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Workers' Compensation Fills a Void

December 26, 1985|JEFFREY S. KLEIN

When does your job end and your personal life begin?

That may not seem like a question for lawyers and judges, but in fact, it is a common legal issue in workers' compensation cases.

The workers' compensation system was set up in California in 1911 to give employees automatic payments for on-the-job injuries. Before that, employees who were injured had to sue their employers just like anybody else. They had to prove that the employer was negligent and then could win whatever a jury thought was fair.

Risk of Losing

Under common law at the time, they risked losing the entire recovery if their injury was due, even in part, to their own carelessness.

The workers' compensation system was a trade-off. It was intended to keep employees out of the courtroom but still be fair by awarding just, but limited, compensation promptly.

Under the workers' compensation system, an employee is generally entitled to receive certain scheduled payments or benefits as well as money for medical fees, but the employee may not receive payment for "pain and suffering," the kind of unlimited payment ordinarily awarded in a civil lawsuit for negligence.

Although the employee does not receive as much in the way of money damages, it is easier to receive some payment; the employee does not have to prove that the employer was negligent. You are entitled to workers' compensation benefits as long as your injury arose "out of and in the course of the employment."

Sounds easy, right? If you're injured on the job, you receive benefits. If you're injured while you're playing baseball with the neighbors, no benefits.

But it's never as easy as it seems when lawyers are involved. What if you hurt your finger while you're playing on the office baseball team?

That's what happened to Marilyn Ezzy in 1980. She was working as a law clerk for a Northern California law firm. She testified that she was "drafted" to join the office team, which needed four women to remain in the league. The coach was a partner in the firm, which paid for the post-game pizza.

A California Court of Appeal found that Ezzy honestly believed that her participation on the team was expected by her employer--and that her belief was a reasonable one in the circumstances. Although she had struck out at the workmen's compenstion board, the court ruled that she was entitled to benefits to cover her injury. Off-duty sports activity, the court said, is considered part of the job and covered by workers' compensation benefits if it is required or "reasonably expected" by your employer.

The job site may include the baseball diamond, but the California Supreme Court recently said it does not usually extend to your own home, even if you're working overtime there.

In this case, a widow contended that she should receive death benefits because her husband, a Santa Rosa Junior College mathematics teacher, died in a 1982 car accident while commuting home.

Ever since a 1916 case, the Court had ruled that workers' compensation did not apply to accidents that occurred while "going to or returning from" work. But the college professor's widow contended that he was actually going to a second job site, his home, because he was bringing home students' papers to grade when the accident happened.

Rejected Argument

The court refused to accept this argument, saying it did not want to create a "white collar" exception that could apply to many professionals such as the draftsman who "designs on a napkin" at home, the businessman who "plans at breakfast" and the lawyer who "labors in the evening."

In another California case in 1964, a bus driver was injured during a coffee break. She was across the street from the bus station during a 41-minute layover when she was assaulted. Her employer argued that she could have purchased coffee from a vending machine and taken her break in the terminal--so the trip to the coffee shop should not be considered within the course of her employment. But the court disagreed and ruled that she should receive workers' compensation benefits.

As you can see, the crucial issue in these cases is whether the injury occurred on or off the job. If it was on the job, there will be an automatic no-fault payment. If it was off the job, you'll have to go to court to prove whose carelessness was the cause of your injury.

If you think you have a valid claim, you should check with the personnel or insurance department of your company.

If you believe your claim is denied improperly, you may want to consult a lawyer who specializes in the field. To obtain a list of certified specialists in your county, write or call the State Bar's California Board of Legal Specialization, 555 Franklin St., San Francisco, Calif. 94102. Telephone (415) 561-8265.

Local bar assn. referral services also list lawyers who practice in the workers' compensation field, though they may not all be "certified specialists." In Los Angeles County, call 622-6700.

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