It is not unreasonable to expect that during the course of a work day, an employee may stop and take some time out to attend to personal matters.
If an accident occurs during this time, the question may arise if the injuries sustained are covered by the employer’s workman’s compensation insurance. It is not uncommon for the insurance carrier to try and use the scope of work argument in this type of case to deny the claim. If your claim for workman’s compensation has been denied because you were doing something outside of the scope of your job, contact a Missouri workman’s compensation attorney to help you file an appeal.
The Appeal Process
Workman’s compensation claims are denied with some frequency, but luckily for an employee there is an appeal process in place to help. This is much like a civil court hearing necessitating the presence of a lawyer to help you make your case. You and the employer are both allowed to present evidence as well as expert witnesses relevant to the case.
The Personal Comfort Doctrine
A St. Louis worker who had her compensation denied chose to appeal the decision based on the personal comfort doctrine. This is a part of workman’s compensation law that allows for employees to be compensated even if they were attending to personal needs at the time of the accident. For example, if you were to get up from your desk to buy a drink at the vending machine, and tripped and fell on the way, this would be covered by workman’s compensation. Even though getting a drink is not part of the job description, it is reasonable to expect that an employee will have to do some things during the day that are not exactly work related.
When the Accident Occurs Off the Premises
The problems with the personal comfort doctrine for an employee most often arise when the accident occurs off of the premises. For whatever reason, insurance carriers seem to believe there is a difference between buying a soda at the vending machine and going to the convenience store next to your job to buy one. They will often look at whether or not you were clocked in to further make their case. This is what occurred with the St. Louis woman. Her being off of the clock when she tripped in the parking lot led to the denial of her claim. The courts looked beyond that and into the policies of the employer when making their decision. If they find that this is a common accepted practice at the job then they will award the compensation be paid, and with interest.
It is tricky to navigate the laws governing workman’s compensation and use them to fight the insurance carriers. If you feel strongly that your claim is being wrongfully denied then you should exercise your right to appeal despite these complexities. An experienced Missouri workman’s compensation attorney is your best weapon to help you recover your compensation. Call The Law Office of James M. Hoffmann at (314) 361-4300 if your claim was denied and start preparing your appeal.
Influencing Factors & Denied Claims
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