When you become hurt or sick due to your job, there are some confusing terms you may encounter as you navigate workers’ compensation, the program that provides medical and wage loss benefits to employees injured at work. A workers’ compensation attorney can guide you through the process and explain any jargon that comes up, but it can be helpful to have some knowledge of common terms as you prepare to file your claim. This is especially true when the terms pertain to your eligibility to collect workers’ compensation benefits. AOE and COE are two terms you will encounter often as you fill out the forms required to file a workers’ compensation claim.
WHAT IS AOE AND COE IN CALIFORNIA WORKERS’ COMPENSATION?
AOE stands for “arising out of employment” and COE stands for during the “course of employment.” To be eligible to receive workers’ compensation benefits including medical treatments, disability benefits, vocational rehabilitation, and death benefits, it must be shown that an injury or illness both arises out of employment and occurs during the course of employment. Here’s a closer look at the implications behind these two terms.
AOE, ARISING OUT OF EMPLOYMENT
In order to receive workers’ compensation benefits, an employee must prove that his or her injury resulted from employment activities. The workers’ compensation system approaches AOE from a position of risk and causation. If an employee’s job exposes him or her to an increased risk of harm as opposed to a general member of the public, being employed in that job can be causally linked to the injury in question.
For example, construction workers are exposed to powerful tools and heavy machinery on the job. This puts them at a higher risk for injuries due to malfunctioning equipment than the general public. If a construction worker suffers a crushed limb due to a forklift accident, the injury would be considered to have arisen out of employment; the causation is tied to the specific risks of working on a construction jobsite.
COE, DURING THE COURSE OF EMPLOYMENT
In addition to an injury arising out of employment, it must also occur during the course of employment. To demonstrate that an injury occurred during the course of employment, three conditions should be met:
- The injury occurred while the employee was working
- The injury occurred at a location related to work activities
- The injury occurred while the employee was performing duties on behalf of or for the benefit of the employer
Let’s demonstrate COE using the example above of the construction worker who suffered a crushed limb due to a forklift accident. For the employee to collect workers’ compensation benefits, the injury must have occurred while the worker was on the clock, it must have occurred on the construction site he or she was assigned to, and it must have occurred while the worker was performing a work-related task.
Unfortunately, even when all of these conditions are met, there are some instances when a workers’ compensation claim can be denied.
WHY WAS MY CLAIM DENIED EVEN THOUGH MY INJURY WAS RELATED TO WORK?
Certain conditions can disqualify an employee from having his or her workers’ compensation claim approved. This is true even if the injury occurred at work while performing job-related duties. A workers’ comp claim can be denied if you were injured:
- While intoxicated
- Intentionally by your own doing
- By starting a fight
- While committing a felony
- During a voluntary recreational event, like a company picnic
- While engaging in horseplay
- While commuting to or from work
- While on a lunch break
If you suffered an injury at work and your workers’ compensation claim was denied, you can file an appeal to the Workers’ Compensation Appeals Board. At your hearing, an appeals judge will listen to both sides of the case and make a decision as to whether your claim should be paid. Whether or not you need to file an appeal, working with a workers’ compensation attorney from the beginning of the claims process can be extremely helpful in developing a strong case and receiving the maximum benefits you’re entitled to.
CALL A SAN DIEGO WORKERS’ COMPENSATION ATTORNEY
At The Law Office of Matthew Russell, our workers’ compensation attorneys have decades of collective experience defending injured workers in San Diego and the surrounding areas. We’d be honored to help you, too. Call our office today at (619) 544-1506 to schedule your free initial consultation.