What Is A Compensable Injury?

A compensable injury is an injury that happens on the job. In order for an injury on the job to be compensable, it has to arise out of and be in the course and scope of employment. The “course and scope” of employment essentially deals with the time, place, and circumstances of the worker’s injury. “Arising out of” generally deals with the connection between the employment and the injury. To further explain, “arising out of” means that the work-related functions that caused the injury have to be sufficiently related to the job duties to be considered part of the employee’s service to the employer.

For instance, a pizza delivery driver who goes up to a person’s front door and slips and falls on the way up to the front door with the pizza has an injury that arises while working. That injury arose out of the work because walking to the front door was part of that person’s work duties. To fulfill his or her work duty, the pizza delivery driver had to go to the front door, and it was on the way to the front door that he or she was injured. The pizza delivery driver was clearly at work. He or she was clearly doing something work-related that was benefiting the employer.

Simply because somebody has a medical event happen while they’re at work doesn’t necessarily make it work-related. The easiest example is a heart attack. It’s very difficult for a heart attack to be found compensable because there are many other factors leading up to the heart attack. To reiterate, just because somebody happens to be on the job and have a heart attack, or a seizure or a stroke at that time doesn’t mean that the heart attack/seizure/stroke is in the course and scope of employment or arose out of the employment.

There can be unexplained accidents that are work-related and compensable. Because there isn’t a witness to an accident doesn’t mean that the injury is not compensable. There isn’t a requirement to have a witness, and simply because an individual doesn’t know exactly what happened doesn’t mean that the injury isn’t compensable. Head injuries are a good example because people that have closed head injuries often don’t remember what happened.

There’s a 2014 Colorado Supreme Court case that’s right on point. The case is City of Brighton v. Rodriguez. In the City of Brighton v. Rodriguez case, the worker, who worked for the City of Brighton, had gone to a different part of the building. As she was walking back to her office, she stood at the top of the stairs talking to a co-worker, the co-worker then walked away, and nobody knows what happened after that. Another co-worker found the claimant at the bottom of the stairs a little while later. The injured worker didn’t remember what happened. There was nothing wet on the floor that would indicate that the claimant had slipped. The Colorado Supreme Court determined that her fall would not have occurred if she hadn’t been walking to her office during the workday, which placed her on the stairs where she fell. That was a compensable claim.

The City of Brighton case sets out three different types of injuries. The first category is the easy one. There’s a direct link between the job duty and the person being injured. The second category that the City of Brighton identified is called “idiopathic injuries.” Idiopathic injuries are injuries or events that would not necessarily have happened at work. The second category refers more to the scenario of the heart attack. Just because something happened on the job doesn’t automatically mean that it is work-related. A stroke that happens at work does not mean the stroke was caused by the job duties. Another example of an idiopathic situation is one where a worker with long-standing knee (or shoulder, back, etc.) problems happens to have it give way while at work. The argument from the insurance carrier is that the knee could have buckled any time and the event is not tied to any specific work duty. A worker must tie the injury to work conditions or job duties as much as possible to avoid having an injury classified as “idiopathic.”

The last category identified in the City of Brighton case refers to a situation where the direct cause of an employee’s injury is not from a specific job duty (think of carrying the pizza up to the front door). The cause of the injury is because the job places the worker in a position where the injury occurs. Going back to the example, the City of Brighton employee was going down-stairs to her office when she fell and was hurt. We don’t know if she fell down the stairs and then hit her head, or if she passed out then fell down the stairs. Either way, the injury still arose out of work because “but for” being on those stairs, she wouldn’t have fallen to the bottom of them and been hurt. Essentially, as long as the job duties and the work contribute to the effects of the disabling condition, then the injury is considered compensable.

There is a line of cases on head injuries because the insurance companies, for a long time, defended those cases as not “work-related” due to the employee not being able to recollect what happened. Now, with the City of Brighton case, that defense is not effective. In another head injury case, a semi-truck driver was climbing up into the cab to grab his lunchbox. When he went to step down backward from the cab, he missed the bottom step, fell, and hit his head. As a result, he has no memory of the accident. It’s not necessary in a closed head injury case to have a video or witnesses to the accident. The City of Brighton case clarified and used the “But for” analysis. “But for” the worker climbing up to the cab of the truck, he would not have been injured.

For more information on Compensable Injuries in Workers’ Comp, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (303) 420-8080 today.