The Basics of Compensability

Our attorneys at Lundmark, Barberich, LaMont, & Slavin, P.C. strive to help our clients understand their legal rights and obligations when faced with workers' compensation claims. We can help you understand the basics of compensability in Arizona, such as what constitutes a compensable claim and other factors that play into workers' compensation according to state law.

An Overview Of Compensability In Arizona

Arizona is perhaps unique among the states in having a Constitution that mandates workers' compensation coverage. Enacted in 1912, during the height of the so-called Progressive Era, it directs the Arizona Legislature to enact workers' compensation laws providing compensation for personal injuries and death "from any accident arising out of and in the course of . . .employment," when the accident is "caused in whole, or in part, or is contributed to, by a necessary risk or danger of such employment, or a necessary risk or danger inherent in the nature thereof, or by failure of such employer, or any of his agents, or its agents or employee or employees to exercise due care." Ariz. Const, Art. XVIII, Section 8.

The conforming legislation follows this directive. It provides that "every employee who is injured, and the dependents of every such employee who is killed by accident arising out of and in the course of his employment . . . shall be entitled to receive and shall be paid . . . compensation for loss sustained on account of the injury or death . . . " A.R.S. §23-1021(A). In the abstract, this language means next to nothing, but as defined by decades of appellate eases, "in the course of" refers to the time, place and circumstances under which an injury occurs, whereas "arising out of" refers more broadly to the nature of the source of the injury to the employee.

Language this ambiguous invites appellate interpretation. Hundreds of cases spanning the better part of a century have yielded a rich — and sometimes daunting — body of law outlining what constitutes a compensable claim. The decision whether to accept or deny a claim, of course, must always rest on its unique circumstances, but here are a few of the key features of the Arizona scheme.

What Is An Injury?

An anatomic organic change is not required. A symptomatic aggravation of a pre-existing condition is enough to constitute a new injury, as long as the aggravation necessitates medical care. Injuries that occur gradually are covered. See eg. Mandex, Inc. v. Industrial Commission, 151 Ariz. 567, 729 P,2d 921 (App. 1986).

What Is An Accident?

An injury is "accidental" if either the cause or the result is unexpected. This means that routine exertion that causes an injury can be regarded as accidental. The risk may not be greater than the risk associated with daily living. On the other hand, an intentional act that causes a "foreseeable or expected result" — as in the case of an employee who slammed his fist into a wall in anger — cannot qualify as an accident for compensation purposes. See Glodo v. Industrial Commission, 191 Ariz. 259, 955 P.2d 15 (App. 1997).

The Going-And-Coming Rule

Generally, a trip to and from work is not within the course of employment, but this rule is riddled with exceptions. An employee is considered within the course of employment while on the employer's premises, whether or not the employee has either started work for the day or clocked out and headed home. By special statute, police officers and firefighters are considered within the course of employment during a going and coming trip, even before they reach the employer's premises. See A.R.S. § 23-1021,01.

Personal Comfort

Employees remain within the course of employment while engaging in personal comfort activities such as eating, making phone calls during lunch breaks, or using the bathroom.

Traveling Employees

Absent unreasonable behavior, an employee is afforded 24-hour coverage during work-related travel. See Bergman Precision Inc. V. Industrial Commission, 199 Ariz. 164, 15 P.2d 776 (App 2000).

Recreational And Social Activities

Participation at a company picnic, office party, or on a sports team is within the course of employment when (a) the employer sponsored the activity to a substantial degree, and (b) the employer benefited beyond the intangible of enhanced employee morale.

Horseplay

Horseplay is a deviation from the course of employment only when it is substantial. Momentary frolic intermingled with work performance is generally not enough to disqualify the employee from coverage. See Jaimes v. Industrial Commission, 163 Ariz. 307, 787 P.2d 1103 (App. 1990).

Intoxication And Impairment By Drugs

Impairment by drugs or alcohol does not bar recovery unless the employee is no longer able to "follow" his employment and thus abandons it. The Arizona Supreme Court has ruled unconstitutional the decision that barred workers' compensation coverage to employees whose accident was caused in part by drugs or alcohol. See Grammatico v. Industrial Commission, 211 Ariz. 67, 117 P.3d 786 (2005).

