AOE/COE: Should That Claim Be Accepted?

Accidents in the workplace sometimes occur without warning or notice and often when the employee is doing something outside the scope of their regular work duties. When an employee is injured and it is determined that the injury occurred outside the scope of regular work duties it is denied based on AOE/COE determinations. This is important to know, as some claims may seem to be compensable, but due to AOE/COE considerations the claim is denied and the employee sometimes feels let down.

AOE/COE is defined as “arising out of employment, in the course of employment.” To be compensable, a workers’ compensation claim must have arisen out of the course of employment. This requires that some sort of connection exist with the employment and the injury, so that the injury is not separate from the employment.

It may be easier to think in a way that looks at whether the activity that caused the injury is related to required job duties. For example, you may have a clerical worker who makes your daily deposits. During one such trip she deviates from her routine to drop off her personal insurance payment. On the way out of the insurance agent’s office, she slips and falls. She believes she should be compensated through workers’ compensation as she was making the daily deposits at the same time. However; because she deviated from her job responsibilities and chose to also include her dropped off payment, she was injured performing an activity that was not required as part of her regular job duties. The claim would be denied, based on AOE/COE considerations.

It is important to have your employees understand that when performing daily job responsibilities that only the performance of work activities are covered under your workers’ compensation coverage. Help them keep work and personal business separate so this type of issue does not arise.

You may also find it important to consider this information when completing your accident investigation report. Often, when an accident occurs outside specific work duty responsibilities, it is outside the control of your accepted safety program and difficult to recommend a solution. This may be a way to show what outside activities cause injury to your employees, working to keep them involved in activities that are performed safely within the workplace.

For more information on AOE/COE determinations you can contact your self insured group’s third party administrator, Associated Risk Management, Inc. at (800) 935-0640.