When an employee seeks medical treatment and compensation under the Indiana Workers Compensation Act, the employee must prove that he suffered “personal injury or death by accident arising out of and in the course of employment.” Ind. Code § 22-3-2-2(a). A recent case decided by the Indiana Court of Appeals highlights that employers may need to view the requirement that an injury arise of out employment more broadly than they have previously when deciding whether to accept a workplace injury as compensable. Waters v. Indiana State University, 2011 Ind. App. LEXIS 1434. In Waters, the Court of Appeals ruled against the employer and determined that the employee’s injury arose out of her employment, so the employer must provide medical treatment and compensation.
The employee, Betsy Waters, had worked for Indiana State University for almost eighteen years. Waters made draperies for residence hall rooms. Prior to her injury, Waters had several significant health issues, including obesity (360 pounds), diabetes, and knee problems requiring that she use a cane to walk.
Waters fractured her femur while attending an annual employee appreciation lunch. ISU held the lunch during the work day at a cafeteria on campus. ISU did not require employees to attend the lunch, but paid employees for the time during which they attended the lunch if they decided to attend. Waters sat at a booth during the lunch, although the cafeteria included other types of seating. She had difficulty exiting the booth at the end of the event. She had to rock and then twist to get out of the Booth. She felt a “pop” in her upper right leg as she twisted to leave the booth. Waters had fractured her right femur. The injury required surgery to repair the fracture with a plate and pin. Recurring infections and multiple surgeries followed the initial surgery. Waters did not return to work.
ISU denied Waters’ claim for workers compensation benefits on the ground that the injury did not arise out of her employment, but rather resulted from risks personal to Waters. The Single Hearing Member agreed with ISU’s arguments and found in favor of ISU. The Hearing Member concluded that the ISU work environment did not present an increased risk for the injury suffered by Waters. The full Workers Compensation Board agreed with the Hearing Member and affirmed the decision in favor of ISU.
On appeal, the Court of Appeals sided with Waters and reversed the finding in favor of ISU. The Court concluded that although Waters’ physical condition contributed to her injury and complicated her recovery from the injury, the injury itself arose from an activity (exiting the booth while at an employer provided luncheon) that was “incidental to, and therefore considered to arise out of the employment.” Waters, at *17. The booth, the Court noted, constituted a condition of the work environment that contributed to the injury. The Court based its decision on cases holding that risks arising from an employee’s pursuit of personal comfort or convenience, such as seeking fresh air, going to the bathroom, or cleaning up at the end of the work day are considered to arise out of employment. Although recognizing that employers do not have to compensate employees for injuries caused by an employee’s pre-existing conditions if the injuries are unrelated to employment, the Court stated that “where an employee’s pre-existing condition combines with a circumstance of his or her employment to result in an injury, the employee is entitled to recover for the full extent of the injury.” Waters, at *12
In reaching its decision, the Court acknowledged that an employee could suffer injuries while at work that would not arise out of the work. It cited the example of an employee who faints at work and suffers injuries from the fall as an example of injuries caused by purely personal risks. In contrast, the Court offered the example of an employee with pre-existing heart disease suffering a fatal heart attack at work brought on by the stress of a workplace fire as an example of a compensable injury arising out of work. . The Court sent the case back to the Workers Compensation Board for further determinations based on the Court’s opinion. ISU is asking the Indiana Supreme Court to review the Court of Appeals decision.
As the Waters case illustrates, an employer must undertake a thoughtful analysis of the facts surrounding the occurrence of a workplace injury before deciding to deny a claim. The employer should examine both the immediate factual circumstances of the injury and the existence of prior medical conditions of the employee. Employers cannot assume that an employee’s pre-existing health problems will provide a basis for denying a claim. If a connection exists between the injury and a condition or circumstance at work, then, under the Waters analysis, the employer may end up paying the claim even if the employee’s personal health conditions complicate treatment of the injury and greatly increase the length and cost of the treatment and recovery.
Karen Dutcher, an attorney in Ice Miller LLP’s Labor and Employment Section, concentrates her practice in defending employers in workers compensation matters.