Posts Tagged ‘going and coming’

Holiday Health Wonk Review, news notes, and holiday humor

Thursday, December 22nd, 2011

Gary Schwitzer makes his hosting debut with Unwrapping early presents, wrapping up ’11 Health Wonk Review series. Gary is the publisher of the excellent HealthNewsReview.org and its associated Health News Watchdog blog – take a look around while you are there.
Absence Management – The Disability Management Employers Coalition and Liberty Mutual recently released a set of best practice for absence management and easing the transition back to work after a disability leave. Download a whitepaper on Best Practices in Return to Work or view Taming the Intermittent Beast, a one-hour webinar on managing intermittent leave.
Support a good guy – Joe Paduda explains why you should join the Friends of Sandy Blunt on LinkedIn.
Desperate Housewives – Reality just got a little harsher for a would-be reality TV star caught in a huge California workers comp scam, She and her husband were charged with $30 million in premium fraud. “The couple gained notoriety in 2010 after fraud investigators raided several properties they owned and found luxury cars including a Bentley, two Ferraris, $500,000 in jewelry and $51,000 in cash. They also found an application for Kile to appear on the television show.”
Going and coming – Injuries that occur while traveling to and from work generally are not compensable. There are several common exceptions to this “going and coming” rule – if an employer provides transportation, if traveling is part of the normal course and scope of an employee’s job (such as a salesperson), or if the employee is on a “special mission” for the employer. Risk and Insurance reports on a recent benefit denial by the New Jersey Superior Court, Appellate Division in a case where a company president was invoking the “special mission” exception for an injury that occurred during an early trip to work for a special meeting. In denying the appeal, the court reasoned that the exception did not apply because the president was not required to be away from the restaurant’s usual place of business and he did not have “identifiable time and space limits on his employment.”
Up in smoke – Roberto Ceniceros posts about a denied claim involving a landscaper injured after a fall from a tree. Ceniceros notes that, “A urine sample taken at the hospital the day after the Tennessee man fell showed he had an intoxicant level 50 times beyond the threshold for a positive result, leading a doctor to describe him as a chronic pot user.” The court concluded that while the employee was not guilty of willful misconduct, his intoxication was a proximate cause of the injuries.
Hope for PTSD relief?Wired has an interesting article on a how the Navy is testing neck injections to relieve PTSD. The unorthodox procedure, which is called stellate-ganglion block (SGB), has secured immediate relief for some PTSD sufferers.
NYWCB Web change – Effective December 20, the New York State Workers’ Compensation Board (WCB) updated its website to use the standard “ny.gov” domain naming convention – the new web address is www.wcb.ny.gov. WorkersCompensation.com has more detail about related email changes.
On the lighter side: Holiday roundup
In honor of the holiday season, we’ve put together a grab bag of some fun holiday links. We wish all our friends the best for the season!

Health Wonk Review’s Health Policy Heat Wave and assorted work comp news briefs

Thursday, August 4th, 2011

Joe Paduda has posted a steamy Health Policy Heat Wave edition of Health Wonk Review over at Managed Care Matters. He notes that “Far from the summer doldrums, activity related to the debt limit, IPAB, Medicare reform and Health Exchanges is at a late-September pace.” Get in on the action, Joe always hosts a lively and informed edition.
Coming & Going – Roberto Ceniceros discusses the compensability case of a NC public school principal who was shot while driving to work. This is an interesting case because the principal was conducting phone business on a school-issued phone while commuting and he was also paid for travel expenses. He was awarded benefits, but the case is headed for appeals court. Ceniceros notes that injuries that occur during a commute generally are not compensable. He also notes that this might be some of the earliest case law on this issue. And with the brave new world of ubiquitous work enabled by mobile devices, it surely won’t be the last.
Radical change – Peter Rousmaniere talks about the recent Illinois workers’ comp reform and the radical change that the reform signified for workers’ comp, change that he notes has largely gone unnoticed. He discusses two significant issues that surfaced in the reform: the “nuclear option,” which Rousmaniere noted “freaked out almost everyone” – yet despite the dramatic language, an opt-out or non-subscribe program has long existed in Texas. The second issue that he notes is “an easy-to-overlook provision” that allows for union carve outs, which he discusses in greater detail. Peter’s take on all things workers’ comp is always well worth reading.
FL CFO tackles check-cashing fraudWorkCompWire reports that the Florida CFO will be reviewing check cashing services for collusion in workers’ comp fraud, which is said to be diverting more than a billion dollars from Florida’s economy. According to CFO Jeff Atwater, this latest workers’ compensation premium scheme is highly organized and orchestrated by individuals who know the construction and subcontracting industry and are intent on evading payment of workers’ compensation premiums.
MA AG recoups millions in drug overcharges – In the latest of a series of settlements, Rite-Aid will pay $2.1 Million to resolve allegations of prescription drug overcharges. The settlement is the 5th in a series of similar settlements, the result of an investigation by Attorney General Coakley’s office into prescription drug overcharges by pharmacies to public entities under the workers compensation insurance system. Settlements now total $7.9 million. Walgreens recently settled for for $2.8 million. Other pharmacies with settlements include CVS, Shaws Supermarkets, and Stop & Shop. Recouped money will be returned to cities and towns.
OH BWC publishes Facebook fraud page – If you commit workers comp fraud in Ohio, you may find your photo on Facebook. Yesterday, we posted about workers’ comp and social media, so we were interested to see that the Ohio Bureau of Workers Comp has launched a special investigations Facebook page. It will include news on recent investigatory action, a most-wanted section and a link to report fraud. The page can be found at www.facebook.com/ohiobwcfraud
World’s scariest job? – If not the scariest, it certainly is a contender: Chinese Road Workers. For other scary jobs, see our post on the workers on the cruise from Hell and the untethered tower workers. I’ll stick with blogging, thanks.
Quick takes

