In Florida workers compensation claims it is not uncommon for the workers compensation carrier to deny that it is responsible for paying lost wages and medical benefits claiming the injured worker did not have an accident arising out of and in the course and scope of employment.
A good Florida workers compensation claimant attorney knows that when an adjuster makes this statement a shot-gun defense is being raised. In fact, the defense did not sustain or have an “accident arising out of and in the course and scope of employment” suggests several things. Did the employee not have an “accident”? Did the accident happen but it wasn’t “arising out of” the employment. Did an accident happen which arose out of the employment but it was not “in the course and scope” of employment?
An “accident” is relatively straight forward. It is an unexpected or unusual event or result happening suddenly resulting in injuries to the worker. (There are two exceptions to the definition. The first is a repetitive trauma injury and the second is an occupation disease which are unusual but still happen.)
The terms “arising out of” the employment or job duties means something different. The Florida worker compensation law defines “arising out of” as pertaining to occupational causation. An accidental injury or death arises out of employment if work performed in the course and scope of employment is the major contributing cause of the injury or death. For example, if the employee fell at work, the adjuster may argue the fall was caused by vertigo which was a personal condition for the employee and had no connection to the job duties. If the employee was attacked at work by their spouse, the adjuster would argue the attack had no connection to the job duties and is not covered by the workers compensation law.
The adjuster may taking the position that the accident and injuries have occurred and they have arisen out of the employment but the employee was not acting in the “course and scope” of their employment when the accident and injuries occurred. For instance, if the employee is a delivery driver in a company van and on the clock at the time of the motor vehicle accident, the injured worker typically receives workers compensation benefits. However, if it is shown that the driver drove thirty miles off his assigned route to place a bet at the horse track where his accident occurred, his activities are not in the course and scope of his job.
The terms “accident”,”‘arising out of” and “course and scope” of employment are each legal terms of art.
If you have been denied workers compensation benefits or have questions about your claim contact us for a free consultation. The compensation you deserve….it’s what we work for.