ACCIDENTAL INJURY AND WORKERS’ COMPENSATION BENEFITS

In order for an employee to obtain workers’ compensation benefits, he or she must often prove an “accidental injury” that “arose out of” and “in the course of ” the employment. Once those facts are proven, employers are strictly liable under states’ workers’ compensation systems for nearly all work-related accidents.

Accidental Injury

The workers’ compensation statutes in some states have eliminated the need to prove that an injury was “accidental.” Other statutes, however, retain the requirement. Where required to be proven, an “accidental injury” is generally defined as an “unexpected” injury. Some courts require that the injury occur “suddenly” in order to be compensable. Others find an accidental injury where the injury occurs gradually over time. Some courts have stated that when an injury occurs under normal work conditions, it is not accidental. If in doubt, courts interpret the law in favor of the employee.

The following are examples of injuries not found to be accidental:

1. heart attack occurring while employee was driving a snowplow during overtime hours, and
2. back injury occurring after employee had been servicing heating and air conditioning installments in crawl spaces for several weeks.

The following are examples of injuries found to be accidental:

1. asthma gradually worsened by employee’s exposure to secondhand smoke in the workplace, and
2. back injury occurring due to “unusual” strain on the part of the employee.

“Arising out of employment”

“Arising out of employment” generally means that there was a causal link between the injury and the employment. Different state courts use different tests to determine whether an injury arose out of the employment. Some courts have stated that an accident “arises out of employment” if the risk causing the injury was greater for the employee than for a person not engaged in the employment. Others have stated that it means that the employment contributed significantly to the injury.

“In the Course of Employment”

If an employee proves that an injury arose out of his or her employment, he or she must still prove that the injury occurred “in the course of the employment.” Most courts hold that the two requirements, though related, are distinct.

An injury occurs “in the course of employment” where it occurs while the employee is actively engaged in the performance of his or her duties during working hours, either on the employer’s property or at some place where the employment takes the employee. Misconduct by an employee is generally viewed as falling outside of the “course of employment,” even when a resulting accident occurs during working hours and on company property.

The “Going and Coming Rule”

Generally, injuries sustained by employees while traveling to and from work are not compensable under workers’ compensation statutes. These injuries are usually not found to have either arisen from the employment or to have occurred in the course of employment. As with other general workers’ compensation rules, however, there are some exceptions. The most notable exception involves situations where an employee is within a range of dangers “peculiarly associated with” the employment.

Copyright 2012 LexisNexis, a division of Reed Elsevier Inc.

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