Health Wonk Review’s Research Edition & a roundup of other news

Thursday, June 24th, 2010

Brad Wright of Wright on Health has an excellent edition of Health Wonk Review, which shines a spotlight on research. Brad notes that, going forward, research will be incredibly important as health reform is implemented and evaluated. He offers a fine research roundup from leading healthcare bloggers – check it out!
Healthcare – According to a Commonwealth Fund report on healthcare, which assessed and compared data from patient and physician surveys in seven countries in 2007, 2008 and 2009, the U.S. scored sixth out of seven countries on quality issues, yet we spent more than double per person than any other surveyed country. See the full report How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update, which includes both a snapshot chart and an interactive comparison tool. Related: Results from the National Scorecard on U.S. Health System Performance, 2008
The importance of timely reporting – In Manucy v. Joe Manucy Racing, The Louisiana Court of Appeal recently ruled that an employee who was injured during horse training was ineligible for benefits because although the injury was immediately apparent, the worker did not file for benefits until about a year and a half after the injury occurred. Louisiana law stipulates a one-year from date of injury filing deadline for injuries that are immediately evident, and two years for injuries that do not develop immediately. In this case, the injury was immediately apparent, requiring ambulance transport and surgery within two months. State law varies on statues of limitations for benefit eligibility, most commonly falling between one and three years from date of injury. Many states offer some exceptions to the statutes – such as starting the clock ticking at date of disability rather than date of injury or allowing exceptions if there is conduct that might be regarded as deceptive on the part of the employer.
Going and coming – As a rule, any injuries that happen to an employee when they are traveling to or from work – ‘going and coming’ – are not compensable, but there are exceptions. Fortney v. AirTran Airways, Inc. deals with one of those exceptions: service/benefit to the employer. In this case, the employee was killed in a plane crash while flying on a reciprocal arrangement with another airline. The Kentucky Supreme Court upheld benefits to the estate of the deceased. At Lexis Nexis Workers’ Comp Community, Roland Legal PLLC summarizes the issues: “Whether an employer uses transportation or transportation expense as an inducement for an employee to accept or continue employment is material to supporting compensability, particularly when the journey is sizeable and when the employer pays all or substantially all of the expense.” See our prior post about common exceptions to the ‘going and coming’ rule.
Medicare – Get your popcorn and follow along as Joe Paduda offers a guide to the status of the Medicare “fix” and looks at various scenarios for how things may play out.
Retroactive Insurance in Georgia – events continue to play out in the wake of the insolvency of Southeastern U.S. Insurance Inc (SEUS) in Georgia (a story in and of itself, and worth a read if you haven’t been following along). After the SEUS demise, many employers were left holding the bag for the open claims of injured workers because they had not paid into the state’s insolvency fund and were therefore ineligible for coverage. New legislation will cover employers retroactively if they pay into the state insolvency fund, but the Georgia’s Insurers Insolvency Pool has filed a challenge to the new law. “The pool is placed in a position of uncertainty as to whether the legislation imposes duties and obligations on the pool retroactively in violation of the Georgia state constitution,” the filing says.
Arizona judge: no raiding the compensation fund – The state of Arizona is considering an appeal to Maricopa County Superior Court Judge Larry Grant’s ruling which found that Governor Brewer and legislators ignored the plain language of the law by trying to use $4.7 million from the State Compensation Fund to help balance the budget. According to the judge “The proceeds held by the special fund are insurance proceeds held in the benefit of employees and employers covered by the Workers’ Compensation Act.”
Safety shorts