Work-Rule Violations

Arizona follows the familiar "means-ends" misconduct rule. A violation of a rule relating to the manner in which an employee is to perform his work is no bar to coverage, but an employee loses coverage if the rule violated pertains to the "scope, ambit or sphere of work which the employee is authorized to do."

Assaults

As long as the dispute concerns the employment, coverage is available to an employee injured in an assault even though he may have instigated it. See Colvert v. Industrial Commission, 21 Ariz. App 409, 520 P.2d 322 (1974). Assaults arising from mere "friction and strain" are likewise covered. PF. Chang's v. Industrial Commission, 216 Ariz. 344, 166 P.3d 135 (App. 2007).

Normal Bodily Movements

An accident that occurs during actual work performance is covered even though the activity may have been routine and even though the employee's personal health may have contributed to the injury. See eg. Nowlin v. Industrial Commission, 167 Ariz. 291, 806 P.2d 880 (App. 1991) (back strain from sitting down in chair); Samaritan Health Serv. V. Industrial Commission, 170 Ariz. 287, 823 P.2d 1295 (App. 1991) (pre-existing knee injury aggravated while employee was merely reaching down for a file on the floor); Lou Grubb Chevrolet v. Industrial Commission, 171 Ariz. 183, 829 P.2d 1229 (App. 1992) (secretary strained neck while merely turning head). See also Farish v. Industrial Commission, 167 Ariz. 288, 806 P.2d 877 (App. 1990) (actual risk of injury while walking).

Positional Risks

Arizona recognizes the positional risk doctrine. When the risk of injury is neither work-related nor personal, but the workplace is where the employee is injured, the injury or death presumptively arises from the employment.

Unexplained Deaths And Falls

Deaths and falls that are unexplained are rebuttably presumed to rise out of the employment, if the death or fall incurred in the course of employment.

Idiopathic Falls

A personal health condition that produces an injury is never compensable, unless the workplace somehow increased the risk of injury.

Occupational Diseases

By special statute, coverage is extended to diseases "due to causes and conditions characteristic of and peculiar to a particular trade, occupation, process or employment, and not the ordinary diseases to which the general public is exposed." A.R.S. § 23-901(13)©. Injury-by-accident analysis, however, applies when an illness is not peculiar or particular to the employment. See eg. Lorentzen v. Industrial Commission, 164 Ariz. 67, 790 P.2d 765 (App. 1990); McCreary v. Industrial Commission, 172 Ariz. 137, 835 P.2d 469 (App. 1992).

Heart Or Perivascular Injuries

By special statute, a "heart-related or perivascular injury, illness or death" is not covered "unless some injury, stress or exertion related to the employment was a substantial contributing cause of the heart-related or perivascular injury, illness or death." AR.S. § 23- 1043.01(A). The phrase "substantial contributing cause," however, has been defined to refer to activity or exertion that is greater than "insubstantial" or "slight." See Skyview Cooling Co.v. Industrial Commission, 142 Ariz. 554, 691 P.2d 320 (App, 1984).

Mental Injury

By special statute, a "mental injury, illness or condition" is not covered "unless some unexpected, unusual or extraordinary stress related to the employment or some physical injury related to the employment was a substantial contributing cause of the injury, illness or condition," A.R.S. § 23-1043.01(B). For mental injuries, "substantial contributing cause" has the same definition used for heart and perivascular injuries. See TWN Custom Framing v. State Compensation Fund, 198 Ariz. 41, 456 P.2d 745 (App. 2000). Stress that is inherent in the nature of the employee's work is generally not enough to qualify as unusual, extraordinary or unexpected. See eg. Sloss v. Industrial Commission, 121 Ariz. 10, 588 P,2d 303 (1978); LaPare v. Industrial Commission, 154 Ariz. 318, 742 P.2d 819 (App. 1987).

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