Is Every On-The-Job Injury Covered by Work Comp?

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Generally speaking, an employee will be provided with benefits under Missouri’s Worker’s Compensation Laws if the injury, death, or work-related illness occurs while the employee is working. The Law refers to this as occurring in the "course and scope of employment." The employer will be responsible for providing medical treatment and benefits so long as the injury and its effects are caused by a work-related accident. These two issues can be extremely contested in work comp cases and may well provide the tipping point in settling a claim or having to go before a judge.

The scope or course and scope of employment is a legal term of art. In Bivens v. St. John’s Regional Health Center, the court noted that an injury that occurs during the general nature of employment is within the term’s meaning. Essentially, the test is whether the injury was brought on during a work task: something that the employer expects to derive a benefit from or does derive a benefit from. Additionally, actions that an employer encouraged or had knowledge of, even if the actions were technically outside the scope of the employee’s employment because they didn’t benefit the employer, may be covered by the laws. 

The Law is crafted and interpreted in a way that reflects really life, though. This means that even actions that are not directly within the above definition can be covered by work comp. These include entering and leaving a place of employment, such as walking from the parking lot into the building. Attending social events, like a work barbeque or recreational events, like a company softball game, are also covered. Activities done by the employee for his or her own “personal comfort” also fall under the Law. These include eating lunch or taking a water break at a construction site. Additionally, an employee may be covered even if they are injured while doing actions that are actually detrimental to the employer, such as horseplay. In Peet v. Garner Oil Company, the Missouri Court of Appeals determined that even if an employer has warned an employee against horseplay, benefits are still available if the employee is injured during such horseplay. The Law also covers horseplay gone too far: if a coworker assaults or attacks another, the victim can seek work comp benefits for those injuries.

It is also worth noting what constitutes an “accident” under the Law. Almost all work comp injuries result from an accident, which is an unexpected trauma or an unusual strain on the employee. The accident must be unforeseen and must cause trauma. In the case of an unusual strain, the strain must be out of the ordinary for the employee. Common accidents include slipping, splashing, herniation, and inhalation of gas or smoke.

The accident an employee suffers must be the “prevailing factor” of an injury and any symptoms. This means that, although there can be other factors which led to the injury, the accident itself is the foremost cause. There must be a clear link between the accident, the injury, and the symptoms. Even if the injury results from a series of events, the employee will be awarded benefits if the occurred in rapid succession and were uninterrupted. 

An occupational disease differs from most injuries because it is developed over time, rather than occurring immediately after an accident. An occupational disease and its symptoms are covered by the Law if exposure to the disease occurs at work. The exposure must be a greater rate than the general public and there must be a recognized link between the disease and the employee’s job. An example of an occupational disease would be carpal tunnel syndrome for a typist: repetitive motion is the exposure, and though anyone can develop carpel tunnel, a typist is at greater risk than the general public and this connection is recognized. Further, it must be established that the employee was exposed to the disease as a natural result of the employee’s job. If the employee was exposed to the disease in an unusual way, the employer will not be liable under the laws. Finally, occupational diseases may develop over the course of multiple employment with multiple employers. The last employer where the employee was exposed to the disease is responsible for the injury. This is true even if the employee worked for the last employer only a handful of days; it is simply a judgment call made by the General Assembly to simplify this complex type of injury.

When dealing with occupational diseases, the prevailing factor rule still applies. Similar to injuries caused by accidents, the employee’s exposure to the disease through his employment must be the prevailing factor with the disease. Although there can be other factors leading to the disease, the employee’s exposure at work must be the primary cause of the disease. Returning to our typist suffering from carpel tunnel, the typist may have difficulty showing the carpel tunnel developed primarily from being a typist if the employee also is an avid piano player. A doctor would have to determine which activity was the primary cause and thus, prevailing factor, of the injury.

Most injuries that occur on an employer’s premise or during work hours will be covered by work comp. However, knowing whether a particular injury is covered can be a difficult legal question. A specialized knowledge of Missouri’s Workers’ Compensation Law is essential to understand when an injury is compensable and when it is not. Even more difficult is the issue of proving an injury and its symptoms are caused primarily by a covered work-related injury. Experience and knowledge of the ins and outs of work comp is important to ensure full redress for a work-related injury is achieved.