In this case, the Court of Appeals reversed a Oregon Workers' Compensation Board order finding that a worker who is injured in the lobby of an office building during a meeting with a friend for a coffee break should not be covered under the Workers' Compensation system.
The analysis in this case focused on whether or not the worker was engaged in a social or recreational activity primarily for her personal pleasure. If the employer can prove that the injury occurred during this kind of activity, then it can deny the claim. To decide this issue, the Court explained that three questions must be resolved. First, was the injured worker performing a recreational or social activity? Second, was the activity primarily for her personal pleasure? Third, was the worker injured while engaged in performing, or as a result of the recreational or social activity?
The Court of Appeals found that taking a coffee break was not primarily for personal pleasure, but instead, was sufficiently connected to work because a mandatory work break prompted the coffee break in the first place.
After resolving this defense, the Court of Appeals found that the Board relied on case law that have been overruled in making its decision. As result, the Court "remanded" the case back to the Board so that it could apply the facts of the case to current case law. However, the Court of Appeals commented on some of the arguments made at the Board level in making its decision. In the end, the Court explained that in order to figure out whether a worker was injured on the job, the Board must look at the nature of the worker's activity to determine whether there is enough of a connection to the employment so that the worker is considered not to have left the course and scope of employment.
Workers' Compensation carriers can deny claims for many reasons. When an insurance company or its employer says you are not in the course and scope of your employment, the outcome of any appeal depends upon the specific facts of each case. That is because there are are many facets to the rules that govern "course and scope" and "arising out of" denials. When we appeal these denials, we know that investigation is critical to determine the case's outcome. If you are not sure whether to appeal a denial of your workers' compensation claim, call us at 503-325-8600. We can investigate your case to let you know whether it makes sense to request a hearing.