Accidents Arising out of and in the Course and Scope of Employment in Florida Workers Compensation
In Florida workers compensation claims it is not uncommon for the workers compensation carrier to deny payment lost wages and medical benefits claiming the injured worker did not have an accident arising out of and in the course and scope of employment. In fact, the defense "did not sustain or have an accident arising out of and in the course and scope of employment" suggests several things. Did the employee not have an "accident"? Did the accident happen but it didn’t "arise out of" the employment. Did an accident happen which arose out of the employment but it was not "in the course and scope" of employment? An "accident" is relatively straight forward. It is an unexpected or unusual event or result happening suddenly resulting in injuries to the worker. (There are two exceptions to the definition. The first is a repetitive trauma injury and the second is an occupation disease which are unusual but still happen.) The terms "arise out of" the employment or job duties means something different. For example, if the employee fell at work, the insurance company may be claiming the fall was caused by vertigo which was a personal condition for the employee and had no connection to the job duties. If the employee was attacked at work by their spouse, the insurance company may mean the attack had no connection to the job duties and is not covered by the workers compensation law. The insurance company may be taking the position that the accident and injuries have occurred and they have arisen out of the employment but the employee was not acting in the "course and scope" of their employment when the accident and injuries occurred.
For instance, if the employee is a delivery driver in a company van and on the clock at the time of the motor vehicle accident, the injured worker typically receives workers compensation benefits. However, if it is shown that the driver drove thirty miles off his assigned route to place a bet at the horse track where his accident occurred, his activities are not in the course and scope of his job. The terms "accident","arising out of" and "course and scope" of employment are each legal terms of art.
If your workers compensation claim has been denied because the workers compensation insurance company is claiming you did not have an accident arising out of and in the course and scope of employment you should speak with an attorney who specializes in Florida workers compensation law.