Worker’s knee popped walking up stairs: Does she get comp?
August 9, 2010 by Fred HosierPosted in: Injuries, new court decision, Special Report, What do you think?, Workers' comp
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An employee injures her knee just by walking up stairs at work and applies for workers’ comp benefits.
Maureen Shay was a teacher in North Carolina. She normally used the school’s elevator to reach the second floor where her classroom was because it was difficult for her to walk up the stairs.
Then the elevator broke and she had to use the stairs. A month later, her knee gave out while walking up the stairs.
Another month later, her knee pain hadn’t improved. An MRI revealed a medial meniscus tear in her knee.
Shay had surgery and filed a claim for workers’ comp benefits.
The insurance company denied coverage, saying the injury wasn’t work-related.
On appeal, the workers’ comp commission ruled in Shay’s favor and awarded her benefits.
The company appealed to a state court.
Was it an ‘accident?’
In court, both sides agreed that the injury arose out of and in the course of Shay’s employment. However, there was another issue to settle.
Under the state’s Workers’ Compensation Act, an employee is entitled to compensation for an injury only if it is caused by an “accident.”
North Carolina courts have defined accident as “the direct result of a specific traumatic incident” and not part of the employee’s normal work routine.
The court said in Shay’s case, since she didn’t stumble, fall, trip, slip or twist her knee, she didn’t suffer an accident.
Shay tried to argue that, because the elevator broke, walking up stairs to her classroom wasn’t part of her normal work routine.
But the court didn’t buy that argument either. It noted that she’d been walking up the stairs for four weeks before she injured her knee. It said that climbing the stairs for a month became part of her normal work routine.
The court’s final word: Comp benefits denied.
(Shay v. Rowan Salisbury Schools, Court of Appeals of NC, No. COA-09-1587, 7/20/10.)
What do you think about the court’s decision? You can leave a reply below.
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Tags: accident, knee injury, walking up stairs, work-related injury, Workers' comp
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August 10th, 2010 at 11:57 am
I must say that I am surprised by the decision.
August 10th, 2010 at 12:12 pm
SHAME ON NC! She was FORCED to use the stairs because the elevator was broken. Her “usual” was to use the elevator, not the stairs, so it should not be deemed as her “normal work routine”. Is there something we’re missing here?
August 10th, 2010 at 12:21 pm
Love it!! This is rare, in my opinion. Seems like people will file a claim for over just about any pain. I’ve had ones where people were getting into their cars in the parking lot and ones where they just have pain in their feet and believe the concrete floor is to blame. Our insurance co. denies them but I’ve always been afraid that if someone pursues it further, it might be accepted. Glad this one wasn’t.
August 10th, 2010 at 12:25 pm
How would the court rule on a carpal tunnel case, or any other RSI for that matter? I think they are wrong in this matter to say sincce she had not fallen etc. it would not meet the state definition.
August 10th, 2010 at 12:31 pm
Each state has established different set of rules for compensable injuries. In Texas, she would have been awarded compensation benefits.
August 10th, 2010 at 12:31 pm
While I feel for Shay’s pain and suffering I wish that more states implemented the same criteria concerning injury/accident. Great North Carolina court.
August 10th, 2010 at 12:46 pm
SINCE; Under the state’s Workers’ Compensation Act, an employee is entitled to compensation for an injury only if it is caused by an “accident”. & North Carolina courts have defined accident as “the direct result of a specific traumatic incident” and not part of the employee’s normal work routine ” WOULD THIS MEAN WORKER’S COMPENSATION WOULD NOT BE APPLICABLE TO A REPEDITIVE MOTION INJURY (I.E. WORK RELATED CARPEL TUNNEL INJURY) IN NORTH CAROLINA??
August 10th, 2010 at 12:57 pm
Totally Agree with the court’s decision. More decisions should be so soundly based….
