WHAT COUNTS AS A WORK INJURY FOR WORKERS COMPENSATION?
Does my work accident qualify for a workers comp claim?
One of the most common questions that arises in the field of workers’ comp law is “was the injury or illness caused within the ‘course and scope of employment?’” While some workers’ comp situations are straightforward – such as when an injury occurs in the workplace while an employee is carrying out his or her normal day-to-day activities – others require a more in-depth analysis of what exactly the “course and scope” of an employee’s job encompasses.
Section 301(c)(1) of the Workers’ Compensation Act, Act of June 2, 1915, P.L. 736, as amended, 77 P.S. § 411(1), provides, in pertinent part:
shall include all other injuries sustained while the employe is actually engaged in the furtherance of the business or affairs of the employer, whether upon the employer’s premises or elsewhere, and shall include all injuries caused by the condition of the premises or by the operation of the employer’s business or affairs thereon, sustained by the employe, who, though not so engaged, is injured upon the premises occupied by or under the control of the employer, or upon which the employer’s business or affairs are being carried on, the employe’s presence thereon being required by the nature of his employment.(emphasis added)
In O’Rourke v. Workers’ Compensation Appeal Board (Gartland), 83 A.3d 1125, 1136 (Pa. Cmwlth. 2014), the Commonwealth Court stated the following in relevant part:
In construing the term ‘premises’ in section 301(c)(1) of the Act, this Court has stated that ‘the determinative question is not whether the employer had title to or control over the site of the accident[.]’ ICT Group v. Workers’ Compensation Appeal Board (Churchray-Woytunick), 995 A.2d 927, 931 (Pa. Cmwlth. 2010). ‘[T]he ‘premises of the employer’ are neither defined as nor limited to the employer’s actual property.’. . . Rather, by its very language, section 301(c) states, in pertinent part, that an injury must occur on ‘premises occupied by . . . the employer, or upon which the employer’s business or affairs are being carried on[.]’
Were you furthering the employer’ business or affairs when you were injured?
Employer’s will sometimes argue that what you were doing at the time of your injury was somehow outside of the course and scope of your work. For instance, maybe you were injured after clocking out of work, on your way home after stopping to eat dinner with friends. In that type of scenario, an employer might prevail on a course and scope defense.
While course and scope can be defined, it is important to look closely at the circumstances surrounding each case.
Sports injuries are common in workers’ comp, however, if the activity that caused the injury is outside of the course and scope of the athlete’s job, the employer might be let off the hook for paying workers’ compensation benefits. Employer’s will argue whatever defense might apply, such as violation of law, or if the athlete was in violation of a policy (such as a drug free policy, or an explicit rule against physical altercations), an employer might argue that the activity was not within the scope of employment and that the injury is not compensable.
There is no one-size-fits-all explanation for whether something falls within this definition. Although there are many examples that have been addressed since the inception of the Workers’ Compensation Act, the unique nature of each case requires a careful analysis of the facts and situations that led to the injury or illness. At Martin Law, we have helped many clients throughout Pennsylvania address this issue and seek the benefits they require.
What types of injuries are excluded from workers’ compensation?
- Intentionally self-inflicted injury or death
- Injury or death caused by the employee’s violation of law
- Violation of a positive order
- Due to personal animosity
- Injuries that would not have occurred but for the intoxication of or illegal use of drags by the employee.
Violation of Law:
- Burns v WCAB (State Pipe Servs) and Abbots Dairies v. WCAB (Yates) state that where injury/death is caused by violation of law, compensation is not payable.
- If substantial evidence shows that intoxication did not cause the death, compensation was payable – MDS Labs v. WCAB (Munchinski) and Oaks v. WCAB (PA Electric). Mere proof of intoxication at a level in violation of the Motor Vehicle Code, without proof that the intoxication caused the injury of death, is not sufficient to deny compensation.
- Graves v. WCAB (Newman) the employee was not eligible for benefits when he was injured on the job, because he obtained the job after escaping official detention. Therefore, his inability to work was not caused by the injury, but rather by his own violation of law and his having to be in detention.
Violation of positive work order:
- Affirmative defense, employer must establish
- Injury was caused by the violation
- Employee actually knew of the order or rule
- Order or ule implicated activity not connected with employee’s work duties
- Examples: joyriding a forklift without being certified to drive, violating a forbidden work area, driver injured when changing tire on truck when employer mandated that tires are to e changes by professionals and not drivers = benefits not payable.
- An injury caused by a third person intending to injure an employee because of personal reasons to the third person and not directed against the employee because of the employment is excluded from the course and scope of employment and therefore not compensable.
Often, disputes in workers’ compensation claims involves medical questions, such as whether carpal tunnel syndrome is job related or whether a heart attack stems from work. In other cases, the issue is not the injury at all. Instead, it involves whether the injury happened during the course and scope of employment.
In Pennsylvania, the Workers’ Compensation Act requires employers to pay for injuries that workers suffer in the course of employment, which means they are furthering the business or affairs of the employer at the time of the injury. The Pennsylvania Commonwealth Court has held that workers are eligible for compensation for injuries suffered on the employers’ premises during work hours as long as they did not abandon their employment or do something foreign to the employment. Given this broad standard, how do cases involving the course and scope of employment arise?
In one recent case, the issue was whether a convenience store worker had abandoned his work by chasing a would-be thief into the parking lot. The worker was a manager who had come to work early to help a coworker. He saw a thief attempt to take money from the register and chase after him. The worker chased him into the parking lot and reached into the man’s car as he was driving away. The thief dragged the worker as he drove off and ran over his head. The man later died from severe head injuries.
The employer argued that the man had abandoned his employment. The Pennsylvania Commonwealth Court ultimately held that the man was acting in the course and scope of his employment and was eligible for workers’ compensation benefits.