In Search of a Good Cup of Joe

Wednesday, January 20th, 2010

We recently blogged a “to and fro” case involving a meandering motorcycle ride back to work from a conference. The cycle crashed and the employee filed for workers comp. The court in Wyoming determined that the accident took place during a deviation from the direct route home and thus was not compensable. Some readers commented that the employee was following his supervisor’s lead, so the injury should have been compensable. “To and fro” often raises issues in the gray zone. Here’s another gray area: coffee breaks.
Jesse Cooper, master plumber and foreman, needed to consult with someone at the union hall in Winslow Township, New Jersey. His contact was teaching a class, so Jesse decided to take a coffee break. He preferred the coffee at a deli some five miles down the road. On his way to a good cuppa, he was involved in a serious accident, breaking his arm and both legs.
Personal Comfort or Personal Errand?
Cooper’s employer, Bernickel Enterprises, argued that the coffee break was a personal errand. Workers comp judge Bradley Henson determined that a coffee break was part of the working day and that Cooper was under the “coming and going” rule while on his way to a somewhat distant cup of joe*. He found the injuries to be compensable.
Henson describes Winslow Township as a “rural area”, so the options for coffee are somewhat limited. In his summary of the case, New Jersey comp guru John Geaney notes that there were other coffee options closer than the deli; the judge, however, “accepted as credible that petitioner knew the deli had good coffee.”
This ruling certainly stretches the parameters of the “personal comfort” doctrine to its outer limits. One wonders when that hypothetical line between work and personal might actually be crossed: if I have a sudden craving for a Caramel Brulee Latte (not likely, mind you) and the nearest Starbuck’s is 15 miles out of the way, am I still “working” when I head in that direction?
The Driving Hazard
These two cases share one important characteristic: both involve accidents while driving, statistically the most dangerous part of the working day. As risk managers contemplate enhancements to safety programs, they would do well to put safe driving near the top of the list.
* Why do they call it a “cup of Joe”? Check this link for a possible if not entirely plausible answer involving a former Secretary of the Navy.

California Comp: Personal Responsibility?

Monday, October 5th, 2009

Fernando Martinez worked for the D. H. Smith Company, as did his two sons. The company provided Martinez and his sons a Ford F350 flatbed to drive to and from work. Because Martinez did not have a driver’s license, only the sons were to operate the vehicle. In June 2007, Martinez and his sons were on their way to a construction site, with the elder Martinez behind the wheel. Martinez rear-ended another vehicle on the freeway, injuring himself and his son. At first, Fernando and his son lied to the investigating officer from the Califomia Highway Patrol about who was driving the company truck. However, marks on their bodies from their seatbelts showed that Fernando was driving and his son was a passenger at the time of the collision. They eventually fessed up to the fact that Fernando was driving.
Both filed workers comp claims. There is no doubt that the son’s injuries are compensable. But what about Fernando?
At first, Fernando’s claim was denied. Here is an excerpt from the initial ruling:

After consideration of all of the evidence, testimony at trial and in deposition, and the demeanor of witnesses, it was found that applicant’s conduct in driving the company truck to work without a driver’s license, against the express orders of the employer, was a cause of the injury, and takes the activity in which the injury occurred outside the course of employment. The conduct of driving the company truck on public highways against the express order of the company was more than the manner of performing duties. It was different duties than he was employed for. It appears that applicant did drive the truck before his sons were licensed, contrary to the testimony of defendants. However, on the evidence it is clear that he was not allowed to drive after they were licensed, and he and his sons were well aware of that…Applicant’s conduct in this case posed an increased hazard to his own safety and life, to that of his son and members of the public, and greatly increased the risk of liability to the employer for damage to property and injury.

Sounds reasonable, but remember, this is California. The review board overturned this decision. They found the injuries to Fernando were compensable, as he was in the course and scope of employment and furthering the interests of the employer, even though he was disregarding the employer’s instructions pertaining to his driving.
Golden State Precedents
The review board cited some fascinating cases to support their contention that the injuries were compensable:

Benefits not barred for injury incurred following a high-speed chase through heavy traffic after employee had run a red light [Williams v. Workmen’s Comp. Appeals Bd. (1974)];

Bus driver who sustained injury as a result of nearly hitting an oncoming vehicle while recklessly driving his bus not barred from recovering workers’ compensation benefits for the injury [Westbrooks v. Workers’ Comp. Appeals Bd. (1988)]

With precedents like these, it would be hard to come up with a case where employee misconduct resulting in an injury was not compensable. In California at least, virtually anything you do at work is compensable.
The review board goes on to say:

In this case, it does not matter that applicant may not have been authorized by defendant to drive the truck because his travel to the job site in the truck was authorized by the employer and was of benefit to the employer.

