What Injuries are Outside of Work Comp?

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While many accidents and injuries are covered under Missouri’s Workers' Compensation Law, not all are. The Law seeks to cover as many work-related injuries as possible, but its reach does cover every single accident or injury. Instead, each worker’s compensation claim is handled on a case-by-case basis and it is important to seek experienced legal advice to determine if your injury is covered or not. below is a brief overview of common injuries that fall outside the coverage of work comp.  

Generally speaking, the gradual onset of problems that comes with aging is not covered under the Law. This includes ordinary wear-and-tear that comes from working, such as sore backs, knees, and joints. Much more commonly, the employee is involved in an accident which results in an injury independent of the aging process. However, in some cases, "gradual deterioration" injuries are covered under worker’s comp. In such cases, the deterioration must be caused by the employee’s work, or at least significantly so.  

The test to determine if an employee’s injury is covered under work comp is whether or not the accident or work itself was the "prevailing factor" in the injury. If the employee’s workplace accident is not the prevailing factor in the employee’s injury, the employer is not required to pay worker’s compensation benefits to the employee. To be the prevailing factor, the accident or work itself must have been the primary cause of the injury. In other words, there needs to be a direct connection between the employee’s injuries and the accident; an aggravation or agitation is not enough. 

In certain cases, employers will try to state that the accident was a “triggering event” in order to avoid paying worker’s compensation benefits to an employee. In Drewes v. Trans World Airlines, Inc., the court held that if the workplace accident only “triggered” the employee’s injury, it is not the primary cause of the injury, i.e., it fails the prevailing factor test. In this scenario, because the employee’s injury was only triggered by the accident, the employer was not liable to pay worker’s comp benefits to the employee. In Cahall v. Cahall, the Court stated that a “triggering” event is the last event of multiple factors. In order to avoid paying benefits, employers will try to frame the employee’s accident as only being the “triggering” event, and not the primary cause, of the employee’s injury or symptoms.  

Experienced worker’s compensation attorneys can successfully argue on behalf of an employee that the workplace accident was not a “triggering” event of the injury, but actually the prevailing factor of the injury. There is not a hard and fast rule that sets a “triggering” event apart from prevailing factor. Instead, testimony from doctors will be needed. Each side will supply a doctor, each claiming that the injury or symptoms should be looked at one way rather than another. It will be up to the administrative law judge to determine which doctor is correct—a work comp case never goes to a jury.   

Another way that employers may try to avoid paying employee’s their worker’s compensation benefits is by framing the injury as a pre-existing condition or pre-existing injury, and not an injury caused by the accident. It is a general rule that employees are not compensated for a pre-existing injury, including aggravation of a pre-existing condition. In these cases, the pre-existing condition is the primary cause of the injury: the prevailing factor. For example, an employee that has a back condition cannot receive benefits if he aggravates his back lifting a box at work. Though the employee's work (lifting the heavy box) work in conjunction with his back problem to create the injury, the back problem is the primary cause of the symptoms. To put it another way, an employee without that back problem would not have suffered the same injury lifting the same box. Such an injury is simply outside of what work comp covers under Missouri law.  

An employer may also try to avoid their responsibility under worker’s compensation laws by arguing that the injury was a "natural occurrence." Natural occurrences are conditions that an employee is no more exposed to the risk of during work than they are at work, such as a heart attack. Even if an employee suffers a heart attack at work, that injury is not covered. However, an employee who suffers a heart attack at work may be covered if the heart attack was caused by the employee’s work. Another common example are trip and falls that occur off the employer's premises. Employers often try to frame these falls as a risk that always exists in everyday life and that risk is not amplified by being on-the-clock. Missouri courts do not fall for these arguments often, though. For example, in Dorris v. Stoddard County, an employee tripped and fell on a crack in the sidewalk while she was walking to the site of a new country building. The court found that though the fall was caused by walking at a location open to the public and off the premises of the employer, the employee was walking there because of her employment: her supervisor invited her to see the construction site and the employee was walking to that location when she tripped. Thus, the fall was work-related, not a natural occurrence, and was covered under the Law. 

Worker’s compensation claims are complex and difficult to navigate. Employers will try different ways to avoid paying the benefits that an employee deserves. Experienced work comp attorneys can help you get the compensation you are owed. Only a lawyer that regularly practices in this area knows the ins and outs of this complex area; do not try to navigate your claim alone, work with an experienced attorney to ensure that you receive the benefits you are legally owed.