Under normal circumstances, if you’re injured at work, workers’ compensation insurance will cover your medical bills, medications, transportation costs, and other reasonable out-of-pocket expenses. It should also cover about two-thirds of your lost wages. You may even get a lump sum settlement if you become disabled. In case of death, the benefits go to your surviving dependents.
When Employer Liabilty Begins and Ends
To be eligible for workers’ comp insurance benefits, a worker must be injured while “within the scope of their employment,” also referred to as “on the job,” or “on the clock.” So what does this include?
Defining the beginning and end of the work day is crucial in a workers’ comp claim. On-the-job activity can overlap with personal activities, making the lines hard to determine. Questions of liability are often raised when injuries occur during the commute to or from work, in parking lots, or at non-scheduled work activities.
Most states follow the “while in the course of employment” rule. The rule basically states that regardless of an employee’s physical location or the time of day she’s injured, if performing assigned job duties, the injury is considered a work place accident and is covered by workers’ compensation. While this rule seems clear, it remains the subject of thousands of legal disputes each year.
What’s Not Covered
Most states exclude injuries when a worker is traveling between home and work. This is often referred to as the “going or coming” rule, or as the U.S. Department of Labor calls it, the “portal to portal” rule. Under the portal to portal rule, workers’ comp coverage doesn’t begin until the employee arrives at his workplace. It ends when the he leaves at the end of his work day; but there are numerous exceptions.
Exceptions to the Portal to Portal Rule
1. Benefit to the Employer
A worker may be covered if he is injured commuting to or from work, when he is required to be away from his workplace or home to perform work duties that directly benefit his employer.
Example: Car Accident After Client Dinner
Adrian is a salesperson for a national corporation. Her primary job entails traveling to various states in her region to support customer relations. She usually flies into each city, checks into a hotel, and rents a car to travel back and forth to customers’ businesses.
One evening after dining with a client, Adrian was driving back to her hotel when a car ran a red light and crashed into her rental car. She was seriously injured in the accident. Although Adrian was commuting back and forth to her temporary home, she was covered by workers’ compensation. She was injured while performing duties that directly benefited her employer.
There is an exception to this exception. If Adrian had been arrested and convicted of driving while intoxicated, she would not be covered. Workers’ compensation does not extend to workers who are injured while committing a crime, and a conviction for DUI is a crime. In most cases this would be true whether the employee’s impaired state contributed to the accident or not.
2. Special Missions
A worker may be covered if he is injured commuting to or from work, when he interrupts his normal route to conduct a work task or special mission required by his employer.
Example: Slip and Fall While Running an Errand
Jodi works at a law firm. Her normal lunch hour is from noon to 1:00 p.m. Her employer asked if she would stop by the court house on her way back from lunch to file some legal documents with the court clerk. Jodi agreed. She stopped at the courthouse at 12:45 p.m. on her way back from lunch. While walking up the courthouse steps, Jodi slipped and fell, breaking her arm.
Even though Jodi was on her lunch hour, the detour to the court house was a “special mission” for her employer. From the moment Jodi pointed her car to the courthouse, through the time she returned to the law firm’s offices, she was within the scope of her employment. Jodi’s injury on the courthouse steps is considered to be a work place accident and is therefore covered by workers’ compensation.
3. Sidewalks and Parking Lots
In most cases, workers’ compensation coverage begins when an employee starts his workday by stepping onto his employer’s premises or an area controlled by his employer. It ends when a worker steps off his employer’s premises or an area controlled by his employer.
The term “controlled by” refers to property an employer either owns outright, pays a mortgage on, pays property taxes on, pays a third party (like landscapers) to maintain, or is designated as a common area for which the employer contributes rent along with other tenants.
An area controlled by an employer is considered an extension of the worker’s actual workplace. Examples of areas controlled by employers include sidewalks, grassy areas, parking lots, and any other property a worker traverses on his way to and from his actual workplace.
Example: Hit in a Parking Lot
Charlie is a cashier in a large grocery store. Management requires employees to park their cars at the rear of the parking lot so shoppers can use the main area in front of the store. One evening, as he crossed the store’s lot to leave work, Charlie was struck by a car backing out of its parking space. He was seriously injured.
Even though Charlie had punched out and left the grocery store, he’s covered by workers’ comp because the parking lot is under his employer’s control. His employer knew that Charlie had to traverse the parking lot to get to his car, and it is an “extension” of the grocery store.
Charlie also has a valid third-party claim against the driver of the car. He can sue the negligent driver for his injuries and resulting damages, including pain and suffering. (Workers’ comp doesn’t cover pain and suffering.)
4. Outside of Regular Business Hours
When a worker’s duties include a responsibility that falls outside of regular business hours, and the worker is injured while performing that duty, workers compensation normally covers injuries sustained during that time.
Example: Car Crash While Speaking with a Patient
Raquel is a nurse who works for a doctor’s private medical practice. Her employer wants someone to always be available to his patients, so business calls are forwarded to Raquel’s cell phone after the office closes.
Raquel was driving home one evening when her cell phone rang. It was one of the doctor’s patients. As she began to speak with the patient, Raquel dropped the phone, which caused her to momentarily take her eyes off the road. She crashed and was seriously injured.
Even though Raquel was negligent, she was still discharging her work duties while in the scope of her employment. This qualifies as a work place accident and is covered by workers’ comp. The same principle extends to business professionals who talk with clients on their cell phones while driving to and from work (if speaking with clients is part of their work duties).
5. After-Hours Visits to the Workplace
One of the more controversial coverage issues involves employees who aren’t scheduled to work, but come to the workplace to visit with coworkers or for other personal matters. In most cases, employees who aren’t scheduled to work are not covered by workers’ compensation if injured on work premises.
On the other hand, if the employer is aware that unscheduled workers come to the workplace to visit with coworkers, and the employer tacitly consents to the visits by not objecting, workers’ comp may be forced to provide coverage when a non-scheduled employee is injured on the premises.
Example: Basketball During Lunch Break
Steven works at a warehouse and is friends with several coworkers. They are on a company-sponsored basketball team and play against other local businesses’ employee basketball teams. Most days the workers practice during their lunch break on a basketball court their employer set up in a corner of the warehouse.
Steven wasn’t scheduled to work one day, but he wanted to practice for an upcoming game. Steven’s employer knew non-scheduled workers would come in some days to practice. Steven came and was injured during the practice game.
Although it was lunch hour, the accident happened on a court provided for employee recreation during their break. The employer knew his employees frequently came to the workplace on their days off to practice, and he never objected. His failure to object to Steven’s off-hours presence effectively validates it as a work place accident and makes Steven eligible to receive workers’ compensation benefits.
Workers’ Comp Attorneys
Many employers and their workers’ comp insurance companies will deny legitimate claims. They’ll say an injury isn’t work related because it happened off the employer’s property, while the worker was on break, or because the worker wasn’t acting within the scope of his employment.
If your work injury claim is denied based on these issues, you may want to consider speaking with an attorney with experience in work place accident claims. This is especially true if your injury falls within one of the exceptions listed above. Most workers’ comp attorneys do not charge for initial office consultations. They only receive a fee if they succeed in winning you a settlement or a court award.
Auto Mechanic Injured While Not on Shift
Do workers comp benefits still apply if an employee is covering another worker’s shift? What about if the employee is volunteering their time? These are some of the legal issues addressed in this case study.
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Visitor Questions on Issues with Work Injury Claims
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