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.
However, the employee's work injury claim may be denied if he or she is injured:
- while intoxicated
- intentionally by him or herself
- deliberately, causing his or her own death
- by starting a fight
- while committing a felony
- during a voluntary recreational work event
- while engaging in “horseplay” at work
- while commuting to or from work
- on a lunch break
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.
There are situations where an employee is not performing regular job duties but is engaged in activities benefitting the employer. An employee can claim an injury where:
- an employee is injured at an employer-provided housing facility. This is referred to as the “bunkhouse rule”
- an employee is injured when he or she is asked by an employer to run perform work outside his or her usual work duties. This is called the “special mission exception.”
In this article, our California personal injury attorneys will explain:
- 1. How does an employee prove a work injury?
- 2. Exceptions to a work-related injury
- 2.1. Intoxication
- 2.2. Intentionally self-inflicted
- 2.3. Suicide
- 2.4. Initial physical aggressor
- 2.5. Felony
- 2.6. Voluntary off duty recreational activity
- 2.7. Horseplay
- 3. When does a work day start and stop?
- 4. Special situations to claim a work injury
- 5. Nearly all injuries at work are valid work injuries
To claim a work injury, an employee has to show he or she:
- was at work when the injury occurred
- was engaging in activities that could be considered work-related
- actually suffers an injury
Any kind of injury can be a work injury. The employee only has to show that the employment is the main factor that exposes him or her to the situation that causes the injury.1 If an employee is doing work he or she is expected to do in a place he or she is expected to be doing it, any injury is likely a work injury.2
A good test is to ask, without the employment would the injury would have occurred?3
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.
Each injury is decided on a case by case basis.4
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.
A work injury can happen if it takes place at work even if the injury has nothing to do with work.5
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.
Even if an employee is at work, there may not be a valid work injury if the employee:
- is intoxicated7
- intentionally self-inflicts the injury8
- willfully and deliberately causes his or her own death9
- starts an altercation where the employee is the physical aggressor10
- is injured during the commission of a felony11
- is participating in a voluntary off duty recreational activity12
In these situations, there is no work-related injury because even though the employee is at work, he or she is engaging in activities beyond his or her employment.13
Once an employee claims an injury, it is up to the employer to show that one of those exceptions apply.14
Intoxication must be the main cause of the alleged work injury to deny the claim.15
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.
Although Patrick intentionally hit the wall, he did not intend to injure himself. Because the injury was not intentionally self-inflicted, Patrick can claim a valid work injury.17
An employee who commits suicide is not entitled to workers' compensation benefits. However, the suicide needs to be a thought out decision not caused by employment-related stress or other factors.18
The question to ask is without any employment-related issue, would the employee have committed suicide?19
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.
An employee who is injured while engaged in horseplay may have his or her work injury claim denied.23
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.
However, if an employee is injured while others are engaging in horseplay, that employee's injury may be a work injury.24
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.
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.
An employee cannot obtain workers' compensation benefits while going and coming from work. The employment relationship is suspended from the time the employee leaves work until he or she resumes work.25
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.
Because Joan is commuting she does not have a valid worker's compensation claim
However, if the employer requires an employer-owned vehicle to be used by the employee, any injury to and from work is compensable.26
Example: Roger trips and falls while walking from his house to his work vehicle. Roger files a workers' compensation claim.
At the time that Roger fell he was not yet working so there was no employment relationship at that moment. Roger's workers' compensation claim is denied.27
If the employee travels for work, an injury during that time is compensable. It is called the commercial traveler rule.28
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.
Therefore, he is performing work for the employer and can claim a work injury.29
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.
The going and coming rule may not apply if the employee is on a “special mission” for the employer. It is considered a business-related trip by an employee at the request of the employer.31
However, if an employee is asked to start work early or leave late, it is not a special mission.32
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.
The California workers' compensation system favors the injured worker.34
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.
Call us for help...
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.
Westbrooks, at p. 253.
Truck Insurance Exchange v. Industrial Accident Commission (1957) 22 Cal. Comp. Cases 15.
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.
William Smith v. WCAB (2000) 65 Cal. Comp. Cases 277, 278
Chu v. Workers' Comp. Appeals Bd. (1996) 49 Cal. App. 4th 1176, 1184
Id., at p. 1185.
Jessie Mathews v. WCAB (972) 37 Cal. Comp. Cases 124, 127.
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.
State Lottery Comm'n v. Workers' Comp. Appeals Bd., 50 Cal. App. 4th 311, 315
Id., at p. 311.
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.
Id., at p. 536.
Irene Aubin v. Kaiser Steel (1960) 25 Cal. Comp. Cases 217.
Cal. Lab. Code § 3202.