August 10th, 2010 at 1:09 pm
I would guess that while North Carolina denied benefits, most states would have accepted the claim and paid benefits as she sustained an injury while in the course of employment. If that same incident occurred in the States of Washington, California, Illinois or Oregon, it would more than likely be covered.
August 10th, 2010 at 1:09 pm
All I can say is AAAAAAAAAAAAAMEN! How absurd and ridiculous for her to file a WC claim! Good on the court!!!
August 10th, 2010 at 1:18 pm
This is a hard call. I can see both sides. It is unfortunate for Maureen, and I do think she should have tried to report it as a comp claim the first time she went to see a doctor, if she did indeed believe it was caused by her job.. Unfortunate, also that N. Carolina, the law says it has to be an incident in order to get benifits. My end opinion is that, If I understand the story correctly, she had a pre-existing condition, and just “happened” to be a work when it blew out. So, I guess I side with the courts.
August 10th, 2010 at 1:23 pm
I’m just curious to know why it would take more than a month to fix the elevator. If they would have been proactive in fixing the elevator, maybe none of this would have happened. What school can go without an elevator and still be in compliance with all disability acts requirements? Was there another elevator she could have used? Lots of questions not answered in the write up.
August 10th, 2010 at 1:27 pm
I believe this would have been covered as a workers comp. case in Illlinois. If it was not the result of an accident, then it could be considered an agrivation of a preexisting condition with her knees. This appears to be more than a sore knee but a tear of a ligament. Did she do other type activities which this could have been caused by?
August 10th, 2010 at 1:29 pm
What nobody has noticed is that Ms. Shay was a teacher and therefore she is an employee of the STATE and their WC doesn’t follow the same process as the rest of the employees in NC. If this had occurred in manufacturing then the claim would have been accepted 100%. We had an employee turn in an accident report 30 days after the occurrence and all during that time the employee denied any accident at work. On day 30 the employee knew exactly what time it happened and what they were doing. The NC Ind. Com. accepted the claim even though we provided documentation of his denial and that he delayed reporting it for 30 days therefore delaying a drug screen for 30 days. So the gist of the story is that the State protects itself from WC claims from their employees while the rest of the manufacturing sector has to absorb these claims.
August 10th, 2010 at 1:40 pm
Wasn’t she a teacher? Don’t teachers have great health insurance? If so, why would she want her work comp carrier to pay for her knee injury?
August 10th, 2010 at 1:49 pm
I want to move to North Carolina. Sounds like they are reasonable!! Anyone need an HR professional in that state?
August 10th, 2010 at 1:51 pm
If you have replied and think it is a bad decision to deny this, you without a doubt don’t own a business or have responsibility to control costs. So if you owned your own company and someone put this claim against you… you are telling me that you would be ok with it? No way! Well you may the first time till you see how much it costs you in the long run and you can’t afford your insurance anymore. It is upsetting that people think everything should be under comp just because it happened at work. I’m glad at least the court made a good decision here. Look… if you have a legit accident caused by your work.. .fine.. that’s what the insurance is there for. It just give me a bad taste because I see so many fraud cases get approved.
August 10th, 2010 at 1:57 pm
Wonderful for NC. Wish more states would incorporate fules like this. It would promote more businesses to start and stay within a state, and would keep the costs low enough to provide better medical coverage for the employees when they did have a similiar injury or personal health problem. WC is not universal health care, although it is treated as such by many people. The employee did not have a health problem (disability) that would have prevented her from walking up stairs, so the company should not be held liable.
It is time that there was some personal responsibility enforced within the courts. Personally, we are at the age when we could assign a percentage of exposure to a job which would distribute the actual exposure responsibility to the appropriate parties.
August 10th, 2010 at 2:09 pm
Way to go NC!
To answer the previous question comparing walking and CTD’s. IMHO, walking/climbing in it’s true form is not traumatic to the legs (it’s what we do as humans). CTD’s are strains/injuries to muscles that are not meant to to be used in such manner (repetative motion) and therefore cause injury.
