This includes knowing the law and in other cases, coordinating their efforts with appropriate legal counsel.Īuthor Michael Stack, Principal, COMPClub, Amaxx LLC. In circumstances involving ingress/egress or other hazards they must redouble their efforts. ConclusionsĪll work-related injuries require members of the claims management team to conduct a diligent investigation. Issues examined under this test will often include whether the hazard is unique to the workplace itself or if its origins rest in risk the employee would encounter in everyday life. In these instances, the courts will generally use a balancing test to determine compensability. A review of case law has noted many examples where people are struck by a batted baseball, stray bullets or assisting in the rescue of unknown third parties become compensable injuries. Examples of these hazards people encounter inside and outside the workplace are numerous. The doctrine of “special hazards” can sometimes serve as the lynchpin for whether a claim is compensable. Common examples are eating food, drinking a non-alcoholic refreshment or situations involving necessary bodily functions.įREE DOWNLOAD: “Step-By-Step Process To Master Workers’ Comp In 90 Days” When the employee is furthering the interests of the employer or engaging in activities necessary for the human condition.If the injury occurs at a location that could be constructed as the employer’s workplace, or an area under their control or.The circumstances that generally lead to an injury being compensable are as follows: When determining issues of compensability for these types of injuries, courts will look at a number of factors. The possibilities for mischief are endless as they go out to eat, engage in the entertainment of clients and countless other activities not directly related to their work. They typically receive “portal-to-portal” coverage, which means they are covered from the minute they leave until they return. Traveling Employees: This type of employee should send fear down any claim handlers spine.Most jurisdictions also recognize injuries that take place when employees are smoking cigarettes. Examples of compensable injuries include taking breaks on company premise and even when the employee is walking to a nearby restaurant or convenience store. Unpaid Work/Rest Breaks: Just because an employee is not being paid, does not mean they are not covered under a workers’ compensation act.Injuries that occur during these times are generally compensable when they take place within a reasonable time before or after work in entryways/cloakrooms, bathrooms, parking lots and sidewalks on or near the company premises. Beginning/Completion of a Work-Shift: Generally, employees are covered under a workers’ compensation act from the time they arrive on company property until the time they leave.Here are some of the common situations that take place: There are an infinite number of possibilities when it comes to the ingress and egress of an employee.
“Step-By-Step Process To Master Workers’ Comp In 90 Days” Understanding Unique Scenarios The result is members of the claims team need to investigate these issues on their own merits and sometimes consult with an attorney before they accept or deny primary liability. It is important to remember that claims involving these matters are fact specific. The result of this was an acknowledgement that employer’s obligations under a workers’ compensation act sometimes start even before the workday begins. When dealing with these questions of whether a personal injury is “work-related” courts early on recognized that employees need to first enter the workplace on time in order to perform the necessary functions of their work duties. The Origins of Ingress/Egress Compensability This is a challenge the claims management team must master in order to be effective. One such issue involves the “ingress and egress” of employees as they enter and leave the workplace. While it may seem very basic, the reality is there are many gray areas that lurk beneath the surface. Did the personal injury arise out of and occur in the course and scope of employment? Questions concerning compensability under any workers’ compensation act starts with a simple question.
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