Present: Carrico, C.J., Compton,1 Lacy, Hassell, Keenan, 

Koontz, and Kinser, JJ. 

LAURA LEE COMBS 

v. Record No. 990534 OPINION BY JUSTICE CYNTHIA D. KINSER 

 March 3, 2000 

VIRGINIA ELECTRIC & POWER COMPANY, ET AL. 

FROM THE CIRCUIT COURT OF THE CITY OF RICHMOND 

Melvin R. Hughes, Jr., Judge 

 In this personal injury action, the sole question is 

whether the circuit court correctly ruled that an 

employee’s exclusive remedy against an employer is under 

the Virginia Workers’ Compensation Act (the Act), Code 

§§ 65.2-100 through -1310. Because we conclude that the 

employee suffered an “injury by accident arising out of and 

in the course of . . . employment,” Code § 65.2-101, we 

will affirm the circuit court’s judgment sustaining the 

employer’s special plea in bar. 

FACTS AND PROCEEDINGS 

 Virginia Electric and Power Company (Virginia Power) 

arranged for an independent instructor to teach an aerobics 

class at its Richmond office for the benefit of its 

employees. Participation in the class by Virginia Power’s 

employees was voluntary. Virginia Power advertised the 

 1

 Justice Compton participated in the hearing and 

decision of this case prior to the effective date of his 

retirement on February 2, 2000. 
class on its bulletin boards and in its newsletter. It did 

not charge for the use of its facility, but participating 

employees were required to pay a fee to the instructor for 

the class. 

The plaintiff, Laura Lee Combs, was an employee of 

Virginia Power. During her lunch hour on May 24, 1994, 

Combs participated in the aerobics class and, while doing 

so, developed a severe headache. The aerobics instructor 

assisted Combs in lying down and then called Virginia 

Power’s Employee Health Services (EHS), as she had been 

instructed to do by the EHS coordinator of health programs. 

The EHS receptionist answered the call and informed Sharon 

Robinson, EHS coordinator of administrative support, that 

someone in the aerobics class had a headache and needed 

some medication. Shortly thereafter, Robinson went to the 

aerobics room to determine what was happening with regard 

to Combs. When Combs’ head pain did not subside, she was 

taken to the EHS “quiet room” to rest. The “quiet room” is 

used by employees who become ill at work, or by 

recuperating employees who have returned to work after an 

accident or illness and need to rest during the workday. 

When an employee is using the room, an EHS staff member is 

required to be in the office, and the employee is to be 

checked at regular intervals. 

2
 After she went to the “quiet room,” Combs was not 

examined by any medical or emergency personnel, nor was her 

condition regularly monitored by anyone. Approximately two 

hours after Combs entered the “quiet room,” Robinson 

checked on Combs and discovered that Combs had vomited on 

herself and was in a coma-like state. Robinson then called 

security. Combs was eventually transported by ambulance to 

the Medical College of Virginia where she was diagnosed 

with intracranial bleeding, a right giant middle cerebral 

aneurysm, and an intraparenchymal hemorrhage. She 

subsequently underwent two neurological operations. After 

release from the hospital, she entered a rehabilitation 

center where she received therapy for her partial paralysis 

and cognitive brain damage. 

On April 30, 1996, Combs filed a motion for judgment 

against Virginia Power and four of its employees, alleging 

that the defendants owed her a duty to “have in place 

proper procedures, and to properly train . . . personnel, 

so that employees using EHS could do so without harm to 

themselves and detriment to their well-being.” Combs 

further asserted that the defendants breached these duties 

and were negligent by, inter alia, failing to properly 

train non-medical personnel working in EHS; failing to 

implement procedures to provide appropriate medical care to 

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Virginia Power employees who seek treatment at EHS, 

especially when licensed healthcare professionals are 

unavailable; and failing to provide proper medical care and 

treatment when Combs suffered a medical emergency, thereby 

leaving her unattended for approximately two hours before 

calling security and a rescue squad. Finally, Combs 

alleged that the defendants’ negligence proximately caused 

her injury and damages.2

 In response, the defendants filed grounds of defense 

and a “Special Plea of Workers’ Compensation Bar.” In the 

special plea, they asserted that the exclusivity provision 

of the Act, Code § 65.2-307, barred Combs’ claim and 

therefore deprived the circuit court of subject matter 

jurisdiction over her claim.3 Accordingly, the defendants 

asked the court to dismiss Combs’ action. 