She should have and had every right to make the school fix the elevator or make accomodations for her under the ADA.
August 10th, 2010 at 2:14 pm
Give me a break! Cant believe this person even tried to claim for WC. I am in favor of the courts ruling.
August 10th, 2010 at 3:10 pm
Interesting. That certainly would have been covered in Texas. I wonder if she’ll file a general liability claim now, where she could end up having all her medical paid for, plus some.
August 10th, 2010 at 3:16 pm
I was surprised at this verdict, but I am remembering a WC case in Illinois many years ago that I could never figure out. A supervisor was walking in the plant and felt knee pain. It was deemed WC because he WAS AT WORK!
August 10th, 2010 at 3:17 pm
LINDA!
You gotta be absolutely kidding me that this is a “hard call!” All due respect, but are you serious? No “accident” occured! Her knee gave out, therefore, was not a valid claim. Very black and white/open and close to me…
Also, why is it “unfortunate” for the state to have reasonable language and criteria for their WC claims like “as a result of an accident?” I think this is great! Why should the state pay for frivolous claims?
August 10th, 2010 at 3:29 pm
Silly claim- she admitted she already had a condition with her knee. To keep going up the stairs when her knee hurt was not the smartest move on her part. I would think a discussion with the school admin re ADA might have made a difference. But to file a claim? That is similar to an employee with a history of back injuries just deciding to lift 70 pounds without assistance or a back support device and then filing a claim. There has to be some individual responsibility- your employer isn’t your mother!
August 10th, 2010 at 3:37 pm
Why was the elevator broken for a month?
August 10th, 2010 at 3:59 pm
I’m in Ohio and I would fight this tooth and nail. Too many bad claims are out there and the cost is herific!
August 10th, 2010 at 4:14 pm
PAUL! I am allowed my opinion. I also said I agreed with courts decision, and please stop yelling.
August 10th, 2010 at 5:50 pm
Reasonable conclusion by the court and probably would have been the same conclusion in Kansas as Kansas also refers to “personal injury by accident” and “the balance of proof is on the claimant” as well as that aggravation of a preexisting condition is only covered to the extent that the injury causes increased disability.
August 10th, 2010 at 6:20 pm
Although wc denied, this sounds like a lawsuit due to ADA laws regarding access to a building.
All public buildings are suspose to be ADA accessable. How could they not fix an elevator for
a month…
August 10th, 2010 at 6:24 pm
I fully agree with the court decision. Also do not use unrelated occupational injuries with preexisting conditions. She had already suffered from her knee which could have been something where she directly could have contributed to. Carpal tunnel is due to your task, job, etc. This is something that could have occurred at a restaurant, home or anywhere. Did her job hire her knowing that she had a special necessity which required the use of the elevator? Most likely not, the elevator was a convenience not a requirement to be able to perform her job. I’m so glad the court used reason.
August 11th, 2010 at 7:43 am
I see a lot of different opinions here. Anyone who does WC for a living sees all the silly claims filed by employees trying to make a free buck. I say Yay for NC court. I have locations all over the US and the claims that are accpeted are completely off the wall. She most likely had a pre-existing condition which caused this. It was stated in the begining of the story it was difficult for her to walk up the stairs, why? In this age of baby boomers getting ready to retire at least 50% of my claims are aggravation of a pre-existing condition.
August 11th, 2010 at 8:47 am
I had a comp case in IL where an individual had a heart attack; he had 98% blockage and it was deemed a comp case with er liability b/c being at work must have exasperated the condition. I think this case (at least how it is presented here) warrants the notion that perhaps she had a pre-ex that was worsened by location which just happened to be at work. I like the ruling but it also makes me uncomfortable. We she have sued if this happened at a mall or walking up the stairs of a friend’s home? Why is there a presumption of guilt simply because it happens on an employer’s premises?
