In many cases individuals claim to have been hurt at work but they do not know whether what happened qualifies as workers’ compensation injury under North Carolina law. In the recent decision by the North Carolina Court of Appeals, Allsbrook v. Illinois Tool Works/Wilsonart, we find a very good discussion of the legal standard that applies in most North Carolina workers’ compensation claims: the “injury-by-accident” standard.
What Are The Primary Benefits Under NC Workers’ Compensation Law?
If an employee has a North Carolina workers’ compensation injury, their employer (almost always through an insurance company), will have to provide (1) medical treatment and (2) lost wage benefits to the injured employee, among other benefits. All North Carolina employers with at least three employees must provide workers’ compensation benefits. When an individual needs medical treatment and cannot work due to their injury, knowing if they are entitled to workers' compensation benefits is crucial.
What’s An Injury-By-Accident?
Under the “injury-by-accident” standard, an employee’s injury is compensable (entitling them to workers’ compensation benefits) if (1) the injury took place “in the course and scope” (2) of their assigned work duties and (3) was caused by something unexpected that happened during the work duties. In other words, there needs to be an injury caused by something unexpected that took place while the employee was working. This is how North Carolina defines an “injury-by-accident” for purposes of workers’ compensation.
The Key Facts of the Allsbrook Case
In the Allsbrook case, Mr. Allsbrook worked as a “saw helper” at an Asheville area company which manufactures kitchen and bath countertops. The primary dispute in this case was whether Mr. Allsbrook was doing his normal job in the normal manner when he felt a pop in his chest. Mr. Allsbrook suffered a pretty significant injury, requiring surgery to his right shoulder and sterno-clavicual joint, among other problems. This injury has caused him to be out of work since 2009.
Mr. Allsbrook worked as part of a team which cut the countertop materials to specific lengths using large industrial saws. At the hearing, Mr. Allsbrook testified that he was using an older, manual saw that was rarely, if ever, used for his job. However, the injury report from the employer stated Mr. Allsbrook was using a newer, less physically demanding saw when he felt pain.
Probably the most crucial evidence came from Mr. Allsbrook’s own lips. Early on, he gave a recorded statement to the insurance company. He agreed that he was doing his normal job in the normal way when he felt pain near the end of his February 26, 2009 shift. At the original hearing, Mr. Allsbrook’s former manager, who no longer worked for Wilsonart, testified that the saw which Mr. Allsbrook was using on the day of the injury was very much in regular use by Mr. Allsbrook in doing his job. There was similar testimony from the plant manager for the employer.
At The Commission Hearing
When this claim was heard by the North Carolina Industrial Commission, the original hearing officer (called a “Deputy Commissioner”) decided to believe the testimony and evidence that Mr. Allsbrook was doing his normal job in the normal way when he felt the pain in his chest. Thus, she ruled that Mr. Allsbrook did not have a compensable claim. Because his injury was not caused by an “accident" that occurred while he was working he was not entitled to have his medical bills paid through workers' compensation. Nor was he entitled to recover any lost wages from the insurance company.
Thereafter, Mr. Allsbrook’s case was heard on appeal by three Commissioners at the North Carolina Industrial Commission, who are part of a group of individuals who make up The Full Commission. The Full Commission had the option to re-consider all the evidence and was not required to rule the same way as did the Deputy Commissioner. They could have decided that the weight (or majority) of the evidence proved Mr. Allsbrook injured his shoulder due to an “injury-by-accident.” However, they agreed with the Deputy Commissioner, and ruled against Mr. Allsbrook. The Full Commission ruled that Mr. Allsbrook was not entitled to any worker’s compensation benefits.
At The NC Court of Appeals
This week, the North Carolina Court of Appeals also ruled against Mr. Allsbrook. However, they were applying an entirely different legal standard. At this point, the judges simply asked whether there was any credible evidence on which the Full Commission had relied in ruling against Mr. Allsbrook. In this instance, there was clearly good and credible evidence on which both the Deputy Commissioner and the three member panel of the Full Commission relied.
In my judgment, Mr. Allsbrook’s early statement to the insurance adjuster, that he was doing his normal job in the normal way when he felt this pain, was probably the decisive factor.
What If Mr. Allsbrook Had Hurt His Back?
What you might find puzzling is that, if Mr. Allsbrook had injured his back, rather than his shoulder in this case, he would almost certainly have won. There is a lower, and easier to meet, standard for a compensable back claim in North Carolina: the “specific traumatic incident.” No accident is required to meet this standard.
Both employees and employers need to understand these legal issues. If you have questions, please consider consulting with an attorney who handles North Carolina worker’s compensation claims to understand this issue and the various rules that apply to specific types of injuries in the workplace.