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Understanding how workers' compensation laws work is crucial for those wanting to seek legal action after experiencing an accidental injury. In all states, including Ohio, these people must meet certain requirements to qualify for benefits.
Not every workplace injury may fall under the Workers' Compensation Act, which may affect many people.
Ohio law (ORC Chapter 4123) states that a wound that applies to workers' compensation is: “Any injury, whether caused by external accidental means or accidental in character and result, received in the course of, and arising out of, the injured employee’s employment.”
What does "arising out of" and "in the course of" employment mean? Although they seem like complex terms, they follow simple guidelines that people must be aware of.
This page covers both definitions, ensuring those interested in building a legal case have all the resources necessary to work. Our team can also help answer questions like what is an occupational disease?
Understanding Ohio's Workers' Compensation Law
The definition mentioned above explains that any work accident applies to a compensable claim, regardless of fault. This applies if the injury occurred in the course of the person's employment. It's crucial that the accident arose out of the employment too.
As long as these conditions are met, the victim may be able to file a claim. However, a few factors affect whether a person's claim is eligible for workers' compensation benefits. It's important to consult with a legal professional who can clear things up for their client. They can explain statutory employer meaning as well.
Below is an overview of each definition:
Differences Between "Course of Employment" and "Arising from Employment"
"Arising from employment" is a bit more difficult to understand compared to the other term. This section will start with the definition of "course of employment" and move on from there:
Course of Employment
Essentially, this element oversees the circumstances, time, and place of the accident/injury.
When evaluating the "course of employment," it's important to include any activity that's consistent with the contract of hire. People should also include all activities related to the employer's property/business.
What does this mean? If the injured worker seeks benefits, they must confirm that their accident occurred while they were doing something required by their employer.
To summarize, the accident happens "in the course of employment" when it occurs:
Somewhere where the employee performs their duties reasonably
Within the person's period of employment
While the person is fulfilling their job duties or is doing something incidental to their work
Here's when it gets tricky. If the injury occurred on the employer's premises, but the worker wasn't doing something related to their employment, they may not be compensated.
Determining whether an activity falls under one's employment requirements or not is difficult. Victims should always consult with a workers' compensation attorney who can evaluate all circumstances of the case, gather substantial evidence, and guide them through the entire process.
Arising from Employment
Following up on the previous definition, "arising from employment" evaluates whether there's a causal connection between the person's employment activity and the injury.
Legal professionals must evaluate several circumstances to determine this connection, including:
How close the workplace was to the accident
How much control the employer/owner had over the accident scene
Which benefits the employer received from the worker's presence at the accident scene
Usually, workers' compensation doesn't cover injuries that occurred while the person was doing any activity that was incidental to and logically related to their employment but was disconnected enough from the job.
It's easy to understand this concept using the following example: Many people have to drive to other places to perform their job duties. Driving to the workplace may be considered an activity that is "incidental to and logically related to their employment." However, people who get injured on their way to work aren't usually entitled to coverage.
This is because employers don't have control over the roads. Also, accidents that happen while commuting aren't usually in close proximity to the workplace.
To summarize, "arising out of" and "in the course of" employment are two concepts that limit what Ohio's workers' compensation law covers.
Other Requirements for Filing a Workers' Compensation Suit
As a general rule, victims must prove four factors if they want their claim to be valid. Some employers may try to disprove them, and if they succeed, the claim may fail.
This page just covered two of the most important factors. Below are the other two:
Employer/Employee Relationship
In many cases, employers will claim that their worker is a contractor and not an employee. If this is the case, they would not be covered by workers' compensation. Another tactic is to falsely classify an employee as a temp or intern. This is common in the trucking and construction industries.
There's a lot of personal risk when working in certain scenarios, so having an employer trying to disprove a claim can be devastating. If the injury arose due to valid reasons and is under the scope of the workers' compensation law, the victim should talk to workers comp lawyers in Columbus so that they can compile work records that prove they are employees.
The Injury Is "Accidental in Character and Result"
Ohio law requires people to prove that a risk/hazard that's directly related to their employment was the cause of their injury. Common disputes include:
Repetitive Motion Injuries: A person may have to perform repetitive motions or activities at their employer's request. This may lead to conditions like carpal tunnel or rotator cuff syndromes. Some employers, however, will try to question these claims and say that the injury was caused due to another unrelated activity or previous employment.
Heart Attacks and Strokes: While some factors in the workplace may contribute to heart attacks or strokes, there are also many genetic, lifestyle, and health elements to consider. Even if the heart attack/stroke happened in the workplace, the person may not be eligible for workers' compensation benefits.
Toxic Exposure: People working in certain areas may be more prone to developing diseases like asbestosis and silicosis. However, these diseases are known to show symptoms after a while. Some employers may try to point at other potential causes of the disease.