After reviewing the parties’ memoranda, the circuit 

court sustained the special plea and dismissed Combs’ 

 2

 Combs also filed a claim with the Virginia Workers’ 

Compensation Commission on May 23, 1996. Virginia Power 

subsequently filed a report regarding the accident with the 

Commission. 

3

 Code § 65.2-307 provides that “[t]he rights and 

remedies herein granted to an employee when his employer 

and he have accepted the provisions of this title 

respectively to pay and accept compensation on account of 

injury or death by accident shall exclude all other rights 

and remedies of such employee . . . on account of such 

injury . . . .” 

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action with prejudice. In a letter opinion, the court 

concluded that the aggravation and acceleration of Combs’ 

pre-existing aneurysm was “an injury by accident arising 

out of and in the course of her employment with” Virginia 

Power, and that her action was therefore barred by the 

exclusivity provision of the Act. We awarded Combs this 

appeal. 

ANALYSIS 

“An injury is subject to the exclusivity provision of 

the Act if it is the result of an accident and arises out 

of and in the course of the employment.” Richmond 

Newspapers, Inc. v. Hazelwood, 249 Va. 369, 372, 457 S.E.2d 

56, 58 (1995). Thus, the critical inquiry in this appeal 

is whether Combs’ injury was (1) an injury by accident, (2) 

arising out of, (3) and in the course of, her employment. 

See Code § 65.2-101; Briley v. Farm Fresh, Inc., 240 Va. 

194, 197, 396 S.E.2d 835, 836 (1990). If any one of these 

elements is missing, then Combs’ claim is not covered by 

the Act, Snead v. Harbaugh, 241 Va. 524, 526, 404 S.E.2d 

53, 54 (1991), and she can proceed with her personal injury 

claim in the circuit court. Thus, we will address each of 

these criteria seriatim. 

I. INJURY BY ACCIDENT 

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This Court recently addressed the requirements of an 

“injury by accident” in Southern Express v. Green, 257 Va. 

181, 509 S.E.2d 836 (1999). There, we held that an “injury 

by accident” occurs when the injury appears “suddenly at a 

particular time and place[,] and upon a particular 

occasion[;]” when it is “caused by an identifiable incident 

[,]or sudden precipitating event[;]” and when the injury 

results “in an obvious mechanical or structural change in 

the human body.” Id. at 187, 509 S.E.2d at 839. The 

circuit court found all these factors present with regard 

to Combs’ injury, and we agree. 

At the outset, it must be emphasized that Combs’ 

injury is not the aneurysm itself. Instead, her injury is 

the aggravation, exacerbation, and/or acceleration of the 

aneurysm. That injury resulted from the alleged negligent 

emergency medical care, or lack thereof, that she received 

from Virginia Power and its EHS employees after she 

suffered a severe headache during the aerobics class. 

Thus, Combs’ argument that there is no evidence with regard 

to when the aneurysm initially started leaking or when she 

experienced the first onset of symptoms is irrelevant to 

the question whether she sustained an “injury by accident.” 

The record in this case, in particular Combs’ motion 

for judgment, demonstrates that she suffered an “injury by 

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accident” under Code § 65.2-101. The particular time, 

place, and occasion of her injury was at the EHS “quiet 

room” in Virginia Power’s Richmond office, during the two 

to three hours that elapsed from when she first developed 

the headache and was taken to the “quiet room” until she 

was transported to the hospital. The identifiable or 

precipitating event was the alleged negligent emergency 

medical treatment that she received during this span of 

time. Finally, Combs’ paralysis and cognitive brain damage 

represent the mechanical or structural changes in her body 

that resulted from her injury. Thus, all the requirements 

of an “injury by accident” are present in this case. See

Winn v. Geo. A. Hormel & Co., 560 N.W.2d 143, 149 (Neb. 

