his or her duties.
Acts to assist others outside the employment. Generally, an act outside an employee’s regular duties, which is performed to advance the interests of the employer, is considered to be within the course of employment.
Acts of “personal comfort.” Under what is known as the “Personal Comfort Doctrine,” injuries that are sustained while an employee is attending to personal needs or comforts are generally held to be within the course of employment. This can include getting a drink of water, smoking, and using the restroom.
Horseplay. “Goofing around” or “horseplay” is generally considered to be incidental, or related to employment, and injuries that occur during such activities are generally compensable.
Violation of employer rules. Even violating an employer’s rules which results in an injury, is usually not grounds to deny benefits, unless the employee is engaged in a prohibited act at the time of the injury, and there must be a direct link between the performance of the prohibited act and the injury.
Recreational activities and employer sponsored events. Most social and recreational activities are no longer considered to be within the course of employment, unless the employee is able to show that the employer ordered or assigned the employee to participate in the program.
Injuries during lunches or breaks. Injuries that occur during a lunch break that is unpaid and off the employer’s premises are usually not covered, although there are some exceptions.
Work from home and home offices. This is becoming more and more common. Injuries sustained by employees during the actual performance of work activities while at home are generally compensable.
Substantial Contributing Factor
In addition to meeting the legal causation requirements set forth above, an employee must also show that his or her work activities were a substantial contributing factor to the development of his or her injury. There are a variety of different types of injuries that satisfy this definition, including specific injuries, Gillette-type or cumulative trauma injuries, aggravations or accelerations of a pre-existing condition, and occupational diseases. An employees work activities need not be the only cause of the condition—they need only be a substantial contributing factor.
Specific injuries. Specific injuries occur as a result of a specific incident or an accident. These are usually pretty clear. For example, falling off a ladder, sustaining a lifting injury, or being involved in a work-related motor vehicle collision are all specific incidents or events.
Cumulative trauma or Gillette-type injuries. Compensation is allowed for injuries that occur as a result of repetitive, minute trauma brought about by the performance of ordinary job duties. These types of injuries can occur over a long period of time. So long as an employee’s work activities are a substantial contributing factor to the development of the injury or condition, they are covered. Some common examples of these types of injuries include carpal tunnel syndrome or degenerative disc disease of the spine.
Aggravations or accelerations of a pre-existing condition. If an employee’s work activities substantially contribute to an aggravation or acceleration of a pre-existing condition, those conditions or injuries are compensable as well. A work-related aggravation can be temporary, or an aggravation can be permanent.
Occupational diseases. In very general terms, a disease that arises out of and in the course of employment, and which is peculiar to the occupation in which the employee is engaged, and which is not an ordinary disease of life to which the general public is equally exposed, is covered under Minnesota workers’ compensation. Occupational diseases have very specific definitions, causation requirements, and procedural rules.
Consequential injuries. Injuries that occur as a direct and natural consequence of a previous compensable injury are also, themselves, compensable. This can include conditions that develop as a medical consequence of an injury, and it can include injuries that are sustained as a legal consequence of a prior, work-related injury. For example, an injury that is sustained while doing physical therapy for a prior injury is a consequential injury. Injuries sustained as a result of a car accident on the way to a workers' compensation doctor's appointment are consequential injuries.
Psychological injuries. Physical injuries which are occasioned by mental stimulus, and psychological injuries which are caused by a physical injury, may be covered for purposes of workers’ compensation. Psychological injuries which are occasioned by mental stimulus are not generally covered by workers’ compensation.
Some on-the-job injuries are obvious – if you fall off a ladder while performing your job duties and you sustain injuries, that’s clearly a work-related injury. If you sustain a lifting injury and hurt your back while performing your job duties, that’s clearly a work-related injury. Some work-related injuries, however, are not quite so obvious. If your injury falls into one of these "gray" areas, chances are, the workers' compensation insurer will deny your claim. Don't rely on the workers' compensation insurance company to make a "fair" determination as to whether your claim is compensable or not.
We frequently talk to individuals who sustain injuries or conditions that clearly meet the requirements of a work-related injury, but they didn't realize they had a compensable claim. If you believe you've sustained an injury that may be a result of your work activities, contact Meuser & Associate for a free, no-obligation case evaluation at 877-746-5680, or click here to send us an email.