Common infections often don't count as occupational diseases under workers' compensation law.
Workers who want to fight these claims must gather enough documentation of their medical condition. This ensures that no objection is enough to disprove the victim's claim.
Are There Any Limits to the Workers' Compensation Law in Ohio?
There are a few injuries or conditions that aren't covered by the law. Below is a breakdown of them:
Pre-existing Conditions
Pre-existing conditions are hard to manage in workers' compensation cases. People with pre-existing conditions may not be eligible for workers' compensation benefits.
If the condition was "substantially aggravated" in the workplace, though, there's a chance that the injury is work-related.
People with a herniated disc, for example, may not be eligible for benefits. However, if that person is required to lift heavy items constantly, this activity could cause their condition to get much worse. In the worst-case scenario, the person may lose their ability to sit up or stand without pain. This could count as a work-related injury.
Traveling to and from Work
Most people can't claim benefits if they are injured while driving to work. The same applies to those who drive home and have a fixed location for work.
There are a few exceptions to consider, though. If the person's work duties start before they reach their workplace, the injury may qualify for benefits. On the other hand, if the employer pays for the victim's transportation, an exception to the rule may apply.
Psychological Injuries
More often than not, psychological/psychiatric conditions don't count as "injuries" under workers' compensation law. As with the previous factors, there are exceptions to this rule.
If the condition developed out of an occupational illness or injury, for example, the person may be eligible for benefits. Also, if the conditions arise from forced sexual conduct at work, the person may file a legal claim.
Other Non-covered Injuries
Certain injuries don't qualify for workers' compensation. Some scenarios include:
Natural deterioration of body tissue or organs
People who suffer injuries while participating in recreational activities sponsored by their employer (as long as they signed a waiver)
People who naturally lose their eyesight over the years
Other Common Legal Issues When Trying to Claim Workers' Compensation Benefits
Employers will usually try to object to certain claims to avoid giving benefits to workers. While this may become a problem for the victim, it's important to examine the following factors to ensure the case truly falls under the scope of the workers' compensation law:
Horseplay
Horseplay refers to any activity where a person pushes or hits another one. It may also be considered "rough play."
People who get injured because of horseplay that they initiated may not be eligible for workers' compensation. If the injury happened in a workplace where horseplay is common and tolerated by the employer, the claim may be valid.
Injuries Caused by a Third Person
Contrary to popular belief, the accident doesn't have to be the employer's fault to qualify for workers' compensation. In fact, the law doesn't require an employer or fellow employee to cause the injuries.
However, these cases may require a change of strategy. People who get injured because of a third party's actions may have to file a personal injury claim. By following the right steps, they can hold that third party accountable for what happened and get compensation.
Intoxication
Workers' compensation is a "no-fault program," but that doesn't mean that all scenarios will be eligible for benefits. If a person is consuming drugs or alcohol at the workplace, and that was the cause of the accident, they will not be able to recover damages.
Employers are responsible for proving that the person's intoxication was the proximate cause of the injury. If they can do it, the claim will be denied.
Recreational Activities
As mentioned before, injuries sustained during recreational activities may not be eligible for workers' compensation if the victim signs a waiver before doing them. If this isn't the case, the victim may still file a claim and get compensation for what happened.
Eligibility doesn't apply to informal worker gatherings.
Out-of-state Accidents
Some people are required to travel in and out of Ohio for work. Even if the headquarters are in Ohio, getting into an accident in another state can affect the workers' compensation case.
It's common for Ohio courts to consider factors like:
The location of the contract for hire
The location of the worker's home
The physical location of the injury
The location of the worker's supervisor
The state in which the workers' compensation premiums were paid
Contracts that indicate the intent of the employee and employer may also help when evaluating the case's eligibility.
Union Member Activities
People who get injured while engaged in union activities may not be eligible for workers' compensation. If the person was engaged in any action to benefit the union and not his employer, the case may not apply.
Intentional Torts
While people can file a workers' compensation claim and get money without proving fault, they may still sue their employer in some scenarios. If the employer caused the victim's injury because of gross negligence (or if they were intentional with their actions), they may be sued.
Victims must prove three main factors in this case:
The employer knew of the risks associated with performing a specific task.
The employer knew that the worker was exposed to said risks.
The employer knowingly let the worker continue to perform the task.
Bottom Line
Navigating workers' compensation law isn't complicated, but that doesn't mean that victims should file a case on their own. Most of the time, these workers will benefit from having legal assistance by their side.
In many scenarios, people can consider case law when evaluating their claim. While interpretations of case law vary depending on the case, knowing the outcome of previous claims may help the victim understand what they can expect.
An attorney can help victims evaluate all aspects of their case, gather evidence, and fight for their rights with the right tools. Those interested in learning more about workers' compensation can seek a free consultation with the team at Larrimer & Larrimer.