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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.

In This Issue

CLAIMS
SAFETY

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Dear Adjuster,

I am an employer for a local pizza company.  We are going to be participating in the Taste of Downtown, a local fundraiser that provides food sampling of 35 restaurants in the area.  Since most of our employees will be working at the restaurant on the date of the event, we would like to have our friends help us with the sampling downtown.  If one of our friends was to be injured while helping us, would our worker’s compensation insurance cover their injury?

Signed, Just Wondering

Dear Just Wondering,

Pursuant to Nevada Revised Statutes 616A.075 “Casual,” defined refers only to employment  where the work contemplated is to be completed in 20 working days or parts thereof in a calendar quarter, without regard to the number of persons employed, and where the total labor cost of the work is less than $500. 

Since your friends were only going to work for you for this event and you were not planning on paying them, these friends would not meet the statutory qualifications of an employee, therefore they would not be covered under your workers’ compensation policy.  We might suggest, however, that you speak with your liability insurance carrier to find out if they have an exposure from this aspect.


Dear Adjuster,

I am an employer in your Transportation group.  I have a driver who was sleeping in his truck in between driving and says he was bit by a spider.  He required treatment and I need to know if my workers’ compensation policy will cover this incident?

Signed, Worried

Dear Worried,

Pursuant to Nevada Revised Statues 616C.150, An injured employee or his dependents are not entitled to receive compensation pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS unless the employee or his dependents establish by a preponderance of the evidence that the employee’s injury arose out of and in the course of his employment. It is very hard to prove by a preponderance of evidence that a spider bite definitely happened while the employee was at work, therefore without this evidence this claim would be denied.  One test to the course and scope rule is whether or not the employee is paid during the time he is sleeping and whether or not this activity is within his established job duties.

Submit Claims questions to Kelly Woodward at
Pro Group Tel: (800) 859-3177,
Fax (866) 439-9701 or email: kellywoodward@pgmnv.com


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NTNSIG NEWS  
 

NTNSIG NEW MEMBERS

Beresovoy Custom Welding
Central Cal Transportation
NORVIC Demolition Inc.
Priority Grading
Ruby Mtn. Construction Inc.

For those of you who are new members, have new employees handling claims, or just missed the previous workshops...

Pro Group Management has scheduled Claims Workshops via Video Conferencing to take place on the following days in our Carson City and Las Vegas offices unless otherwise noted.

Seating is limited.

REGISTRATION - To reserve your seat for the training, please call Jackie Vogel at 1-800-859-3177
Register online, View Live Reservation Form (PDF) or fax this form back to Pro Group Management.

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Site Specific Safety Training

Site specific training is available for group members planning to provide training to 5 or more employees, (excluding CPR First Aid Certification which requires a guaranteed Minimum of 10 employees & a Materials Fee per Attendee).

Contact PGM Safety Services at 800-859-3177 to discuss your specific training needs.

"If you think training is expensive,
try ignorance!"

See Site Specific Training List (PDF)

See Safety Training Insert for
Specific Class Locations and Times

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PGM Safety Services  

NPGA Issues Safety Alert on Anhydrous Ammonia and Propane Cylinders

The National Propane Gas Association (NPGA) has issued a safety alert that may impact employers and employees at propane cylinder exchange and filling stations, as well as response personnel involved in methamphetamine raids and cleanup operations. The alert addresses the hazards of cylinders used in meth labs to store and use anhydrous ammonia. When the cylinder's valve comes in contact with anhydrous ammonia, a "violent, unexpected expulsion of the valve" may occur, resulting in serious injury or death. Refer to the alert, or contact your local OSHA office for more information on properly handling and disposing of these cylinders.

EPA to Study Formaldehyde Use in Pressed Wood Products

EPA officials announced that they are launching a broad effort to gain a greater scientific understanding of the potential health risks of formaldehyde's use in pressed wood products.

Through this process, the agency will develop risk assessments on the potential adverse health effects, evaluate the costs and benefits of possible control technologies and approaches, and determine whether EPA action is needed to address any identified risks, officials said.

The agency plans to issue an advance notice of proposed rulemaking (ANPR) in fall 2008. The agency is pursuing this course of action following review of a petition submitted under the Toxic Substances Control Act (TSCA) by the Sierra Club, a number of other environmental organizations, as well as a large number of private citizens. The petition requested that EPA adopt nationally a California regulation to control formaldehyde emissions from composite wood products and extend the rule to include composite wood products in manufactured homes.

