What Makes an Injury “Job Related”?
To qualify for workers’ compensation, an employee’s injury must be related to his job. But what exactly does that mean? The rule under California workers' compensation law is that the injury must “arise out of employment” (AOE) and occur “in the course of employment” (COE). Let’s consider each element separately.
- AOE — A doctor must provide direct evidence that the activities of work led to the injury. This may require the description of a single incident, such as a fall, that caused trauma to a worker’s back, head, hand, etc. The physician might also describe how repetitive stress from a work activity caused structural or functional damage, as in carpal tunnel syndrome. Perhaps exposure to toxins in the workplace produced an illness, or constant load noise brought about hearing loss. In most cases, the activity of work must create a specific risk of the injury the worker suffered.
- COE — Course of employment means more than “during employment” or “during the work shift.” COE refers specifically to tasks that are necessary for the performance of the job. This includes activities that are not in the workers’ job description but are integral to successful completion of work. Another way of looking at the question is whether the activity confers a benefit to the employer.
These rules effectively eliminate claims of injuries where the worker was behaving in a manner outside the scope of employment and contrary to the interests of the employer. For example, a worker who engages in horseplay and causes injury to himself is usually barred from collecting benefits, unless he can show that horseplay was somehow encouraged in his workplace.
California law defines certain injuries to certain workers as job related when they manifest during periods of active service. Other conditions are presumed to be job related. For example, classes of workers who are required to do lifting are presumed to be covered when they develop a hernia. The burden is on the insurer to prove a non-work event caused the injury.
If there is any question that your injury might not be work related, you should consult an experienced workers’ compensation attorney. A knowledgeable lawyer at the Tous Law Group can evaluate your case for free. Call 714-602-4473 or contact our Orange County office online to schedule a free consultation.