1997)(holding that negligent medical treatment at 

employer’s first-aid medical facility may constitute 

“accident”). 

II. ARISING OUT OF EMPLOYMENT 

The phrase “arising out of” pertains to the origin or 

cause of an injury. County of Chesterfield v. Johnson, 237 

Va. 180, 183, 376 S.E.2d 73, 74 (1989); Bradshaw v. 

Aronovitch, 170 Va. 329, 335, 196 S.E. 684, 686 (1938). In 

determining whether an injury arises out of employment, we 

have repeatedly quoted with approval the test enunciated in 

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In re Employers’ Liab. Assur. Corp., Ltd., 102 N.E. 697 

(Mass. 1913). An injury 

 arises “out of” the employment, when there is apparent 

to the rational mind upon consideration of all the 

circumstances, a causal connection between the 

conditions under which the work is required to be 

performed and the resulting injury. Under this test, 

if the injury can be seen to have followed as a 

natural incident of the work and to have been 

contemplated by a reasonable person familiar with the 

whole situation as a result of the exposure occasioned 

by the nature of the employment, then it arises “out 

of” the employment. But it excludes an injury which 

cannot fairly be traced to the employment as a 

contributing proximate cause and which comes from a 

hazard to which the workmen would have been equally 

exposed apart from the employment. The causative 

danger must be peculiar to the work and not common to 

the neighborhood. It must be incidental to the 

character of the business and not independent of the 

relation of master and servant. It need not have been 

foreseen or expected, but after the event it must 

appear to have had its origin in a risk connected with 

the employment, and to have flowed from that source as 

a rational consequence. 

Id. at 697; accord Lucas v. Lucas, 212 Va. 561, 563, 186 

S.E.2d 63, 64 (1972); Conner v. Bragg, 203 Va. 204, 208-09, 

123 S.E.2d 393, 396-97 (1962); Bradshaw, 170 Va. at 335, 

196 S.E. at 686. 

In Virginia, we apply an “actual risk test,” meaning 

that the employment must expose the employee to the 

particular danger causing the injury, notwithstanding the 

public’s exposure generally to similar risks. Lucas, 212 

Va. at 563, 186 S.E.2d at 64. Thus, if there is a causal 

connection between Combs’ injury and the conditions of her 

8
employment, then her injury arose out of her employment. 

See United Parcel Serv. of Am. v. Fetterman, 230 Va. 257, 

258, 336 S.E.2d 892, 893 (1985) (“An accident arises out of 

the employment when there is a causal connection between 

the claimant’s injury and the conditions under which the 

employer requires the work to be performed.”). 

Combs argues that EHS was not actually a clinic for 

the treatment of employee health problems and that, 

therefore, it was not a condition of her employment. Thus, 

she contends that her injury did not “arise out of” her 

employment. Assuming that Combs is correct about the 

purpose of EHS, the fact remains that on the day in 

question, the risk of employment was the alleged negligent 

emergency medical treatment by EHS personnel, which 

aggravated her pre-existing aneurysm. Combs was exposed to 

this risk or condition of employment solely because she was 

a Virginia Power employee. The public generally would not 

have been exposed to the same risk because only Virginia 

Power employees could utilize EHS. In fact, Combs alleged 

in her motion for judgment that Virginia Power and its 

employees owed certain duties to her “so that employees 

using EHS could do so without harm to themselves and 

detriment to their well-being,” and that the defendants 

violated those duties, thereby causing injury to her. She 

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further asserted that the employee defendants were acting 

within the scope of their employment when they allegedly 

injured her. 

