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By ELIZABETH A. MORROW, ESQ., the legal editor for Workers' Compensation Report

The fact that an injury occurs while an employee is at work or performing work-related tasks is not necessarily determinative of whether he is entitled to workers' compensation benefits. While each state has its own laws governing what the employee has to prove to secure benefits, generally speaking, the employee must establish the essential elements of his claim, including:

2. The injury or illness must be causally related to the employee's job duties. An employer is not liable for injuries that bear no connection to an employee's work. For example, an employee who is injured while deviating from the course of employment, including leaving the employer's premises, is not generally eligible for benefits unless the deviation was expressly approved by the employer, the deviation or act was in response to an emergency, or it was only a minor deviation from the employee's duties.

3. The injury must occur in the course of employment. The employee must be engaged in his employer's business, must be at a place where the employer reasonably expects him to be, and must be fulfilling his employment duties or doing something incidental to those duties at the time of his injury. While most injuries occur during an employee's regular working hours and on the employer's premises, there are situations when employees are entitled to receive compensation for injuries incurred while they are traveling to and from work, or running a special errand off the employer's premises.

Some cases raise complex issues regarding when an employee is entitled to compensation for his injuries. If the employee's injuries occur while he is serving both his employer's interests and his own personal interests, are the injuries sustained in the course of employment? What happens when the employee is injured while going to or coming from work?

Under certain circumstances, he may be entitled to compensation under one of the exceptions to the coming and going rule. This year, courts also considered whether employees were entitled to compensation despite the fact that they brought about their own deaths, either by suicide or by refusing medical treatment.

COURSE OF EMPLOYMENT

In order for an employee to receive workers' compensation for a workplace injury, the injury must occur within the time and space boundaries of the employment, and the employee must be furthering the employer's purpose or advancing its interest directly or indirectly. If an employee is injured while engaged in a recreational or social activity, but the activity also serves the employee's personal interests, the injury may still be compensable.

For example, the Kansas Court of Appeals awarded compensation to a sales representative who injured her knee during an employer-organized dance contest. The employer organized various activities during work hours as incentives for employees to earn prizes, cash or vacation time.

These activities were designed to "energize and motivate employees as well as to provide incentives for employees to remain with the company," leading the court to conclude that the activities were within the scope of the sales representative's employment. In contrast, the New York Supreme Court, Appellate Division reversed a finding that a correction officer's injury, sustained while practicing volleyball for the employer's "Olympics," arose out of and in the course of her employment. Because the employer did not manage the activity or offer incentives to its employees to participate, the injury was not compensable.

ELIGIBILITY

Eligibility for death benefits turns on several factors, including the status of the person seeking benefits, whether there is a causal relationship between the worker's employment and his death, and whether some other factor or event intervened to break the chain of causation. 2008's death benefits cases covered some interesting ground.

For example, in Missouri, the Court of Appeals ruled that an employee who refuses medical treatment on religious grounds does not lose entitlement to workers' compensation benefits so long as his decision to refuse treatment is not unreasonable. A truck driver's medical treatment was complicated by his refusal to accept a blood transfusion. Seven days after the accident, he died from cardiac ischemia and severe anemia due to blood loss.

The court awarded the widow death benefits from the date the employer terminated them, concluding that the driver's religious beliefs should have been accommodated. In South Carolina, the Court of Appeals held that a worker's willful intention to kill himself was an independent, intervening variable that broke the chain of causation between his work-related injury and his suicide. It reversed an award of benefits to the worker's mother.

Finally, in Indiana, the Court of Appeals determined that a widow was not entitled to benefits because she was not living with her husband at the time of his death and was not dependent upon him for financial support.

EMPLOYMENT STATUS

Being considered an employee for workers' compensation purposes can be a double-edged sword for some workers. An employee whose injury falls within the scope of a state's workers' compensation laws is generally prevented from suing the employer for his personal injuries under the exclusive remedy rule.

Some states have exceptions to this rule for intentional torts, such as where the employer becomes liable because it was aware that substantial harm was likely to occur to the employee and did nothing to prevent it. But in general, once a worker meets the definition of employee under that state's workers' comp laws, his ability to pursue a personal injury suit ends.