A distinction must be made between an unauthorized departure from the course of employment and the performance of a duty in an unauthorized manner. Injury occurring during the course of the former conduct is not compensable. The latter conduct … does not take the employee outside the course of his employment.

It is apparently not a concern to the review board that the “unauthorized manner” in this particular case involves an illegal activity (driving without a license).
The End of “To and Fro”?
Finally, California has interpreted the “coming and going” rule in the most generous manner. In most states, commuting “to and fro” is generally not compensable, even when the employee is operating a company vehicle. The workday usually begins at the worksite. Not in California: “When the employer provides the means of transportation, the course of employment begins when the employee begins to travel.”
NOTE to CA employers: you may want to bag it on the company cars.
Workers comp costs in California are the highest in the country, despite the fact that employee benefits are relatively stingy. The high costs derive from many factors, one of which is revealed in this particular case. There are embedded in case law deeply rooted concepts that tilt the interpretation of compensability in the direction of injured employees. In many states, defense could certainly raise the issue of whether Fernando’s insistence on driving the truck without a license crossed the line into “serious and wilful misconduct.” You know, the concept of personal responsibility. That might be a reasonable argument in some states, but it doesn’t hold any water in California.

Health Wonk Review and other bloggy news notes

Thursday, September 4th, 2008

Hank Stern has posted a fresh roundup of news from the health wonkosphere over at InsureBlog – check it out: Health Wonk Review: Early September Edition.
ADA update – The folks at George’s Employment Blog has been keeping an eye on changes to the ADA. In July, George Lenard posted on what the ADA amendments will mean if they become law, and more recently, Karen Tofte has posted a second part in the series. She examines how the substantial limitation of major life activities element of the ADA’s definition of disability would be altered.
MA health care – Bob Laszewski of Health Care Policy and Marketplace Review comments on a recent NY Times editorial that looks at the Massachusetts health insurance experience and finds it less costly than expected. Bob points to some problems that must be factored in when assessing the program.
Technology risksErgonomics in the News points us to the article The Downside of Mobility: Injury: “As Wi-Fi–and laptops and mobile devices–become more ubiquitous, users from kids to adults find themselves suffering from injuries ranging from carpel tunnel syndrome to “BlackBerry thumb.” The first in a series of features and reviews on the ergonomics of Wi-Fi-induced mobility, this article offers tips on how to prevent injuries.”
Going and coming – Judge Robert Vonada of Pennsylvania Workers’ Compensation Journal reports that PA courts upheld compensability in the case of a home health nurse injured while traveling to her patient’s home. The case was complicated by the fact that she provided services to several employers in the course of her day.
Safety – BLR’s Daily Safety Advisor offers tips on Getting the most from your safety committee.

