My distinguished colleague, Diana Reitz, recently wrote a blog pertaining to coverage for a Workers' Compensation claim by a worker who was injured while on a meal break. Diana noted several court cases that dealt with injuries to workers while they were on lunch break and came to the conclusion that, depending on the particular state jurisdiction, such injuries would be covered by Workers' Comp.
As a rule, in order for Workers' Comp benefits to apply, injury to an employee must “arise out of and in the course of employment.” So, what does this phrase mean? Since neither the various state laws nor the standard Workers' Comp policy define the phrase, the courts have taken on the task of clarifying the meaning.
Courts have decided that the words “arise out of” refer to the causal relationship between the employment and the injury. Professor Arthur Larson, in his work “The Law of Workmen's Compensation,” opines that the phrase refers to the time and space limitations of the claimant's employment and a causality nexus between the injury and the employment responsibilities and duties. In other words, an accident arises out of employment when it occurs while the employee is engaged in some activity or duty that he or she is authorized to undertake and that is calculated to further the employer's business. The term “in the course of employment” has been found to refer to the time, place and circumstances under which the accident or injury occurred. So, as a general rule, for an injury or death to occur in the course of employment, it must occur within the period of employment, at a place or area where the employee may reasonably be expected to be, and while the employee is performing his or her work duties or engaged in an activity at least incidental to his or her employment.
Considering this information, can it be said that a worker who is injured while on a lunch break or who is injured while participating in a company party or a company-sponsored sporting event is eligible for Workers' Comp benefits? Unfortunately, we have to fall back on the tired old maxim: it depends on the facts of the incident. Courts will review the facts surrounding the injury and decide on a case-by-case basis if the injury is a result of the employment.
Incidentally, Diana did note in her blog that, when it comes to such things as lunch breaks, courts consider the personal-comfort doctrine. This doctrine could be applied to lunch breaks, trips to the restroom and even visiting a co-worker under certain circumstances. The Wisconsin Supreme Court in Sauerwein v. Department of Industry and Human Relations, 262 N.W.2d 126 (1978), described the doctrine and its relationship to Workers' Comp coverage thusly: Employees who engage in acts that minister to personal comfort do not thereby leave the course of employment, unless the departure is so great that an intent to abandon the job temporarily may be inferred, or unless the method chosen is so unusual and unreasonable that the conduct cannot be considered as incident of the employment. In other words, eating lunch or getting up to get a drink or going to the bathroom can be considered as activities in the course of employment if they are reasonable and not inconsistent with the employment objectives.
Want to continue reading?
Become a Free PropertyCasualty360 Digital Reader
Your access to unlimited PropertyCasualty360 content isn’t changing.
Once you are an ALM digital member, you’ll receive:
- Breaking insurance news and analysis, on-site and via our newsletters and custom alerts
- Weekly Insurance Speak podcast featuring exclusive interviews with industry leaders
- Educational webcasts, white papers, and ebooks from industry thought leaders
- Critical converage of the employee benefits and financial advisory markets on our other ALM sites, BenefitsPRO and ThinkAdvisor
Already have an account? Sign In Now
© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
