Source: https://www.shouselaw.com/workerscomp/aoe-coe
Timestamp: 2019-04-23 16:59:38+00:00

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AOE / COE - When do workplace injuries fall under workers comp?
California workers compensation benefits only apply to injuries that "arise out of employment" and occur during the "course of employment", referred to as AOE / COE.
In demonstrating AOE / COE, an employee can validly claim an injury for nearly any accident that occurs at work. An injured worker does not have to prove the employer did anything wrong. Within certain limitations, the employer cannot blame the injury on the employee to avoid a workers' compensation claim.
In the above situations, the injured worker is not performing job duties related to his or her employment, or has caused his or her own injury through intentional actions.
1. How does an employee prove a work injury?
3. When does a work day start and stop?
The California workers' compensation system is a no-fault system, meaning an injured worker does not have to show the employer is at fault, or negligent, to claim an industrial injury.
The standard is lower than personal injury or employment law civil litigation, where the injured party must show negligence on the part of the other party.
As part of the workers' compensation no-fault system, the employer cannot claim that the employee was at fault to defend and avoid offering benefits for a work injury.
Example: Julie is walking from her office to a conference room. She trips and falls and breaks her arm.
Julie does not have to prove that her injury was due to her employer's failure to maintain the floor in good condition.
Julie can simply claim an injury because it occurred at work.
Example: James is a machinist. He forgets to set a safety feature and injures his left arm.
Even though he forgot to set the safety feature, James still has a valid work injury. He was injured while doing his expected work.
He does not have to prove the employer did anything wrong. And the employer cannot claim that the injury was James fault to deny the claim.
Example: Matt is a laborer for a farming company. While working in a field, he is shot in the arm by someone in a passing car.
Even though the employer had nothing to do with the injury and the injury had nothing to do with Matt's work, he can claim a work injury because his work placed him in the situation where he was shot in the arm.
Example: Janet is an office manager. While at work, she has a seizure, falls, and hits her head on the side of a table.
The seizure was caused by a condition unrelated to work, but it is a valid work injury. Janet was at work when the seizure occurred, and she was injured.
The California workers' compensation laws refer to injuries at work as “arising out of and in the course of employment.”6 This is abbreviated at AOE/COE.
Although there is a distinction between AOE and COE, the two phrases are used together.
An injured worker's deposition will address injury AOE/COE. There may also be a status conference or mandatory settlement conference to address whether an injury occurred. Sometimes the specific issue of injury is an issue at the workers compensation trial.
Intoxication must be the main cause of the alleged work injury to deny the claim.
Example: Jose is a forklift driver. While driving the forklift, he hits a metal post, falls out of the forklift, and sprains his ankle. It turns out Jose was intoxicated at the time of the injury.
If Jose files a claim for a work injury, the employer will defend the claim by saying the injury was caused by Jose's intoxication.
The injury was not caused by Jose's regular work as a forklift operator, but by Jose's intoxication.
An intentional injury requires proof that the injured worker has a deliberate intent to injure himself or herself.16 An employee can do an act intentionally but if he or she was not trying to cause an injury, the employer does not have a defense.
Example: Patrick is a police officer and gets into an argument with his superior. During the argument Patrick hits his fist against a wall and injures his hand.
The suicide does not have occur at work to be considered a work injury.
Example: Jim works in a sales office. He is overwhelmed with work and is not meeting his quota. He has difficulty sleeping and is very depressed.
One morning Jim does not come into work and is later found dead in his car from a self-inflicted gunshot wound.
Jim's wife files a workers' compensation death claim. Jim's suicide can be considered a work injury if the suicide was related to Jim's stress and depression related to work.
If there is an altercation at work, there must be an exchange between two or more persons in an atmosphere of animosity with a willingness to inflict bodily harm.20 Insults and obscenities do not count as initial aggressor action.21 The initial aggressor is the one who commits the first physical act.
Example: Steve gets into an argument with a coworker. The other worker insults Steve. Steve punches the other worker and after a scuffle, Steve injures his neck.
Because Steve is the initial aggressor, he does not have a valid work injury.
If a worker is injured while committing a felony at work, he or she cannot claim a work injury.
A worker must be convicted of a felony to be denied workers' compensation benefits. 22 If there is no felony conviction, the employer cannot defend the claim on this issue.
Example: Janet is a manager for a mining company. She instructs an employee to use dynamite without following proper safety procedures. The employee is killed. Janet failed to follow safety procedure and it resulted in her employee's death, so she was convicted of involuntary manslaughter.
Janet claims a psychiatric injury due to the incident. Because she was convicted of manslaughter, which is a felony, she cannot claim an injury.
Employers often have events for their employees outside of work to build relationships or for purely social reasons. Events might include picnics, sports leagues, or parties.
If the event is strictly voluntary and the employee is injured at the event, he or she may not be able to claim a work injury. However, if the employer expects all employees to attend, there can be a work injury.
Because of the employer's expectation of attendance, the event becomes part of the employee's job duties.
Example: Susie is at a company bowling event. All employees are encouraged to attend the event.
