Fainting on break - covered?

cbcolorado · April 2004

We're in Colorado and had an employee pass out while she was on her 10 minute break. An ambulance was called because we could not wake her and she was taken to the hospital- not sure what the outcome is as this happened last night. Assuming it had nothing to do with her work environment (she is a crew member at a Taco Bell) would the ambulance ride (and if any injuries) be a work comp issue? Thanks!

Balloonman · April 2004

I would have her submit all claims to her health insurer. Unless there is something work related that caused her to pass out, which is unlikely. State law might say that any actual injuries are covered under WC, but I still would not submit a WC claim.
My $0.02 worth!
DJ The Balloonman

Don D · April 2004

[font size="1" color="#FF0000"]LAST EDITED ON 04-29-04 AT 03:58PM (CST)[/font][br][br]I do not think any of us is in a position to second guess what may or may not be determined ultimately workers comp. I would file the claim and let the people you pay to make those decisions make them. If she files it as a personal insurance claim, the forms will ask if it were at work. Let the two companies subrogate. That's not an HR function. An injury need not be 'work related', it only need occur at the workplace, during the course of employment. An employee injured on break, whether they have a medical condition or not, need not necessarily be impacted by unsafe conditions or employer liability in order for it to be comp. It's the same as if I'm strolling down the hallway and bust my head against a door facing and it was obviously my fault. At least in this state.

Hunter1 · April 2004

Do check your state work comp law. In WI, I don't believe that your incident would be work comp. It has to be attributable to an incident or exposure at work, not just happen in the workplace.

njjel · May 2004

Are you employees being paid while they are on the 10 minute break? I would file the claim w/the insurance carrier in any case and let them make the decision whether or not it is compensable. This way you have all the bases covered.

Beave · May 2004

Don's advice is right on the money, as they say. Check CO work comp regulations. Here in Michigan, I would believe your employees incident would be covered under WC. Submit the claim to your WC carrier & let them sort it out. Good luck.

National Guard · May 2004

All of my previous training says that breaks are indeed covered for WC. A break is paid time and therefore the company is liable. The best phrase I heard from a DOL person is that stupidity is covered under WC. In other words even if the accident was somehow the ee's fault it is still compensable under WC laws. The company would have to prove that the accident was willful and premeditated (with a record of written warnings where the ee had done the same thing before as was warned that it was a safety violation) in order to not have to pay WC.
The example DOL uses is that an ee is leaving to go to lunch and it it the middle of winter and the sidewalks still have patches of ice on them. The ee slips on the ice and braeks an arm - it is covered. THe ee was stupid for walking on the ice when he could have walked around the ice but he is still covered.

sonny · May 2004

Are we to assume the lunch hour is paid? Otherwise wouldn't it be covered under coming and going and not compensable? If not I got jipped out of a 50 buck er copay and 2 days sick pay. $$$

Don D · May 2004

Workers' Compensation programs are state statute driven and have no operational/policy oversight by the federal government. Why would DOL be giving WC advice on what's covered or not? I disagree also that an employee off the clock on his way to lunch who slips on a sidewalk would be a covered comp issue. My recommendation to our carrier would be to disapprove it and have the ee file on his personal insurance. Although we would file the claim with our casualty/liability carrier rather than comp, if and only IF, the sidewalk is owned by the company.

sonny · May 2004

DARN! I agree with Don but was hoping for that $x:D

National Guard · May 2004

Well, I realize that states have WC laws but Congress and others still, decided a long time ago that states still had to come up with WC policies and that WC IS A RIGHT NOT A BENEFIT. And stupidity is still covered!

sonny · May 2004

NG.. if stupidity is covered does that mean I can go back and get my $? x;-)

National Guard · May 2004

I'd say yes Sonny. Even though lunch hour itself is not covered - it is the same as arriving and leaving for work. If you fall on the way in to work or when leaving - it should be covered.

sonny · May 2004

I'm delighted, but surprised. Do the rest of you agree? Just curious. .this was over a year ago and my boss would never go for it. .

njjel · May 2004

I disagree with the above post. If an employee is injured walking into work and he is not on the clock, the employer is not responsible via worker's comp. The er would only be responsible if they owned the property and then it would be filed with the er's liability carrier and not wc. At least that's how it is in NJ.

juju · May 2004

We had the same situation a few months back (2 employees fell on ice while entering the building for their shifts). Here in PA, it was covered under WC.

sonny · May 2004

That's how it worked here Njjel. .Except I didn't turn it into our carrier cuz they would have denied it. . I stepped wrong off a curb and it was no one's fault but my own. x:-8

Don D · May 2004

That's how it worked here Njjel. .Except I didn't turn it into our carrier cuz they would have denied it.

The whole point is that you do not know that. Employers have an obligation to file comp claims. At least in this state, the employer does not have the liberty to lounge around and make assumptions about what it thinks might be approved or not approved. If that were the case, there would be no need for Comp Claims Investigators and claimstakers.

sonny · May 2004

I was talking about the liability carrier not comp.. .I was off the clock, going to lunch. Otherwise I agree with you.

mushroomHR · May 2004

Here is Ohio if you fall on your way to or from work on the employer's property it is WC. We've paid many a claim on this issue.

sonny · May 2004

I guess I should have been a clutz when I still lived in Ohio x:D

Fainting on break - covered?

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