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Worker’s Compensation Outline
Arising Out of the Employment
Compensability Requirements è
Employee Personal Injury OR injury Arises out of Employment (HOW) In the Course of Employment (TIME & PLACE)
§ 6 è The 5 Lines of Interpretation of “Arising”
§ 6.30 è Increased-Risk Doctrine
Employment increased your exposure to the risk (e.g. taxi driver & auto accidents OR placing worker on particular height/metal, thus exposing him to lightning) More than what other workers are exposed to
§ 6.40 è Actual-Risk Doctrine
§ 6.50 è Positional-Risk Doctrine
TEST – Injury would not have occurred BUT/FOR the fact that the employer put you there Covers stray bullets, roving lunatics
§ 7 è The Categories of Risk
§ 7.10 è Employment Risk
Accidents linked to à Machinery, objects falling, explosions, etc… Occupational Diseases from à substances or environment
§ 7.20 è Personal Risk
Injury OUTSIDE of employment is borne by the employee E.g. à Internal weakness unrelated to job (heart attack), mortal enemy who seeks Ee out, or natural death.
§ 7.30 è Neutral Risks
Neither one or other If risk is NOT known – then it is a neutral risk 4 Modern approach à Er bears risk more often than Ee E.g. bit by a mad dog, stray bullet from nowhere, murdered by mistaken I.D., blinded by a flying beetle.
§ 7.40 è Mixed Risks
Personal & Employment risks combine to produce the harm E.g. Ee with weak heart dies b/c of strain occasioned by employment As long as employment is a contributing factor, the injury IS compensable 4
§ 10 è Positional & Neutral Risks
Claimant occupies a “place of danger” = sufficient causal connection (presumption of compensability) Coomes – Injured by unknown cause at lumber yard – compensable But/for TEST satisfies the arising requirement OR Weigh each factor – Heavy in the course of element AND absence of personal risk NOTE: Courts will NOT presume suicide – must be proved Heart attacks presumed solely as personal risk unless proved otherwise
§ 11 è Assaults
Risk of the assault is increased by the employment (nature of the job)
Assault was a quarrel having its origin in the work
Assault was NEUTRAL
Exceptions è Minority of jurisdiction deny compensation if claimant was aggressor Whether the passage of time converts a work related dispute into a personal one 4
Western Airlines à Intentional assault motivated purely by personal desires of an individual in no way connected with employment is NOT compensable J. Lichtman & Sons à Assault compensable even if the subject of the dispute is unrelated where the work of the participants brought them together and created relations & conditions which resulted in the clash.
§ 12 è Risks Personal to the Employee
General Rule è Conditions personal to the claimant do NOT arise out of employment UNLESS the employment contributes to the risk OR aggravates the injury. George à Idiopathic fall compensable where there is a slight work connection (work placed him on concrete surface). Cause of fall = personal Cause of injury = employment related Pre-existing conditions aggravated by employment – compensable Cause of injury is determinative 44 Fragale à Heart attack compensable where work-connected quarrel is a co-operating cause (additional work hazard)
§ 13 è Range of Compensable Consequences
§ 13.10 è Original Compensable Injury Causing Subsequent Injury
General Rule è When the primary injury is shown to have arisen out of and in the course of employment, every natural consequence that flows from the injury likewise arises out of the employment, UNLESS it is the result of an independent intervening cause attributable to the claimant’s own intentional conduct.
2 Groups è Purely MEDICAL question 4 Original Injury worsens – No controversy here Injury exacerbates effect of independent medical weakness – Causal sequence is more complex here – if causal sequence is present – then injury IS compensable E.g. – Primary compensable injury makes it impossible to treat the independent condition, the worsening of the independent condition due to lack of treatment IS compensable Also, when the compensable injury produces a condition that interferes w/normal curative processes that might have alleviated the preexisting independent condition – progression of independent condition IS compensable E.g. being confined to a hospital bed, or strain on back caused by shortened or weakened leg… final resulting injury is entirely compensable.
