Workers’ Compensation and the “Scope of Employment” Requirement

In Massachusetts, an injured worker may receive workers’ compensation benefits for a work-related injury provided that all of the eligibility criteria are met. One of the requirements to receive benefits is that the injury must have occurred while the employee was working “in the scope of his or her employment.” Imagine the following scenarios:

• A police officer stops for the proverbial doughnut at a local coffee shop. While sipping coffee and munching on the doughnut, the officer decides to get up and get a refill. While walking to the counter, she trips and fractures her ankle.
• A construction worker fails to use the proper safety procedures to tie himself off when he descends into an underground tunnel and falls to his death.
• A pizza delivery driver decides to take a short cut to make a delivery. The short cut is well-known for being a dangerous stretch of road and is not the route he was told to take. He is involved in a head-on collision and suffers serious injuries.
• An employee is sent to the local stationary supply store to pick up supplies. On the way, he stops by a coffee shop to purchase a coffee that he intends to drink at his desk. While walking back out to his car he is hit by a car and receives multiple injuries.

Which of these injuries was sustained while the employee was “in the scope of employment?” Which ones are ultimately compensable as a workers’ compensation claim? The answers to those questions are not simple.

In Massachusetts, workers’ compensation claims are handled through the Department of Industrial Accidents. When a worker is injured, the employer typically files a Form 101 “Employer’s First Report of Injury or Illness” to initiate the claims process. The workers’ compensation insurance carrier then has 14 days to evaluate the claim and decide whether to approve and pay the claim. One reason an insurance carrier might deny coverage is because it contends that the injury was sustained while the worker was outside the “scope of employment” at the time of the injury. Analyzing whether an employee was within his or her scope of employment must be done on a case-by-case basis; however, some factors will typically be taken into account when determining whether an employee was within his or her scope of employment when an injury occurred. Answering the following questions may help:

• Was the work of the kind the employee was employed to perform?
• Did the incident occur substantially within the authorized time and space limits of his or her employment?
• Was the activity motivated, at least in part, by a purpose to serve the employer?

No single question can answer the “scope of employment” question in every case. As with many workers’ compensation issues, each injury must be analyzed individually to determine whether it qualifies for workers’ compensation benefits.

If an employer, or insurance carrier, denies an application for workers’ compensation benefits based on a claim that the worker was not within the scope of employment at the time of the incident, then the worker has the right to appeal the denial.

If you have been injured in a Massachusetts workplace and your claim for workers’ compensation benefits has been denied because the insurer contends that you were outside your scope of employment (or for any other reason), we may be able to help. The Massachusetts workplace injury lawyers at Kantrovitz & Associates, P.C., are available to review your claim and help you decide what your next move should be. If you would like to know what legal options you have for a work-related injury, we can be reached by calling 800-367-0871 or by using our online contact form.