News roundup: Cavalcade of Risk, comments, lunch breaks, and quick takes

Thursday, June 22nd, 2006

Risk roundup – The second issue of Cavalcade of Risk is posted over at It’s Just Money. LA Money Guy is the host, and he’s assembled an eclectic array of posts ranging from drug caps to hurricane insurance. Check it out!
Comments – Our apologies if you’ve ever left a comment that didn’t get published here. When emptying several thousand spams from our spam trap this past weekend, we were dismayed to find about a dozen legitimate comments from you, our readers, that had been automatically routed to the spam file. Part of the reason we re-designed the site a few months ago was to incorporate a better comment filter – we get hundreds of trash comments each week, some quite vile. We thought things were working out quite nicely, but realize now that it’s been a little more aggressive than we intended. Our sincere apologies – we look forward to and appreciate your comments! We rescued about a dozen comments and rightfully restored them to the posts where they belong. We made further adjustments to the filter and hope that will do it, but we’ll be checking more carefully going forward so that we don’t lose any of your comments.
Lunch breaks – Are your employees covered by workers compensation when they are out of the office on a lunch break? Yes, according to a new ruling by the Maine Supreme Court as reported by Mark Hoffman in Business Insurance. In this case, the employee slipped on icy steps as she entered the building. The insurer contested the case on the basis of the going and coming rule, which holds that employees aren’t usually covered on their routes to and from work. However, courts often award compensation to workers who are injured in company parking lots or other areas in or around the workplace. (See our prior post on Exception to the “going and coming” rule: operating premises.) In this case, there was an additional twist: the employer was renting the office, and part of the rental contract stipulated that the landlord would keep the walkways clear of ice. Regardless, the employee’s injury would still be compensable. If the employer or insurer would like to try to recoup the costs from the third party through subrogation, that’s another matter. (Read the full court decision: Robyn D. Fournier v. Aetna, Inc., et al.)
Meatpacking hellConfined Space brings our attention to a recent series by Bob Herbert in the New York Times reporting on the brutal and dangerous working conditions at Smithfield Packing Company in Tar Heel, North Carolina. Because these are subscription only articles, we’ll link to Jordan’s two posts: Where the workers come last and Walking Into The Pit Of Hell. (See also: Blood, Sweat, and Fear: Workers Rights in U.S. Meat and Poultry Plants). Now the workers are taking their case for safety and basic worker rights the public.
Medical blogs – If you enjoy learning about emerging medical technologies, then Medgadget is the blog for you. There’s always some fascinating matter to be found. And for another interesting blog by a medical professional, check out the always fresh Emergiblog, a blog we found when Kim, a nurse who runs the blog, left a comment in one of our posts. Today, she kicks off the first edition of Change of Shift, a nursing blog carnival.
Quick takes

Exception to the “going and coming” rule: operating premises

Monday, July 18th, 2005

I was catching up on back issues of Business Insurance this past weekend and came across an interesting recent decision by the Supreme Court of Kentucky involving the going and coming rule.
By way of introduction, the going and coming rule has to do with employees traveling to and from work. Generally, any injuries that an employee would suffer while traveling to and from work would not be compensable. There are several exceptions to this rule and the case of Warrior Coal Company LLC v. Stoud (pdf) offers an illustration of one such exception.
This case dealt with a worker who was driving his own vehicle to work and who turned onto a private access road leading to Cardinal Mines. This road was owned by his employer, used exclusively by the company, and was part of the company’s operating premises. While driving on the access road, the worker fell asleep, drove off the road, and hit a tree, sustaining a neck injury. The employee filed a claim for benefits, which his employer denied, stating that the employee’s injuries were not caused by employment and that “falling asleep was a substantial deviation from the employment.” However, an Administrative Law Judge determined that the worker was indeed eligible for benefits and this decision was upheld by the Court of Appeals. The employer subsequently appealed to the Supreme Court of Kentucky, where the prior decision for compensability was upheld.
In finding for the employee, the court noted the exception to the going and coming rule when an injury occurs on an employer’s operating premises:
“The theory for the exception is that coverage should apply when an injury arises from a peril that is related to the employment, regardless of whether it occurs at the actual worksite. Consistent with the theory, an injury that occurs while the worker is on a personal mission that substantially deviates from the employment is not viewed as being work-related even if it occurs on the employer’s operating premises … But an injury is compensable if the worker is engaged in normal coming and going activity at the time it occurs and has access to the place where it occurs because of his employment.
In this case, the court did not see falling asleep as a sufficient deviation from employment.
Other common exceptions to going and coming rule
Workers comp has many gray areas and every state has different laws. Even when states have similar laws, courts can interpret them very differently. The following are common exceptions to the going and coming rule, but you should check with the law in your state.

  • Salespersons, visiting nurses, and other workers who spend a great deal of their time on the road or on call. Because travel is an integral function of the job for these employees, and because they do not operate from a fixed locale, they are often exempt from the going and coming rule.
  • Supplied transportation. When an employer supplies a vehicle or pays for transportation, any injuries tht occur are often found to be compensable.
  • Business travel away from home. Courts are generally liberal in determining compensability for accidents occurring during business travel away from home. Injuries that occur during recreational pursuits or other activities may be deemed compensable while traveling away from home, even if these activities would not be deemed work-related at home.
  • Driving in a “zone of danger” or an area of special hazards. Such a situation might occur if an employee has to drive through a particularly dangerous area, such as a blasting zone or construction site, to get to work.
  • Dual purpose. An example of this would be an employee who is driving home from work and performing an errand for the employer on the way. If the employer is deriving benefit from the employee’s actions, any injuries that occur may be compensable.

More information:
Compensability: Driving “To and From”
Compensability: Deviation From Employment and “Personal Comfort” Doctrine
Extreme Commuting: Not Exactly the Sporting Life
Course and Scope: A Case of Flag Waving
Where the Rubber Meets the Road: Risk Management for Employees Who Drive