Any medical condition which arises out of and in the course of employment is an "injury" for workers' compensation purposes. The injury can result from a single traumatic event, such as a broken leg, or from a gradual process, such as tendinitis or carpal tunnel syndrome.
A disease which results from causes and conditions characteristic of a particular trade or occupation is a compensable occupational disease, and subject to the more restrictive Occupational Disease Law (39-A M.R.S.A. §§601-15).
A. Arising Out of and in the Course of Employment
All injuries must "arise out of and in the course of" employment to be compensable (39-A M.R.S.A. §201(1)). "Arise out of" means that it must be caused by the conditions of employment rather than by causes entirely personal to the employee. "In the course of" means that it must occur during the time and space limitations of employment. It is sometimes said that "arising out of and in the course of" employment means that the injury must occur both because and while the employee is at work.
Sometimes an injury can occur at work but not "arise out of" employment. One example would be a vertebral disk injured outside work over the weekend which later herniated at work merely from bending over to tie one's shoes and not from any job requirement. Another example is a fall in the company parking lot that is not caused by any condition of the lot. While in real life such scenarios are likely to include other factors, neither of these injuries should be compensable. Another example is an unexplained fall at work caused by a sudden weakness. While the fall occurred "in the course of" employment, there must be some additional factor to link the injury to the employee's work to render it compensable.
"In the course of" means that the injury must occur at work and during work hours. For example, an injury that occurs during the work day while the employee is crossing the street to buy a donut as a personal snack is probably not compensable. Activities that are completely non-work-related are also outside the course of employment even if they occur at work. These include horseplay, violation of company rules, or a non-work-related dispute (e.g., a fight at work over a girlfriend).
B. Going and Coming Rule
Commuting to and from work ("coming and going") and personal trips during work hours are generally not considered "in the course of employment," but an injury is compensable if incurred during job-related travel other than commuting. Many such cases fall into a gray area. For example, an off-duty policeman is not "in the course of employment" while commuting to and from work just because he is on 24-hour call, but an accident in the company parking lot (or other premises) while coming or going may be compensable if the employer is responsible for maintaining the lot and the accident resulted from ice or snow banks.
C. Intentional Injuries and Intoxication
An injury can occur at work and still not "arise out of employment" if the employee intentionally caused the injury or if it results from intoxication (unless the employer knows of and condones the intoxication ) (39-A M.R.S.A. §202).
D. Gradual Injuries
Injuries caused by repetitive work activities over a long period of time are compensable; there need not be a single, "traumatic" injury. Such conditions are compensable if caused by the conditions of work, or if the work activity accelerated the onset of the symptoms or made them more severe.
E. Mental Stress
Under the current standard in effect since 1987 and included in the 1992 Act, the employee, by clear and convincing evidence, must prove both that the stress was "extraordinary and unusual" in comparison to the stresses other employees and that the work stress was the "predominant" cause of the condition. This is to be measured by objective standards rather than by any misperceptions by the employee. Stress injuries are not compensable if they resulted from good faith disciplinary action or work evaluation by the employer (39-A M.R.S.A. §201(3)).
F. Pre-existing Non-Work-Related Conditions
Quite often, a disability is caused in part by a work-related injury and in part either by a previous or subsequent non-work-related condition. The 1992 Act provides that if a work-injury aggravates, accelerates or combines with a pre-existing condition, any resulting disability is compensable only if the employment contributed to the incapacity in a "significant" manner. Under this new provision the entire disability is compensable if the work contribution is significant and, conversely, the disability is not compensable if the work contribution is insignificant (39-A M.R.S.A. §201(4)). Neither "significant" nor "disability" is defined in the statute. In practice, those terms are interpreted by hearing officers on a case-by-case basis.
G. Temporary Aggravation
Occasionally a pre-existing condition will be aggravated, and later will return to the same state it was in prior to the work injury. The employer's responsibility in such cases ends when the work injury no longer causes or contributes to the current condition.
H. Subsequent Non-Work Related Injuries or Disease
For injuries occurring on or after October 17, 1991, a non-work injury or disease subsequent to a work injury can change the compensability of the work-injury (39-A M.R.S.A. §201(5)). Under recent case law, the unrelated subsequent injury should be removed from consideration in determining an employee's work capacity. It will be considered for purposes of permanent impairment and the application of the benefits caps. It is important to note that any subsequent work injury that is non-compensable because of a technical failure such as improper notice or a lapsed statute of limitations becomes a non-work-related injury for the purpose of this section.
