I probably get 2-3 questions a day from clients to help them make a determination on whether an accident or injury c an be denied or if it is compensable. (Keep those questions coming!)
In laymen’s terms, an accident is the event, the injury is the result.
We often use the terms interchangeably as in date of accident or date of injury, but they really are separate. And the statute has different definitions and requirements for proof. You may have a compensable accident, but you may have to challenge the injury.
440.02(1) “Accident” means only an unexpected or unusual event or result that happens suddenly.
Pretty basic. To be a compensable accident, a claimant simply has to report an accident arose out of and occurred during the course and scope of employment. The employer saying it didn’t happen or couldn’t have happened that way is something I hear often. Well..if the claimant says it did, we have to prove it didn’t happen. That can be very difficult if not impossible in many cases. Unwitnessed accidents are compensable
440.02(19) “Injury” means personal injury or death by accident arising out of and in the course of employment, and such diseases or infection as naturally or unavoidably result from such injury.
Still pretty basic, but the burden to prove an injury is much greater than just saying “ouch, it hurts from work”.
Here is part of 440.09(1), and this doesn’t even get to dealing with aggravations to pre-existing conditions:
“The injury, its occupational cause, and any resulting manifestations or disability must be established to a reasonable degree of medical certainty, based on objective relevant medical findings, and the accidental compensable injury must be the major contributing cause of any resulting injuries. For purposes of this section, “major contributing cause” means the cause which is more than 50 percent responsible for the injury as compared to all other causes combined for which treatment or benefits are sought. In cases involving occupational disease or repetitive exposure, both causation and sufficient exposure to support causation must be proven by clear and convincing evidence. Pain or other subjective complaints alone, in the absence of objective relevant medical findings, are not compensable. For purposes of this section, “objective relevant medical findings” are those objective findings that correlate to the subjective complaints of the injured employee and are confirmed by physical examination findings or diagnostic testing. Establishment of the causal relationship between a compensable accident and injuries for conditions that are not readily observable must be by medical evidence only, as demonstrated by physical examination findings or diagnostic testing. Major contributing cause must be demonstrated by medical evidence only.”
So when you are evaluating a claim for compensability, look at those two separately, accident and injury. Many times it will take a medical opinion to determine if the injury is compensable.
Thanks, and I’m always available for questions.
Morgan Indek | Partner