August 11th, 2010 at 9:22 am
Well said Jason Reynolds…
“It is time that there was some personal responsibility enforced within the courts. Personally, we are at the age when we could assign a percentage of exposure to a job which would distribute the actual exposure responsibility to the appropriate parties.”
August 11th, 2010 at 9:32 am
I’m from New York and I like this ruling. NYS should adopt such a law; it would keep frivolous claims out of the system and maybe stop the mass exodus of businesses leaving for a more favorable business environment.
August 11th, 2010 at 9:51 am
I am in total agreement with “Me”. I have asked employees ” if you did this at home would you go to the ER” and I have actually have gotton responses “of course not” or “I can’t ask myself for money”. Unbelievable.
August 11th, 2010 at 10:00 am
It is likely that her insurance company decided for her (as they often do) that the injury was work related and filed suit to get the costs paid. She probably had no choice but to go along with it.
August 11th, 2010 at 10:00 am
I work for a company, where I hold 2 position Electronic Engr. & safety for my company. My job sends me around the world to install and maintain our machines. I had the some injury from flying back from Asia in course of my job. workers comp. covered my injury.
August 11th, 2010 at 11:42 am
LINDA…
I’m not yelling ma’am; how can I yell by typing? I may be missing something here.
Of course Linda you are entitled to your opinion; but folks are entitled to reply to opinions posted. I always try and find out where the other person that sees things differently than I do is coming from; mainly cause I’m not the sharpest knife in the drawer believe me!
But like I asked, “why is it “unfortunate” for the state to have reasonable language and criteria for their WC claims like “as a result of an accident?” I think this is great! Why should the state pay for frivolous claims like this” unforunate or nor not?
August 11th, 2010 at 2:14 pm
@ Paul,
When you type in CAPS, that is considered yelling in this wonderful discussion forum we call the internet
August 11th, 2010 at 2:30 pm
Jason…
Wow, really? Thanks for the insight Jason; much appreciated sir.
Regards,
August 11th, 2010 at 2:32 pm
that is true Jason - there is also a tone to the paragraph indicating frustration
August 11th, 2010 at 3:41 pm
Jason, that’s the first time ever i heard that about typing in caps. Thanks for the heads up!
August 11th, 2010 at 9:18 pm
Some of these comments touch my thinking too; If someone has heart trouble, and have a heart attach and drop dead at work, how is that related to a hazard of employement? Isn’t that a pre-existing condition that disqualifies her from coverage? As others have reasonably mentioned, if she had an issue with climbing the stairs, she should have persued a claim under the ADA reasonable accomodation rules and not waited till she had issues. As far as I can see, the fact that she ‘endured’ the conditions for a month constitute accepting them. I agree with the court, and I am encouraged to see at least one sane ruling!
August 12th, 2010 at 9:12 am
It seems this has implications for future ergonomic issues. Asking for claims to be based upon some form of clear accident implies the person who has worked on a job for a few years without a problem, but develops shoulder problems may have problems justifying a comp claim..
August 12th, 2010 at 9:28 am
We usually get hit with aggravation of a pre-existing condition. If someone had a heart attack at work and files a comp claim it would depend on the type of job they have. If it was a high stress job it is very possible it would be compensable. However, it the job was repetitive, i.e. machine opr performing the same task each day, then it most likely would not be compensable. There are so many loop holes in the wc laws that employers very seldom have a chance of prevailing
August 12th, 2010 at 10:15 am
Wow… I find this interresting. I see alot of cases every day, and it always seems that every case is the companies fault, even if we feel the incident happened outside of work. But then there is the otherside… even if it did happen outside of work, and they were able to work, then its a “Pre-exsisting injury that was made worse from working”… So either way it seems the employer is always at fault. To answer the question about the heart attack…. If you can prove that “Stress” related to the job has declined your health, then yes it could be considered a work related incident. Here in Indiana, it is definately a workers state. Companies/Employers dont seem to have much ground to stand on because the burdon of proof is on us… even if the employee states… “Well I dont know exactly when it happened”… Just this morning I had an employee come to me with a bug bite… she claimed it was a “Spider” but didnt see when it happened and doesnt know when she got it. Looks like a mosqueto bite to me, and they are bad this time of year… Do I say thats work related?
