When does an injury arise out of and in the course of employment?
- What if you suffer a heart attack due to stress on the job? Are you compensable under workers compensation?
- What does the employee receive in workers's compensation benefits?
- What if an employee suffers a permanent disability?
- Are there time limits and notice requirements on filing worker compensation claims?
- Can an employer fire an employee for filing a workers' compensation claim?
An injury arises out of the employment relationship if the cause of the injury is casually related (arose out of) the workplace environment. The injury occurs "in the course of" employment when it occurred during the performance of work-related duties. In many instances, it is clear that an injury is work-related enough to be covered by workers compensation. For example, if you fall and injure your leg at work that injury arose out of the employment relationship and constitutes a compensable injury.
However, let's say that you are at work and suddenly have a lot of back pain. Is the back pain caused by your job or is the back pain caused by activities you have done outside of the work environment, such as helping a friend move furniture to new lodgings?
What if you suffer a heart attack due to stress on the job? Are you compensable under workers compensation?
It depends. In some jurisdictions the question would be whether the heart attack was brought about by physical exertion or strain on the job as opposed to one brought about from mental stress or an emotional issue. If the heart attack is brought on by undue physical exertion on job, that would be compensable. If the heart attack was brought on by mental stress, the question would be whether there was an abnormal or unusual event at work that brought on the heart attack.
For example, one Tennessee court determined that there was a compensable injury under workers' compensation for the family of a security guard who suffered a
Workers can receive compensation for a work-related injury even if the employer was not negligent in the incident (iStock).
heart attack and died on his job shortly after confronting several would-be shoplifters who threatened him. The court reasoned that the injury arose out of the employment relationship because the heart attack was precipitated by the unusually volatile confrontation between the security guard and the would-be shoplifters.
What does the employee receive in workers's compensation benefits?
Normally, the employee receives medical coverage for the work-related injury and the employee receives a portion of his or her wages while the employee recovers and cannot work. Generally the employee receives a portion of their average weekly wage for a
LegalSpeak: Cunningham v. Shelton Security Service (Tenn. 2001)
The rule is different, however, when the heart attack is caused by a mental or emotional stimulus rather than physical exertion or strain. In such cases, "it is obvious that in order to recover when there is no physical exertion, but there is emotional stress, worry, shock, or tension, the heart attack must be immediately precipitated by a specific acute or sudden stressful event rather than generalized employment conditions." Thus, if the heart attack is caused by a mental or emotional stimulus rather than physical exertion or strain, there must be a "climactic event or series of incidents of an unusual or abnormal nature" if a recovery is to be permitted. Id. Although "excessive and unexpected mental anxiety, stress, tension or worry attributable to the employment can cause injury sufficient to justify an award of benefits," the ordinary stress of one's occupation does not because "emotional stress, to some degree, accompanies the performance of any contract of employment." In other words, "normal ups and downs are part of any employment relationship, and as we have said on many previous occasions, do not justify finding an 'accidental injury' for purposes of worker[s'] compensation law." Accordingly, the rule is settled in this jurisdiction that physical or mental injuries caused by worry, anxiety, or emotional stress of a general nature or ordinary stress associated with the worker's occupation are not compensable. The injury must have resulted from an incident of abnormal and unusual stressful proportions, rather than the day-to-day mental stresses and tensions which workers in that field are occasionally subjected.
With these principles in mind, we review the record in the present case to determine whether the employee's death arose out of his employment. We note first that there was no physical exertion or strain involved in precipitating his heart failure. Instead, the mental stress or tension associated with confronting the suspected shoplifters caused the heart failure, at least according to some of the medical proof. Applying the law as just described, the trial court concluded the employee's death was not compensable because he was not confronted with circumstances of an unusual or abnormal nature given his work as a security guard. As the record reflects, verbal confrontations occurred at least once a week at the store, and it was common for the employee to "go out and yell at these people." However, the record also reflects that the individuals chased off by the employee threatened to return and kill him. We believe that this additional circumstance makes a difference and is sufficient to warrant the conclusion that the employee's death did not result from generalized employment conditions, but from something beyond the norm, even for a security guard. Accordingly, we find that the evidence preponderates against the trial court's finding that the employee's death did not arise out of his employment.
The reason, simply put, is that the employee has met the burden of establishing that his heart failure was caused by a mental or emotional stimulus of an unusual or abnormal nature, beyond what is typically encountered by one in the employee's position. We thus reiterate the rule again in this case that if the cause or stimulus of the heart attack is mental or emotional in nature, such as stress, fright, tension, shock, anxiety, or worry, there must be a specific, climatic event or series of incidents of an unusual or abnormal nature if the claimant is to be permitted a recovery, but no recovery is permitted for the ordinary mental stresses and tensions of one's occupation because "emotional stress, to some degree, accompanies the performance of any contract of employment." If the rule were otherwise, workers' compensation coverage would become as broad as general health and accident insurance, which it is not.
We conclude that the evidence preponderates against the trial court's finding that the employee's death did not arise out of his employment. Accordingly, we agree with the Panel that the trial court erred in dismissing the case and that the case must be remanded for further proceedings.
period of time. In most states the employee receives 66 percent, or two-thirds, of their average weekly wage during the pendency of their time away from work recovering from the compensable injury. Keep in mind that worker compensation laws vary considerably from state to state.
What if an employee suffers a permanent disability?
If an employee suffers a permanent disability from a work-related illness the employee generally will receive a lump sum payment that is designed to give at least some redress to the employee not only for the present but also for future expenses. Often it is very important to have an attorney to negotiate the best settlement possible in such a situation.
Are there time limits and notice requirements on filing worker compensation claims?
Yes, there are both time limits and notice requirements for those employees who have suffered a compensable injury. The employee must give notice to the employer and then must file the workers compensation claim within 30 days in most states.
Can an employer fire an employee for filing a workers' compensation claim?
They can but that would be unlawful. Most state high courts have explained that if an employer fires an employee for filing a worker compensation claim, then the employee can file a tort claim for retaliatory discharge. There have been many court decisions providing that employees can recover punitive damages (see chapter on Personal Injury Law) if their employer fired them for filing a legitimate workers compensation claim.