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Compensability can be tricky! Common Pitfalls Explained

December 07, 2015 BY Sarah Dumbacher

The issue of whether an accident that occurs in the workplace is compensable can be tricky. Often, compensability will hinge on just a few keys facts. Thus, to effectively and efficiently handle workers’ compensation claims, it is important to know the facts to look for that are critical to determining compensability under the Georgia Workers’ Compensation Act and common pitfalls to avoid. 
Generally speaking, an employee’s “accidental injury must arise out of and in the course of his or her employment” to be compensable. Stokes v. Coweta County Bd. of Educ., 313 Ga. App. 505, 722 S.E.2d 118 (2012) (citing O.C.G.A. § 34-9-1(4)). But, what does that mean? Thankfully, Georgia courts have provided some guidance. The Georgia Court of Appeals has held that the phrase “arising out of” refers to some causal connection between the conditions under which the employee worked and the injury, and that the words “in the course of” relate to the time, place and circumstances of the accident. Stokes, 313 Ga. App. at 508, 722 S.E.2d at 121. Similarly, the Georgia Supreme Court has held that an accident “arises in the course of the employment when it occurs within the period of employment at a place where the employee may reasonably be in the performance of his duties and while he is fulfilling those duties or engaged in something incidental thereto.” Ray Bell Constr. Co. v. King, 281 Ga. 853, 642 S.E.2d 841 (2007). Common pitfalls to this seemingly easy analysis include deviations from employment, injuries going to and coming from work, idiopathic falls and psychological claims. 
Deviations from Employment 
Looking to how Georgia courts define a compensable accident, we know that an accident will not be compensable if the employee has deviated from the performance of her work duties at the time of the accident. However, what actions constitute deviations are not as clear and often need to be analyzed on a case-by-case basis. In Georgia, if an employee steps aside from her employer’s business to do some personal act not connected with her employer’s business, the employment relationship is said to be suspended and any injury suffered during that time period is not compensable. Specifically, the deviation or “break in employment” must be “pronounced in character.”  Hartford Accident & Indem. Co. v. Souther, 110 Ga. App. 84, 137 S.E.2d 705 (1964).
However, the employment relationship is not suspended or interrupted “when for a brief interval the employee performs a personal errand” or performs some act for her own comfort, such as using the restroom or eating lunch. These time periods are considered incidents of employment, and when an injury occurs during such breaks, it is typically compensable. Accordingly, key facts to develop when investigating a potential deviation from employment include the location of the accident, whether the act that caused the accident was part of the employer’s business and whether the employee was on a personal mission. Put another way, had the employee consciously decided to take advantage of a break in her work day, when she was free to do as she pleased, to run a personal errand? See Stokes, supra
Consider for example an accident that occurs during a coffee break at the office compared with an accident that occurs during a lunch break away from the employer’s premises when the employee is free to do as she desires. During the coffee break, the employee remained at the office and simply refilled her coffee cup. Any accident that occurs during that time frame, free of any willful misconduct by the employee, would likely be compensable. However, with regard to the employee who was free to do as she pleased, this freedom during her lunch break, coupled with the fact that there is no apparent objective performed on the employer’s behalf, would likely render an accident during the lunch break not compensable. 
Injuries Going to and Coming From Work
But what about an accident that occurs before an employee even gets to work or on her way home? Typically, injuries sustained by an employee while going to or coming from her employment are not compensable. Jose Andrade Painting v. Jaimes, 207 Ga. App. 596, 420 S.E.2d 640 (1993). However, there are certain exceptions to this general rule that will deem an accident compensable. First, when the terms and conditions of employment provide for transportation, an employee may be in the course and scope of her employment while traveling to work, and thus any injuries suffered while she is traveling will likely be deemed compensable. See Eickhorn v. Boatright, 219 Ga. App. 895, 467 S.E.2d 214 (1996). Second, an accident might also be compensable if it occurs once the employee has made it to the employer’s premises, or a location maintained by the employer, but is still in route to her office.  In such situations, the period of employment is said to include a reasonable time for coming and going from the work place once the employee has arrived at such locations.  See Peoples v. Emory Univ., 206 Ga. App. 213, 424 S.E.2d 874 (1992).
Accordingly, when presented with an accident that occurred while an employee was traveling to or from work, an adjuster will want to investigate where the accident occurred and whether the employer provided or reimbursed the employee for the transportation. The adjuster will also want to determine whether the employee was in the performance of her work duties, or was instead, strictly on a personal mission when the accident occurred. 
Idiopathic Falls
In Georgia, if an idiopathic condition (purely personal and without any origin in external factors) results in an on-the-job injury that is no greater than it would have been had the employee suffered the same accident elsewhere, off of the employer’s premises, the injury will not be compensable.  Wood v. Aetna Casualty & Sur. Co., 116 Ga. App. 284, 157 S.E.2d 60 (1967). Instead, to be compensable, “there must be some causal connection between the conditions under which the employee worked and the injury he received; the causative danger must be incidental to the character of the employment, and not independent of the relation of master and servant.” Chaparral Boats, Inc. v. Heath, 269 Ga. App. 339, 606 S.E.2d 567 (2004).  
As example, a fall to the bare floor without any evidence that the fall was caused by a slip, fall, trip or contact with any object will typically not be compensable. However, in contrast, where the fall causes the employee to land on a sharp piece of machinery or equipment, cutting her arm, such accident will likely be compensable as the piece of machinery will be deemed a hazard of employment specific to the employee’s work.  Accordingly, when investigating an employee’s fall at work, adjusters will want to pay careful attention to what caused the injury and whether the employee landed on or injured herself due a hazard of her employment.  Obtaining video footage from security cameras may also be helpful with identifying the true cause of the fall. 
Psychological Claims
When a claimant suffers a physical injury and the claimant’s disability is aggravated or prolonged by a psychological result of that injury, the effects of the psychological injury are generally compensable. Indemnity Ins. Co. of North America v. Loftis, 103 Ga. App. 749, 120 S.E.2d 655 (1961). However, if a psychological injury is not preceded by or accompanied by a physical injury or “discernable physical occurrence”, it is not compensable. Clarke v. Freeman, 302 Ga. App. 831, 692 S.E.2d 80 (2010).  W.W. Fowler Oil Co. v. Hamby,192 Ga. App. 422, 385 S.E.2d 106 (1989) (touching gun to head of employee not a discernable physical occurrence). Thus, the key fact to develop when investigating a psychological injury is whether there was a “discernable physical occurrence,” simple touching is not enough. If the employee was not physically injured in any way, her psychological claim will not be compensable.  
While this article only touches on a few scenarios and potential pitfalls encountered by adjusters, it is clear that the compensability of a claim will often hinge on certain key facts.  Thus, to ensure that claims are handled effectively and efficiently, the adjuster must recognize and develop those facts to ultimately determine whether a claim is compensable. The adjuster is also encouraged to document all critical facts when possible, through either witness statements or photographs, as such evidence will greatly assist legal counsel down the road should the  claim be controverted and a hearing request filed.

The Journal is a publication for the clients of Drew Eckl & Farnham, LLP. It is written in a general format and is not intended to be legal advice to any specific circumstance. Legal Opinions may vary when based upon subtle factual differences. All rights reserved. 

Editorial Board:

H. Michael Bagley