August 12th, 2010 at 11:31 am
I get that stuff all the time J- I had a guy that had a staff infection in his finger (over the weekend), ended up in the hospital and stated it must have been a sliver from work. There was no skin puncture or anything but it was deemed compensable. In fact after it was all over the call the insur co and demanded a settlement and sure enough he got one
August 12th, 2010 at 12:11 pm
I’ve had a bee sting claim that happened while the employee was sitting at a breakroom table between shifts. No work of any kind being performed! And the sting was barely noticeable so even if it happened at work, it didn’t require medical attention. I offered ice, etc to avoid swelling but no, we had to run her to the doctor who looked at it and said “Hmm, looks like a bee sting with no excessive swelling.” and sent her back to work! It didn’t cost alot but I find it irritating that people want to have things looked at that they would never pay a doctor to see on their own dime. Just amazing that they think they are entitled to treatment just because we have insurance. We still PAY for it. Don’t know how anyone could expect to have a valid WC claim for a heart attack! There is so much heredity and long term history involved in a condition like that…can’t imagine anyone chocking that up to work stress. JMO.
August 12th, 2010 at 1:37 pm
I enjoyed reading all of the responses and while I agreed with the decision in N. Carolina, most States would have accepted the claim. Generally the burden of proof rests with the employer and unless it can be proved that it did not happen at work, most likely claims such as these will be accepted. The system needs to be revamped across the country to be more consistent.
August 12th, 2010 at 1:55 pm
I’m not a lawyer, but in light of the NC ruling, she still had the option to file suit for compensation using the ADA - American’s with Disabilities Act? She might be considered handicapped if she had a medical reason to use an elevator instead of stairs and the elevator was not provided.
August 12th, 2010 at 3:53 pm
I handle WC in New York and I’ve got to say I’m doing the happy dance for North Carolina. NY is a claimant oriented state and the WCB would have had to pay this one. The decision makes me smile! Good for you NC!
August 13th, 2010 at 9:58 am
Holy Cow…. Has anybody heard the term “fitness for duty”? I mean, c’mon… we are all falling apart in this country with our overeating and fast food dilema. We sit in front of our t.v. sets all night eating heavens knows what…. We shuffle to our cars, roll out onto the pavement, If we have to park more than 50 feet from the building we are yelling for shuttle service…. Jello… that’s all I can think of is, Jello.
Hey.. if you have a medical problem, you have health insurance. It’s not your boss’s fault if you can’t walk up a flight of stairs, unless, of course, you do have a legit ADA situation. But that’s a whole different story.
August 30th, 2010 at 8:51 am
Do you have to cover an injury that happened at work if the employee violated a safety rule which was the direct cause of the injury
August 31st, 2010 at 8:09 am
Bruce - If by cover you mean file a comp claim, unfortunately yes, you do. At least in NY. What we do is file the claim then controvert it, meaning we dispute the claim, on the grounds that the employee committed an unsafe act or otherwise violated a safety policy, resulting in the injury. It also helps if you can provide the paper documenting the employee received the training he/she violated. If you have a good carrier, they should battle it out with the comp board in an attempt to deny benefits. This way we’re covered by recording the injury in all the right places.
August 31st, 2010 at 9:30 am
In NC the employee would still get WC even if they were at fault. The employee being at fault might lessen the award by the Ind. Commission but that is not always the case. What you need to do is review the training for ALL employees to make sure it was documented and thorough to explain the proper safe way to do the job. If the employee failed to follow their training then you should issue a warning explaining continued failure to follow their training and safe work practices would result in progressive discipline up to termination. This is an accepted stance for safety conscience companies but it is only recommended if you are consistent in your safety enforcement.