The Minnesota Court of Appeals grappled with the issue of whether a student in a summer research program met the statutory definition of an employee at the time of his injuries. Under the Minnesota's Workers' Compensation Act, the determination of whether a student is an employee requires courts to evaluate the purpose and character of the work assigned to and performed by the student. Because the scope and nature of the student's activities were not clear, the court declined to dismiss his suit against a college.

However, in a case from the U.S. District Court, District of Rhode Island, the court dismissed a personal injury suit filed by the family of a shipbuilder's employee, who was accidentally killed on the job by a borrowed worker from a staffing company. The employee and the borrowed worker were considered to be in the same employ, and therefore, the family's sole remedy was through the workers' compensation system.

COMING AND GOING RULE

The coming and going rule bars recovery for an injury sustained while an employee is going to or returning from her place of employment. However, many states' workers' compensation laws have exceptions to the general rule.

For example, in Tennessee, which has adopted the "street risk doctrine," when the employment requires the employee to travel on public streets, the risks of the street become the risks of the employment. Street risks include simple falls, assaults and automobile accidents.

In one case, the Tennessee Supreme Court, Special Workers' Compensation Appeals Panel upheld the compensability of a school psychologist's injuries, which occurred as a result of a car accident after she stopped for lunch. Because her job placed her on the streets on the day of her accident, and her choice of a restaurant was for the mutual convenience of her employer and herself, the panel found that her injuries arose out of her employment and were compensable.

The New Jersey Superior Court, Appellate Division reached a different result in a case involving a loss prevention officer's automobile accident while traveling home from work. Although New Jersey recognizes a "travel time" exception to the coming and going rule, which allows workers' compensation coverage for injuries that occur while traveling if the employee is paid wages during the time he spends traveling, the loss prevention officer did not fall within this exception because he was not paid wages for his travel time. Instead, he was reimbursed for actual gasoline used, plus tolls and wear and tear on his car.

INJURIES AND ILLNESSES

The connection between an employee's working conditions and an injury or illness is not always readily apparent, which is why expert testimony--in most cases, credible medical evidence--is needed to establish a causal relationship.

For example, the Texas Court of Appeals ruled that a claimant's medical records did not provide sufficient expert evidence to establish a causal relationship between her head injury and mental conditions that subsequently developed. The court explained that under certain circumstances, the claimant's medical records may comprise the necessary expert evidence, but only when the records establish causation within reasonable medical probability.

Otherwise, expert testimony is generally necessary to establish causation when the medical conditions are outside the common knowledge and experience of jurors.

In contrast, the North Carolina Court of Appeals found that a university lab researcher suffered a compensable occupational disease causally related to a vaccine she received as a condition of her employment.

North Carolina awards compensation benefits for an occupational disease when the claimant satisfies several criteria:

1) the disease is characteristic of persons engaged in the particular trade or occupation in which the claimant is engaged;

2) it is not an ordinary disease of life to which the public generally is equally exposed with those engaged in that particular trade or occupation; and

3) there must be a causal connection between the disease and the claimant's employment.

The claimant satisfied the first two criteria by establishing that her employment exposed her to a greater risk of contracting the disease than the public in general. Although there was conflicting medical testimony as to whether the researcher's disease was causally related to the vaccine, substantial evidence demonstrated the necessary link between the two.

MENTAL INJURIES

An employee's mental or emotional condition will generally generate workers' compensation benefits when it is caused or aggravated by a compensable physical injury. However, the fact that psychological symptoms develop after a physical injury is not sufficient--there must be a causal link between those symptoms and the original compensable injury.

For example, the Mississippi Court of Appeals found that a claimant suffered compensable arm and scalp injuries but failed to establish a causal connection between her physical injuries and her disabling mental condition. As a result, the court reversed the award of benefits related to the mental condition.

In Kentucky, the Court of Appeals upheld an award of benefits to a Walmart employee who suffered physical and psychological injuries as a result of an explosion that shook the store. The physical injury did not need to be permanent to trigger a compensable psychological condition.

In a case involving a mental injury that was unaccompanied by a physical injury, the California Court of Appeal denied an employee's psychiatric injury claim that she alleged resulted from harassment and persecution by her supervisor and coworkers. The court found that the employee's actions--which included being rude, inflexible, and demeaning toward other employees--were the predominant cause of her stressful work environment, not actual events or conditions of her employment.

January 23, 2009

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