work comp questions

What is a Compensable Injury?

Injuries that qualify for Workers' Compensation Payments

A compensable injury is "an injury by accident arising out of and in the course of the employment and shall not include a disease, except when it results naturally and unavoidably from the accident." S.C. Code Ann. § 42-1-160

The courts have been extremely liberal in interpreting the language of this statute. In determining whether something constitutes "injury by accident" the focus is not on some specific event, but on the injury itself. In determining whether something constitutes "injury by accident" under workers' compensation law, no slip, fall or other fortuitous event or accident in cause of the injury is required; unexpected result or industrial injury is itself considered the compensable accident.

Creech v. Ducane Co., 320 S.C. 559, 467 S.E.2d 114, (S.C.App. 1995). The Court of Appeals in Creech, ruled that an "Injury by accident" under workers' compensation law includes not only injury the means or cause of which is an accident, but also an injury which is itself accident, that is, an injury occurring unexpectedly from the operation of internal or subjective conditions, without prior occurrence of any external event of accidental character.

Basically, what this means is if you suffer an injury at work, it will be presumed to be covered by workers' compensation regardless of whether the employee can point to any particular accident. In the Creech case, the claimant had previously suffered a back injury and had been compensated. His claim arose when he bent over to lift an object weighing less than one pound and re-injured his back.

S.C. Code Ann. § 42-1-160 defines "injury" for purposes of the Act, and requires that an injury must be "arising out of and in the course of employment." "Arising out of" refers to the causal connection between the work and the accident. "In the course of" refers to the time, place and circumstances under which the accident occurred. Most often, these issues arise in determining whether an employee was actually working at the time of an accident. "Accident" as used in the workers compensation act, means an unlooked for and untoward event that the person who suffered the injury did not expect, design, or intentionally cause. Yates v. Life Ins. Co. of Ga. 291 SC 301, 353 S.E.2d 297 (S.C. App. 1987).

The language "injury by accident arising out of and in the course of the employment" requires not only that the injury occur within the period of employment, but also that is arise because of the employment as when the employment is a contributing proximate cause. Lee v. Wentworth Mfg. Co. 240 S.C. 165, 125 S.E.2d 7 (1962). Also, the phrases "arising out of" and "in the course of employment" are used conjunctively. One of these elements without the other will not sustain an award. The two elements must coexist. Dicks v. Brooklyn Cooperage Co. 208 SC 139, 37 SE2d 286 (1946).