Quasi-Course of Employment è Activities outside the time & space of actual work Activities undertaken by the employee following upon his injury which, although they take place outside the time & space limits of the employment,… are nevertheless related to the employment in the sense that they are necessary or reasonable activities that would NOT have been undertaken BUT-FOR the compensable injury.
Arising out of Quasi-Course of Employment Activity è E.g. trip to doctor’s office Chain of causation is NOT broken by mere NEGLIGENCE Chain of causation IS broken ONLY by intentional conduct expressly or impliedly prohibited by the employer NOT Arising out of Quasi-Course of Employment Activity è E.g. claimant injures hand while engaged in a boxing match Chain of causation broken by either intentional OR negligent conduct
§ 13.20 è Subsequent Aggrevation of Original Injury
General Rule è Aggravation of original injury by medical or surgical treatment IS compensable [Klosterman] E.g. – Resulting from antibiotics, antitoxins, sedatives, anesthesia, electrical treatments, immobilization, use of crutches, corrective or exploratory surgery
§ 13.30 è Refusal of Reasonable Surgery
NOT attended w/great danger AND Operation offers a reasonable prospect of relief from the incapacity
Refusal of reasonable surgery breaks the causal chain Insurance company has the right to independent medical exams Can cut your benefits off if you do not comply At reasonable intervals Doctor of their choice
Course of Employment – Time & Place
§ 14 è Meaning of “Course of Employment”
General Rule è Injury arises in the course of employment when it takes place within the period of the employment, at a place where the employee reasonably may be, AND while he is fulfilling his duties or engaged in doing something incidental thereto. [not occur BUT arise] TIME, PLACE, MANNER Does NOT require the employee to be in the course of the employment, ONLY that the injury arise in the course of…
§ 15 è Going To & From Work
General Rule è Course of employment should extend to any injury which occurred at a point where the employee was within range of dangers associated with the employment Going to & from work IS covered on the employers premises Injury suffered during a local commute en route to a fixed place of business at fixed hours in the absence of special circumstances is NOT w/i the course of the employment Fixed hours & place injuries are clear Off-premises generally NOT compensable [w/exceptions] Walking across the street from employer-owned parking lot – covered [Illinois Bell] Walking from commuter type lot – NOT covered Choosing route – did employer mandate certain route ??? Customary nature of the act is important Courts look to the authority OR control over the behavior of the employee Result is an extension of the premises of the employer Acts of personal convenience are covered IF; Reasonably contemplated by the employment
Going & Coming RULE è Exceptions Special Errand – E.g. OT – you are injured going to your car You paid for the travel Reimbursement for expenses of the travel
§ 16 è Journey Itself Part of Service
General Rule è Rule excluding off-premises injuries does NOT apply where è If making the journey, or the special degree of inconvenience or urgency under which it is made, whether or not separately compensated for, is in itself a substantial part of the service for which the worker is employed. E.g. – Travelling workers
§ 17 è Employer’s Conveyance
General Rule è Journey made to or from work made in the employer’s conveyance is in the course of employment. Reasoning à Risks of the employment continue throughout the journey Employer himself has expanded the range of the employment and the attendant risks.