 Combs, nevertheless, argues that her situation is like 

that of the employee in Taylor v. Mobil Corp., 248 Va. 101, 

444 S.E.2d 705 (1994), because she did not involuntarily, 

or out of “default[]” as the circuit court found, seek 

medical treatment at EHS. In Taylor, an employee visited a 

doctor at his employer’s clinic for treatment of a heart 

condition. The employee ultimately suffered a fatal heart 

attack at home although the doctor had advised him that he 

was not suffering from heart disease. Id. at 103-04, 444 

S.E.2d at 706-07. This Court concluded that the employee’s 

risk of exposure to negligent treatment by the doctor was 

not an actual risk of employment because the employee 

voluntarily opted to use the doctor at the employer’s 

clinic. He was not required to do so by his employer, nor 

was he treated by that doctor because he became ill at 

work. Id. at 107, 444 S.E.2d at 708. 

In contrast, Combs suffered her severe headache while 

participating in the aerobics class at Virginia Power’s 

office. While taking part in that class was not required 

by Virginia Power, EHS personnel treated Combs because of 

her status as a Virginia Power employee. In fact, the 

10
aerobics instructor called EHS when Combs became ill 

because Virginia Power’s EHS coordinator had directed the 

instructor to do so. Thus, the risk that led to Combs’ 

injury was part of her work environment. See Briley, 240 

Va. at 198, 396 S.E.2d at 837. 

Additionally, the fact that her injury was the 

aggravation of a pre-existing condition does not alter the 

result that her injury arose out of her employment. See

Ohio Valley Const. Co. v. Jackson, 230 Va. 56, 58, 223 

S.E.2d 554, 555 (1985) (“When an injury sustained in an 

industrial accident accelerates or aggravates a preexisting condition, death or disability resulting therefrom 

is compensable under the Workers’ Compensation Act.”). 

Combs’ pre-existing aneurysm united with an actual risk of 

her employment to produce her injury. 

III. IN THE COURSE OF EMPLOYMENT 

 “The phrase arising ‘in the course of’ [employment] 

refers to the time, place, and circumstances under which 

the accident occurred.” Johnson, 237 Va. at 183, 376 

S.E.2d at 74. “An accident occurs ‘in the course of the 

employment’ when it takes place within the period of the 

employment, at a place where the employee may reasonably 

be, and while he is reasonably fulfilling duties of his 

employment or engaged in doing something incidental 

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thereto.” Bradshaw, 170 Va. at 335, 196 S.E. at 686; 

accord Lucas, 212 Va. at 563, 186 S.E.2d at 64; Conner, 203 

Va. at 208, 123 S.E.2d at 396. 

 Combs argues she was not performing any duty of her 

employment at the moment when she initially needed 

emergency medical treatment. As she correctly notes, the 

pre-existing aneurysm was not caused by her employment, and 

she was participating in an aerobics class during her lunch 

hour when she first experienced the headache. Thus, she 

contends that “the reason she ended up at EHS was not in 

any way connected with her employment[,]” and, therefore, 

that her injury did not occur during the course of her 

employment. We do not agree. 

 Combs’ position on this issue overlooks several 

salient facts. First, Combs is not seeking redress for the 

onset of the symptoms associated with the aneurysm but for 

the aggravation of that pre-existing condition. The 

aggravation of the aneurysm occurred after EHS personnel 

responded to the call for assistance from the aerobics 

instructor, during Combs’ period of employment, and at a 

place where she could reasonably be if she became ill at 

work, i.e., the “quiet room.” The only reason that EHS 

responded to that call was because Combs was a Virginia 

Power employee. Thus, Combs “was injured at a place where 

12
she was reasonably expected to be while engaged in an 

activity reasonably incidental to her employment” by 

Virginia Power. Briley, 240 Va. at 198, 396 S.E.2d at 837. 

Her injury therefore occurred “in the course of” her 

employment. 

CONCLUSION 

 For these reasons, we conclude that Combs’ injury was 

an “injury by accident arising out of and in the course of 

[her] employment” with Virginia Power, Code § 65.2-101, and 

is therefore compensable under the Act. Her action in the 

circuit court is thus barred by Code § 65.2-307. 

Accordingly, we will affirm the judgment of the circuit 

court. 

Affirmed. 

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