We are often asked by prospective clients why their workers’ compensation clam was denied and most of the time it involves the issue of compensability. People often assume that because they are injured at work then they are automatically entitled to workers’ compensation benefits. This is simply not the case. Although the overwhelming majority of workplace accidents will entitle workers to benefits under the Virginia Workers’ Compensation Act, there are a number of workplace accidents that simply will not be compensable.
So what does it mean to have a compensable workplace accident? A workplace accident is compensable if the injury “arises out of” the risk associated with the work and is sufficiently discreet in temporal precision meaning that the injury has to be sudden and cannot be the result of repetitive movements. We often see workers who have an injury that is clearly related to the work but it is often the result of repetitive actions such as lifting heavy boxes or continuously moving a body party over an extended period of time in such a way as to induce injury. In other cases, we see that the injury was sudden but the injury did not “arise out of” the employment meaning that the injury is not related to the risk associated with the work such as tripping over a rug in an office or a workplace altercation with a co-worker.
So this may all seem self-explanatory but what does it really all mean? First, an injury arises out of the employment when “there is apparent to the rational mind upon consideration of all the circumstances, a causal connection between the conditions under which the work is required to be performed and the resulting injury.” County of Chesterfield v. Johnson, 237 Va. 180 (1989). In other words, a condition of the workplace must cause or contribute to the injury. Second, the injury must be certain in time or “sufficiently bounded by rigid temporal precision.” In other words, the injury must be reasonably certain in time and place and cannot be an injury that occurred over a period of time. We have seen exceptions to this requirement particularly in law enforcement training cases where the law enforcement officer is required to engage in assaultive type training over the course of several hours and is injured a result. Recent cases have determined that this training is so unique so as to not require the exact time of the injury be proven. But, these are still exceptions and not the rule.
So what does this mean for your case? As stated earlier, the majority of workers’ compensation claims are going to found to be compensable. However, if your case has been denied on the basis of compensability then this is the framework upon which it will ultimately be evaluated.