§ 18 è Dual-Purpose Trips
General Rule è Compensable where à The trip serves BOTH a business and a personal purpose IF the trip involves the performance of a service for the employer which would have caused the trip to be taken by someone even if it had NOT coincided with the personal journey. If the work of the employee creates the necessity for travel, then he is in the course of employment. [Gray] Small deviations/side trips are still COVERED as long as employment created the necessity for travel May also qualify as a special errand Person working at home at the knowledge & request of employer are COVERED Look for à
Regularity of the employment at alternate location Continuing presence of office equipment Encouragement of getting work done by employer Employer continues to pay employee for work at home Acquiescence by employer MAY qualify w/other factors too
§ 19 è Deviations
Deviation is from the main purpose Mixed purpose rule – serves to label the over-all trip as business or personal Look to see if the delay emphasized the personal nature of the identifiable deviation Minor Deviations à scenic routes
Course of Employment – Activity
§ 20 è General TEST of Work-Connection as to Activity
General Rule è Indirect Benefit Theory An activity is related to the employment IF It carries out the employer’s purpose OR Advances his interests either directly or indirectly Work connected activity goes beyond the direct services performed for the employer and includes at least some ministration to the personal comfort and human wants of the employee. going to the bathroom – compensable drink of water breath of fresh air smoking break eating
§ 21 è Personal Comfort Doctrine
General Rule è Employees who, within the time & space limits of their employment, engage in acts which minister to personal comfort do NOT thereby leave the course of employment UNLESS The extent of the departure is so great that an intent to abandon the job temporarily may be inferred OR The method chosen is so unusual and unreasonable that the conduct cannot be considered an incident to the employment. Activity was for the benefit of the employer Activity was contemplated by the employer Risk was incidental to the employment Employee was being paid Employee is on the premises Employer acquiesced on the activity Employee is NOT on a personal mission
§ 22 è Recreational & Social Activities
General Rule è Recreational OR social activities are within the course of employment when: They occur on the premises during a lunch or recreational period as regular incident of the employment, OR The employer, by expressly or impliedly requiring participation, OR by making the activity part of the services of an employee, brings the activity within the orbit of the employment; OR The employee derives substantial direct benefit from the activity beyond the intangible value of improvement in employee health and morale that is common to all kinds of recreation and social life.
§ 23 è Horseplay
General Rule è Injuries to non-participating victims of horseplay are compensable. Where employee instigates OR participates… recovery allowed IF such activity becomes customary Whether initiation of horseplay is a deviation from the course of employment depends on: FACTORS
The extent and seriousness of the deviation The completeness of the deviation (i.e. whether it was commingled with the performance of duty OR involved an abandonment of duty) The extent to which the practice of horseplay had become and accepted part of the employment AND The extent to which the nature of the employment may be expected to include some such horseplay
§ 24 è Resident Employees
General Rule è Generally compensable if 1 of the 2 factors is present è The claimant was continuously on-call OR The source of the injury was a risk distinctly associated with the conditions under which claimant lived b/c of the requirement of remaining on the premises.
§ 25 è Travelling Employees
§ 26 è Injuries After Quitting OR Before Formal Hiring
General Rule è Injuries incurred by an employee while leaving the premises, collecting pay, or getting his clothes or tools within a reasonable time after termination of the employment are within the course of employment, since they are normal incidents of the employee relation. Employee may be compensated where customary to remove tools or other items after quitting or removal from employment [Nails]
§ 27 è Acts Outside Regular Duties
General Rule è Within the course of employment where è Act is undertaken in good faith to advance the employer’s interests, whether or not the employee’s own assigned work is thereby furthered.
4 ways this happens è
Helping a co-employee (doing his job) Helping a customer – outside of what you were hired for Acts benefiting the employee (going to school) Acts benefiting the employer privately (dropping off clothes at launders)
§ 28 è Acts in Emergency
General Rule è Within the course of employment IF è Employer has an interest in the rescue OR Rescue of stranger is compensable IF è Conditions of employment place claimant in a position which requires him by ordinary standards of humanity to undertake to rescue.
§ 29 è CONCLUSION: Work Connection as a Merger of “Arising” & “Course”
§ 29.20 è “Delayed-Action” Injuries
General Rule è Although this type of injury generally implies a weakness of the “in the course of” element… the injury IS compensable if there is a strong causal connection to make up for it. E.g. – Foreman who fires employee and is assaulted by same 1 week later
Personal Injury by Accident
§ 30 è Meaning of “Personal Injury”
Disease Sunstroke Nervous Collapse Traumatic Neurosis Hysterical Paralysis Neurasthenia
§ 31 è Mental & Nervous Injury
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