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Payable Injuries Under NC Workers' Comp

work injuryEmployees are entitled to workers’ compensation benefits if, while carrying out the duties of their employment, they:

  1. Suffer an injury by accident
  2. Suffer a “specific traumatic incident" resulting in a hernia or an injury to the back
  3. Develop an occupational disease

 

How is 'accident' defined? The term, “injury by accident” has a very specific meaning in North Carolina workers’ compensation law. Cases are won and lost simply upon the issue of whether an occurrence was an “injury by accident” under the North Carolina Workers’ Compensation Act. The term “injury” means only an injury by accident arising out of and in the course of the employment. The term does not include a disease in any form except for such disease which result naturally and unavoidably from the accident. Injury also includes the breakage or damage to eyeglasses, hearing aides, dentures, or other prosthetic devices which function as part of the body.

An injury, to be payable, must result from an accident. This accident is to be considered as a separate event preceding and causing the injury. The mere fact of an injury does not in and of itself establish the fact of an accident.

Our courts have defined “accident” in various ways. One definition is that an accident is: “An unlooked for and untoward event which is not expected or designed by the injured employee.” (Is that perfectly clear?) Another court opinion states that an accident is: “An unusual and unexpected fortuitous occurrence.”

An event that involves both an employee’s normal work routine and normal working conditions will not be considered to have been caused by accident. If the employee is performing his or her regular duties in the usual and customary manner, and is injured, there is no “accident,” and the injury is not payable.

It is not always easy to predict how the court will rule on whether a specific event was an accident. The facts of each case are different, and some of the decisions of the court seem inconsistent.

An accident which involves the interruption of the worker’s normal work routine and the introduction thereby of unusual conditions is likely to result in unexpected consequences, and injuries arising there will be considered to be an “injury by accident.” On the other hand, once an activity even strenuous or otherwise unusual becomes a part of the employee’s normal work routine, an injury caused by such activity is not the result of the interruption of the work routine and is not considered to be an “injury by accident.” One case has held that no matter how great the injury, if it is caused by an event that involves both the employee’s normal work routine and normal working conditions, it would not be considered an accident.

A worker who trips or loses his or her balance while carrying out the ordinary responsibilities of their job in the usual way would, however, be entitled to benefits since this tripping or a loss of balance turns the event into an “accident.” Without the fall or tripping, however, that same employee doing their job in the usual and customary way would not be entitled to benefits.

Ordinarily, death from heart disease is not an injury by accident arising out of and in the course of employment so as to be payable. On the other hand, our appellate courts have said that damage to the heart tissue clearly precipitated or caused by “over-exertion,” constitutes an injury by accident.

In another case, the court held that evidence that the room temperature in the nuclear power plant was 85 degrees, and that the worker suffered heat exhaustion while wearing a radiation suit which inhibited his body’s ability to radiate heat unequivocally demonstrated that the worker was exposed to an increased risk of heart-related illnesses because of his equipment, and that the worker’s subsequent cardiac arrest was a payable accident.

Where a carpenter who was hired to perform a number of tasks connected with his employer’s home improvement business was injured when he shifted his position while shingling a roof, the court deemed that that event occurred under normal work conditions and was not payable as an injury suffered as a result of an accident.

Issues involving whether an injury resulted from an accident are usually complex. Therefore, the assistance of a skilled and experienced North Carolina workers’ compensation lawyer should be utilized to help the injured worker resolve these issues.

The requirement that an injury result from an “accident” no longer applies with respect to hernias and injuries occurring to the back.