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Employers are responsible for “accidents arising out of employment” under most state workers’ compensation laws. What does this language really mean? The easiest way to interpret this language is to consider whether the accident has a genuine connection to work or just happens to occur at work.
Take for example someone who is sitting at work talking to a colleague about a work matter when suddenly her jaw locks, causing severe pain and leading to treatment. Would this be a work accident covered under workers’ compensation? It happened at work, yes, but what is the connection to work? The answer is that there is no bona fide connection to work activities. Talking is something we do all day and does not amount to an accident. If you consider the same scenario to have happened at home, where a husband is speaking to his wife when his jaw locks, one would certainly not call this a “home accident.” Just as the home did not cause this to occur, neither would work be the cause of such an incident. Some events just happen to occur at home or at work because we spend most of our time in these two locations. These kinds of events could just as easily happen at the local supermarket or at a museum.
In much the same way, if one is walking from his den to his kitchen at home when his knee locks, leading to a visit to a knee surgeon for treatment, few would call this a “home accident” unless there was a fall on the floor or a collision with an object. The same would be true at work: feeling leg pain while just walking is not an accident absent a fall or some other force acting on one’s body. Yet we all know that claims like this get accepted all the time by employers because of a mistaken belief that something is compensable in workers’ compensation just because it happened at work. The part of the equation that is often missed is that there must be some genuine connection to work, such as a slip and fall on a hard surface, a trip and stumble on a torn carpet, or a collision with an object at work.
The definition of an accident is “an unexpected event.” So if a teacher is walking and a student comes barreling down the hallway, not paying attention, and slams into the teacher causing a hard fall and damage to the knee, that is an unexpected event clearly connected to work. It both happens at work and arises out of work and is therefore compensable.
It remains this practitioner’s opinion that many cases get accepted in workers’ compensation that really have no connection to work other than that the event just happens to occur at work. If you are at home, and you put on your overcoat on a cold day to go outside, when you feel a tear in your shoulder, you would not think that the home caused the tear in the shoulder. The same is true if this happened to occur at work. The reason such events often get accepted is that the employer sends the employee to a doctor, thinking the compensability decision depends on a doctor’s opinion. It doesn’t. The doctor then prepares a report and states the obvious: that putting on the coat caused a tear in the shoulder. But the issue is a legal one not a medical one: does it arise out of work, or is there a true work connection? We all put our coats on during cold weather several times a day. As a matter of law, not medicine, this tearing one’s shoulder while putting on one’s coat to go home is not an accident covered by workers’ compensation. There is no work connection at all, and it just so happens that at this point in one’s life a tear occurred while from a personal action.
We all know this concept is true because we all have heard of cases where someone is driving a car and suddenly has a stroke. Or someone is sitting at a chair at home or work when the stroke occurs. Where the stroke happens to occur is simply pure coincidence because there is just no way for medicine to predict when a person who has risk factors will have such a cerebrovascular event. But we do know that having a stroke sitting at one’s desk is not work related. Those claims get denied and are won by the employer. So think of “arising out of work” as meaning that there is a genuine “work connection.”
John H. Geaney, Esq., is an Executive Committee Member and a Shareholder in Capehart Scatchard's Workers’ Compensation Group. Mr. Geaney concentrates his practice in the representation of employers, self-insured companies, third-party administrators, and insurance carriers in workers’ compensation, the Americans with Disabilities Act and Family and Medical Leave Act. Should you have any questions or would like more information, please contact Mr. Geaney at 856.914.2063 or by e‑mail at email@example.com.