Could you injure yourself at home and submit a workers’ comp. claim to have your lost wages and medical bills covered?
Under very specific circumstances, yes you could.
The general rule in Pennsylvania workers’ compensation law is that a person is only entitled to workers’ comp. benefits if the injury occurs in the course of their employment. This usually happens when somebody gets injured at their workplace. A common exception is if a person is a traveling employee, such as a delivery driver, and is injured in a motor vehicle accident. In this scenario, the driver is entitled to workers’ comp. benefits even though the injury did not occur on the employer’s premises because the injury occurred while the person was doing their job.
A trickier situation arises when a person suffers a work injury that is causing symptoms and restrictions, but subsequently sustains another injury at home – or somewhere else outside of work – and the second injury may have been caused by the original injury. We will give you some examples to illustrate.
Let’s say that you injured your low back while lifting a heavy box at work, and in addition to experiencing pain, you also have weakness in your legs that causes your legs to give out occasionally. Your doctor has told you that, based on a test called an EMG which you underwent, you have nerve damage and that is the cause of the weakness in your legs and occasional giving-out. One day, when you are walking down the steps outside your home, your legs give out and you lose your balance and fall, landing on your head. Your family doctor refers you to a neurologist, who diagnoses you with a concussion. Now, in addition to dealing with back pain and leg weakness that prevents you from lifting more than 10 pounds, you are experiencing headaches, dizziness, sensitivity to light, and difficulty concentrating, all because of your concussion.
Another example: You broke your leg in a work-related accident and were placed in a cast. While you are recuperating, you are confined to a wheelchair and therefore immobilized. You rely on the help of family members to help you on and off the toilet and in and out of the shower. Three weeks after the cast was put on, while watching TV with your family, you pass out, slumping forward in your wheelchair. Alarmed, your family members call 911, and you are transported by ambulance to the hospital where tests show you suffered a blood clot – a pulmonary embolism – that requires emergency surgery to remove the clot. You remain hospitalized for a week, and when you are discharged, you must continue taking medication to prevent future blood clots. Your doctor thinks your blood clot was caused by your immobilization that was the result of the broken leg which you suffered at work.
In each of these scenarios, you would have a strong argument that your injury which occurred at home should be covered under your original workers’ comp. claim because our courts have stated that an injury unrelated to a person’s job is work-related if it is the “proximate, natural, and probable” cause of a prior work injury. In other words, if a condition due to a work injury (weakness, immobilization) directly results in another injury, the workers’ comp. carrier is on the hook.
Don’t be surprised, however, if the workers’ comp. insurance company for your employer denies the claim on the basis that your new injury occurred outside of work. The insurance company may contend that your back injury had nothing to do with your fall at home on the steps – you just lost your balance and fell. Likewise, it may take the position that your immobilization did not lead to your pulmonary embolism – it was caused by some pre-existing condition or just happened spontaneously.
If you find yourself in this predicament, you will need to hire a workers’ compensation lawyer – we strongly recommend Pearson Koutcher Law – to file a petition on your behalf so your case can be heard by a Workers’ Compensation Judge. Your work injury lawyer will present your testimony in which you describe how your condition from your original injury caused your second injury. One of your doctors will also have to testify and explain in medical terms how your second injury is a direct result of your first injury.
The big take-away here for you should be if you have sustained a prior work injury and then you injure yourself outside of your job, do not assume that this will not be covered under your initial workers’ comp. claim. If your doctor believes that there is a causal connection between the two injuries, then you will have a viable claim for the second injury. Whether you sustain one injury or two, it’s important that you have a very experienced and knowledgeable work injury lawyer on your side. At Pearson Koutcher Law, workers’ comp. is all we do. Each of our work injury lawyers has more than 25 years of experience handling workers’ comp. cases, knows the law inside and out, and is dedicated to representing our clients zealously. Please contact our office and let our work injury lawyers’ experience, knowledge, and dedication go to work for you.