If an injury happens at work, does the injured employee always get workers’ comp benefits?
In New York, the law sets a presumption that the injury arose out of employment and that workers’ compensation benefits are available.
But here’s the thing: That presumption doesn’t always apply; it’s not absolute. Instead, the presumption that an injury that indisputably occurred in the course of employment also arose out of employment is rebuttable. That means the injury is compensable unless there is substantial evidence to show that it did not arise out of employment.
In cases that involve assaults at work, the question of whether the employee’s injury arose out of their employment can be particularly tricky to answer.
New workers’ comp decision
New York’s highest court recently issued a decision to clarify how the rebuttable presumption favoring coverage operates in practice.
The injured employee in this case is Justin Timperio, who was working as a first-year resident at Brox-Lebanon Hospital at the time of his injury.
Timperio was working in the hospital when former employee Henry Bello hid an AR-15 rifle under a doctor’s white medical coat, entered the building and opened fire.
Bello killed a doctor and wounded five other medical staffers, including Timperio.
Bello and Timperio never worked together and did not know each other.
The hospital requested an administrative decision from a workers’ compensation board to establish a claim under the state’s workers’ compensation law. While that matter proceeded, Timperio sued the hospital, alleging negligence.
Shooter’s motivation is relevant
In the negligence case, the court rejected the hospital’s bid for dismissal, finding there was no evidence that the shooting was motivated by work-related differences. It then delayed further action pending resolution of the workers’ compensation matter.
Then, a workers’ compensation judge determined that Timperio’s injuries were compensable under state law.
That’s not the result Timperio wanted; instead, he wanted the judge to find that his injuries did not arise out of employment because that would enable him to proceed with his separate negligence lawsuit.
An intermediate state appeals court reversed the worker’s compensation judge’s determination. It ruled that Timperio’s injuries were not compensable under workers’ compensation law because there was no evidence that the shooting was motivated by “employment-related animus.” In other words, it ruled that workers’ comp benefits were not available because there was no showing that the shooting had anything to do with a work-related issue. This rebutted the presumption that Timperio’s injuries arose out of his employment, it found.
The case then reached the state’s highest court for further review.
The state’s highest court reversed the lower court’s decision and decided that the presumption favoring workers’ compensation coverage was not rebutted. It agreed with the workers’ compensation judge who concluded that Timperio’s injuries were compensable under the state’s workers’ comp law.
Workers’ comp presumption is strong
The reviewing court explained that the presumption in favor of workers’ comp coverage is strong, noting that it takes substantial evidence to rebut it.
Essentially, for workers’ comp coverage to be denied, it must be shown that it was not the workplace itself that exposed the employee to injury.
Here, there was a lack of evidence as to the motivation for the shooting. When that is the case, the court said, the presumption in favor of workers’ comp coverage is not rebutted. Instead, it said, the presumption is triggered.
There was not substantial evidence that the assault was motivated by “purely personal animosity,” the court explained. For workers’ comp coverage to be triggered, it explained, there does not need to be an affirmative showing of a nexus to employment.
The intermediate appeals court wrongfully disturbed the initial finding in favor of coverage, the court ruled.
Preventing workplace violence
The Occupational Safety and Health Administration (OSHA) offers a number of resources to help employers prevent workplace violence. OSHA advises employers to:
- Establish a zero-tolerance policy with respect to workplace violence
- Assess worksites to identify ways to reduce the likelihood of an incident occurring
- Establish and implement a workplace violence prevention program
- Implement engineering controls, administrative controls and training.
The case is Matter of Timperio v. Bronx-Lebanon Hospital, No. 46, 2024 LEXIS 626 (N.Y. 5/16/24).