Exposure to formaldehyde can cause watery eyes, headaches, depression and cancer, Sierra Club officials said. People with existing respiratory conditions such as asthma and emphysema have an increased risk of reacting to formaldehyde, which can leach out from plywood, particleboard and fiberboard used in manufactured housing.

Becky Gillette, national formaldehyde campaign Director for the Sierra Club, said, "While disappointed that EPA set an improperly high standard to begin rulemaking, Sierra Club and the other petitioners applaud EPA's alternative approach to addressing the challenge of formaldehyde. We will actively support and monitor EPA's work on this important issue. For the health of all Americans, we need to move now."
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PGM Safety Services  

Ergonomics Issue that could affect work performance.

Tips to Minimize Golf-Related Injuries

Swinging the club on the open green, hitting the perfect shot and playing in the warm sun are just a few things golfers love about hitting the links. Golfing can be a treat for both the mind and body. However, an injury to the bones, muscles or joints can cast a big shadow over the day. That is why the American Academy of Orthopedic Surgeons (AAOS) recommends following the proper techniques to prevent golf-related injuries.

AAOS stated that according to the U.S. Consumer Product Safety Commission:

  • There were more than 103,000 golf-related injuries treated in doctors' offices, clinics and emergency rooms in 2007, which incurred a total cost of approximately $2.4 billion in medical, work-loss, pain and suffering, and legal fees.
  • Golfers most often suffer from hand tenderness or numbness; shoulder, back and knee pain; golfer's elbow; and wrist injuries, such as tendonitis or carpal tunnel syndrome.

"People often think of golf as a relatively safe, low-injury game," said Bobby Chhabra, MD, orthopedic surgeon and member of the Academy's Leadership Fellows Program. "Golfers -- especially beginners, who haven't learned proper techniques yet -- are more susceptible to injuries from overuse and poor mechanics. It's important for golfers to regularly participate in a muscle conditioning program to reduce the risk of common golf injuries."

Because orthopedic surgeons not only treat, but try to prevent injuries of the bones, joints and muscles, the AAOS offers the following tips to help prevent golfing injuries:

  • Newer golfers should take lessons and begin participating in the sport gradually.
  • Practice on real turf instead of rubber mats, when possible.
  • Dress for comfort and protection from the elements. Make sure to wear the appropriate golf shoes: ones with short cleats are best.
  • Do not hunch over the ball too much; it may predispose you to neck strain and rotator cuff tendinitis.
Avoid golfer's elbow -- which is caused by a strain of the muscles in the inside of the forearm -- by performing wrist and forearm stretching exercises and not overemphasizing your wrists when swinging.
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Quick Tips

Summer thunderstorms often leave behind downed trees and branches, placing tree removal crews very much in demand. When power lines are involved, there can be a number of hazards inherent in tree trimming or removal of debris. Employees working to clear away trees should have an understanding of proper safety measures. Here are a few recommendations from OSHA:

  • Do not do any tree trimming or removal work within ten feet of a power line unless you are a trained line-clearance tree trimmer.
  • Do not trim or remove trees in hazardous weather conditions.
  • Only use heavy equipment, such as chain saws, if you have received proper training to operate it safely.
  • Determine the tree's falling direction before cutting it down

OSHA's Tree Trimming & Removal QuickCard® (English/Spanish) is a useful resource explaining some of the precautionary measures that employees should take to protect themselves when clearing away trees. OSHA's Safety and Health Topics Page for the Tree Care Industry also offers information for cleanup employees and others who work with trees to help prevent injuries at their worksites.

 

 

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Group Self Insurance
575 S. Saliman Rd.
Carson City, NV 89701

1-800-859-3177

SIG ALERT

A Publication of Pro Group Management, Inc.

This Newsletter is published for members of the self insured groups administered by Pro Group Management, Inc.
Reproduction for member use is encouraged

Did you know that Pro Group Management receives over 100 requests for Certificates of Coverage a day. When requesting a Certificate of Coverage please take a minute to check and make sure that we are getting all the information that is needed to assure the correctness of your certificate

 We have recently changed the fax number for Certificate requests. The updated  form shows the new number as well as an e-mail address for those that choose to request certificates via e-mail.

Most important of all, make sure your COMPANY NAME is clearly noted.  Many certificates are delayed because we have no idea who a specific person is without a Company Name or phone number being referenced.

You will find the current request form as a link in this month’s SIG-Alert. If you find you need more information regarding certificate requests, please contact Phyllis Priester of Pro Group Management  at 800-859-3177 ext. 202

 

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