While bowling, Susie injures her shoulder. The injury is a work injury even though it is recreational because all employees were expected and encouraged to attend.
Example: Gabe is a warehouse worker. During a slow period, Gabe and another employee throw a football around the warehouse. While doing this, Gabe trips and breaks his ankle.
Because Gabe was engaged in horseplay, he may not have a valid workers' compensation claim.
Example: Jonathan is working in a warehouse. Another employee is running to catch a football and knocks Jonathan over.
The other employee is engaged in horseplay, but since Jonathan is not, he has a valid work injury.
An employee cannot obtain workers' compensation benefits while going and coming from work.
From an employee perspective, a work day may start with the commute to work and end when he or she gets home at the end of the day. However, California workers' compensation laws generally do not consider commuting to be part of work nor is any time when an employee clocks out during a workday.
Example: Joan is involved in a motor vehicle accident while driving to work. Joan is in her own vehicle and is driving to her regular office.
Example: Roger trips and falls while walking from his house to his work vehicle. Roger files a workers' compensation claim.
Example: Eric is a plumber. He drives between jobs. Eric is injured in a motor vehicle accident while driving to and from one job site to another. Eric has a valid workers' compensation claim.
Example: Jessica is driving from her regular office to another company office. She is involved in a motor vehicle accident.
Because Jessica is not commuting but going between offices, she is considered to be engaged in employment and can claim a work injury.
Example: Jim, an off-duty police officer, is involved in a motor vehicle accident. Even though he is off duty, he is carrying a gun and wearing a uniform and is expected to respond to a situation if necessary.
If an employee is not paid during his or her lunch break, an injury during that time is not a work injury.30 The employee is not technically at work.
Example: Amy clocks out and drives to lunch. While driving back to work, she is involved in a motor vehicle accident.
Amy's injury is not a work injury because she is not being paid while at lunch.
An employee placed in situations by his or her employer can claim an injury, because if not for the employer request, the injury would not have happened.
Example: Jackie is asked to stop at a copy shop by her employer to pick up some flyers before coming into work. She is involved in a motor vehicle accident.
Jackie has suffered a work injury because she is performing a special mission for the employer.
If an employee lives on an employer's premises, any injury during that time is a work injury.33 The employee is living at the location at the request of the employer.
Example: Joe is an oil worker and lives in an employer-owned apartment. He is off duty but suffers a slip and fall in the apartment.
Even though Joe is not on duty, he has a work injury because he was living at that location for the benefit of the employer.
Any worker who has an injury that is remotely tied to work should consider filing a claim for workers' compensation benefits.
If a work injury is found, the employee is entitled to medical treatment, temporary disability, and permanent disability. These benefits can help injured workers obtain needed medical treatment and provide financial support during recovery.
For help with filing a workers compensation claim in Calfornia, completing workers comp forms or appealing a denial of benefits, contact us at (855) LAW-FIRM. Our firm helps police officers, firefighters and other workers to get compensation for their job-related injuries.
Alice Azevedo v. WCAB (1966) 31 Cal. Comp. Cases 223.
Westbrooks v. Workers' Comp. Appeals Bd., 203 Cal. App. 3d 249, 252.
Alander v. Vacavalley Hosp., 49 Cal. App. 4th 1298, 1303.
Truck Insurance Exchange v. Industrial Accident Commission (1957) 22 Cal. Comp. Cases 15.
Cal. Lab. Code § 3600(a).
Cal. Lab. Code § 3600(a)(4).
Cal. Lab. Code § 3600(a)(5).
Cal. Lab. Code § 3600(a)(6).
Cal. Lab. Code § 3600(a)(7).
Cal. Lab. Code § 3600(a)(8).
Cal. Lab. Code § 3600(a)(9).
Powell v. Jones, 133 Cal. App. 2d 601.
Smith v. Workers' Comp. Appeals Bd. (1981)123 Cal. App. 3d 763, 770.
Jessie Mathews v. WCAB (972) 37 Cal. Comp. Cases 124, 127.
Mathews v. Workmen's Comp. Appeals Bd. (1972) 6 Cal. 3d 719.
Hillary Schwartz v. Ease Entertainment, 2016 Cal. Wrk. Comp. P.D. LEXIS 106.
Hodges v. Workers' Comp. Appeals Bd., 82 Cal. App. 3d 894, 899.
Pacific Employers Insurance Company v. Industrial Accident Commission (1945) 10 Cal. Comp. Cases 89.
Sheila LaTourette v. WCAB (1998) 63 Cal. Comp. Cases 253.
Garzoli v. Workers' Comp. Appeals Bd. (1970) 2 Cal. 3d 502.
Mission Ins. Co. v. Workers' Comp. Appeals Bd. (1978) 84 Cal. App. 3d 50.
Safeway Stores, Inc. v. Workers' Comp. Appeals Bd., 104 Cal. App. 3d 528, 535.
Irene Aubin v. Kaiser Steel (1960) 25 Cal. Comp. Cases 217.
Cal. Lab. Code § 3202.

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