Injuries Covered by Workers' Compensation
In general, any injury, illness or disease that arose out of and in the course of employment is covered for workers’ compensation. The injury, illness or disease can be one that was caused, contributed to, or aggravated by a specific incident or by the constant stress or nature of the job over a period of time. The following represent circumstances under which injuries are not considered to have arisen out of and in the course of employment and are, therefore, not covered for workers’ compensation:
Coming and Going Rule
As a general rule, injuries that occur while coming to work or going home from work are not within the course of employment and, therefore, not covered. However, there are exceptions to this rule.
Despite the rule, an injury is covered if it occurred during the period of employment, at a place where the employee might reasonably have been expected to be and while the employee was fulfilling the duties of his/her job conditions under which those duties were to be performed.
For example, if an injured worker parks his/her car in a parking lot designated for company employees and is injured while walking from the lot to the employer’s building, then he/she is entitled to workers’ compensation. In such a case, the injury occurred during the period of employment (the period of employment includes a reasonable time before and after actual workday hours), at a place where he/she is expected to be and while doing something under conditions created by the employer (walking in the company parking lot). There are many factual situations that will allow an injured worker to collect workers’ compensation under an exception to the Coming and Going Rule.
Deviation from Employment
As a general rule, if an employee deviates from performing his/her job duties, i.e., does something for a personal benefit, then any injury that occurs during the period of deviation is not within the course of employment and, therefore, not covered. Once the employee returns to the workplace or returns from the deviation to the course of employment, then any injury that occurs after that point is covered. If the deviation is solely for the employee’s benefit, then any injury that occurs during the period of deviation is not covered; if the employer derives some benefit from the deviation, then the injury would be covered.
Injuries that occur during horseplay among employees are not within the course of employment and, therefore, not covered. However, if the employer was aware of such activity and acquiesced to it, then an injury that occurs during horseplay would be covered as being within the course of employment.
An injury that occurs during a fight is only covered if the fight was about some matter related to employment.
An injury that is intentionally caused by the injured worker or by his/her intoxication is not covered.
An employer takes its employees as it finds them. Therefore, an employee’s pre-existing condition that is worsened by a work related injury is covered for workers’ compensation, regardless of whether or not the pre-existing condition itself was work related. This is commonly referred to as an aggravation of a pre-existing condition. The determining factor is whether the work injury or activity contributed to the injury by accelerating or aggravating the pre-existing condition. The work injury or activity can be a specific incident or the constant stress or nature of the job that worsens the pre-existing condition over a period of time.
A recurrence is a prior work related injury which has resulted in a return of disability without being aggravated by a new injury. There is often a dispute between insurance companies as to whether a disability is the result of an aggravation or a recurrence. The dispute arises because the determination of whether a disability is the result of a recurrence or aggravation determines which insurance company is responsible to pay workers’ compensation. If the prior injury becomes disabling without being aggravated by a new injury or work activity, then the insurance company for the employer where the original injury occurred pays workers’ compensation for disability as a recurrence. On the other hand, if there is a subsequent work related injury or activity that worsens the prior injury, then the insurance company for the employer where the subsequent injury occurred pays workers’ compensation as an aggravation.
If an injured worker returns to work for at least 26 weeks, after having collected compensation for an injury, and then suffers a recurrence of disability from the previous injury, the weekly compensation rate for the recurrence is recalculated based on the average weekly wage for the period of time prior to the date of the recurrence.
Read full text of statute » 28-33-20.1.
A “flow-from” is a term used to define an injury or medical condition that results from a work related injury. For example, if an injured worker suffers an injury to his right hand and, as a result, begins to overuse the left hand to compensate for the useless right hand, then any injury to the left hand that results from overuse is considered an injury that “flowed from” the original work related injury. Other examples would be a knee injury caused by a person who fell when their leg gave out because of a work related back injury and depression which resulted from the psychological effect of a work injury.
A “flow-from” injury is covered just like any other work related injury. In fact, if an injured worker recovers from the original work related injury but continues to be disabled as a result of the “flow-from”, then weekly benefits will continue.