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Man with sore back to demonstrate worker's comp claim

Navigating the Legal Pitfalls of Worker’s Comp

Originally Published in Plumber Magazine

To run a successful operation, employers must safeguard their greatest asset – their employees. The unpredictability of accidents and injuries in the workplace requires employers to be ready at all times to respond to any given situation. As soon as they hire their first employee, employers assume a wide range of legal obligations. One of these legal obligations involves worker’s compensation claims. Every state has its own worker’s compensation act, with differing laws and legal precedents.

Brian Bean, Executive Claims Consultant at R&R Insurance, says worker’s compensation requires a different way of thinking than other personnel management practices.

“Worker’s comp is in its own little world. It operates by its own set of rules, its own set of principles, its own set of laws,” he says. “Employers who figure that out quickly function better in it. Employers who resist against it tend to have a lot more problems in claims management.”

Bean warns employers not to take a smug, know-it-all approach to work-related injuries.

“Anytime you think there’s certainty about worker’s comp, you really shouldn’t think that way. You need to get to the facts. Feeling less certain about it is actually a healthier way to deal with it. It makes you investigate more and get on it quicker,” he says. Don’t ignore a situation, he advises.

“The faster you ask questions, the better to find out what’s happening. People are the most honest right after things happen. That’s when you have to try to lock in statements and testimonies and get it to an adjuster,” he says.

The Rules of Eligibility

Employers can avoid common pitfalls related to worker’s compensation by understanding when their employees are covered by a claim and when they’re not. Basically, employees are covered when they are in the course and scope of employment. What exactly does that mean? Some of these examples may surprise you!

An employee who is on the clock is presumed to be in the course and scope of employment. However, they can be off the clock and still be considered to be employed in a usual and customary way.

One of the most puzzling claims for employers involves employees who have a little too much fun on the road. Whether they’re traveling for work or attending a business conference, employees who are intoxicated and injured are likely to have a legitimate worker’s compensation claim. Courts have ruled that just because employees are drunk, they aren’t removed from the course and scope of employment if they are participating in an employment-related activity. Although they are likely to be eligible for worker’s compensation, they probably will get hit with a reduction in an indemnity for safety violations.

However, an employee who is drunk at the workplace will likely be deemed to be deviating from the course and scope of employment. Thus, the employee would not be eligible for worker’s compensation, if injured.  As always, there can be exceptions.

Even a terminated employee can be eligible for worker’s compensation. For example, terminated employees are covered when they come to the workplace to collect a final check or participate in an exit interview. If injured, the employee likely has a compensable claim.

The Personal Comfort Doctrine

Another compensable claim involves an injury or accident that occurs when employees leave the workplace to go to a coffee shop next door during a paid break. Although they are off-premise, they are on a paid break, so they’re considered to be in the scope of employment. Paid lunch breaks off-premises would also be considered in the course and scope of employment. Contrast this to an unpaid lunch break in which an employee slips and falls or sustains an injury at a nearby café. The employee wouldn’t have a compensable claim.

Then there are examples related to the Personal Comfort Doctrine which covers work-time breaks for using the bathroom, smoking, snacking, and drinking water. Injuries or accidents that occur during comfort breaks fall within the course and scope of employment – even for employees working from home who fall and injure themselves on their way to the bathroom.

Personal Comfort claims are routinely covered by worker’s compensation. Sports-related injuries also may be covered for employees who are injured while playing sports during a work break.

“Basketball hoops are a good example. If you play a pick-up game, then there’s a chance someone will get hurt,” Bean says. “It’s better not to have that stuff around, because if you put it up and leave it up, it’s pretty good evidence that you’re condoning it. It becomes usual and customary, and you’re going to have a worker’s comp case you didn’t expect.”

Business or Pleasure?

That brings up the question of off-premises recreation and social events.

“You’ve got to have fun, but don’t take unnecessary risks, and choose your activities carefully,” Bean says.

Courts have upheld a number of claims related to injuries that occurred away from the workplace. Employees have received worker’s compensation for injuries sustained at a donkey basketball community fundraiser, a baseball game given as a reward for meeting a sales goal, and a school dance in which a teacher chaperone was injured doing the limbo.

Yet employees aren’t covered at every off-premise location or employer-organized event, only those in which the employer derives benefits other than just improved morale. If attendance isn’t mandatory, then employees are less likely to be covered at the event.

“What you need to do as employers is make it really clear that it’s truly voluntary. There are no repercussions for not going to it,” Bean says.

On the Road

The use of company vehicles opens up a lot of liability issues and worker’s compensation risks. Bean advises employers to develop clear policies for company-owned vehicles. Policies should define when workers are using the vehicle for employment (a compensable claim) or personal travel (not compensable).

In a related example, an employee injured while on the commute to work or to a job site isn’t covered by worker’s compensation. Employees participating in employee-sponsored carpools aren’t covered, either, as long as participation in the carpool is voluntary, and the sole purpose is transportation to and from employment. However, if the employee is running an errand requested by the employer, then the employee is covered, whether the employee is in a personal or company vehicle.

Traveling employees also are covered by worker’s compensation. They receive door-to-door coverage from the time they leave home to the time they return. The exception is when they deviate from their business activities to engage in an activity for a private or personal purpose.

These scenarios are just a small sampling of the incidents that employers encounter. Understanding the intricacies of worker’s compensation helps employers manage their claims sensibly and effectively. Bean advises employers to be attentive to their state’s labor policies and relevant legal precedents. He also emphasizes the need to investigate claims quickly and thoroughly.

“You need to find out what’s going on, so proper decisions get made whether you defend a case or fight a case or accept a case,” he says.

Every employer who makes safety a part of the organizational culture promotes a sense of order that safeguards their workforce. By proactively fostering a safe work environment, employers can reduce the number of on-the-job injuries and subsequent workers’ compensation claims.

Author: Joan Koehne

Once a mild-mannered reporter and editor, Joan Koehne has taken on the persona of her alter ego, Wonder Writer, saving the world one word at a time. In 2017 she went up, up and away to launch a writing services business, Writer to the Rescue, a division of Packerland Websites. A 2017 college graduate, Joan earned highest honors and the Marketing Student of the Year award.

Joan Koehne

Once a mild-mannered reporter and editor, Joan Koehne has taken on the persona of her alter ego, Wonder Writer, saving the world one word at a time. In 2017 she went up, up and away to launch a writing services business, Writer to the Rescue, a division of Packerland Websites. A 2017 college graduate, Joan earned highest honors and the Marketing Student of the Year award.

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