GQ Corner
Q. Claimant is a truck driver who advised us (in a recorded statement) that he cannot tell us exactly what he did and that he did not trip/slip/fall, but that his ankle started hurting. He told his employer that he had no idea when or where it happened. He advised the Clinic that this was due to getting in and out of the truck. With no specific incident, do we have enough to deny?
A. The fact that there is no specific event does not mean there cannot be an injury, but I would still lean towards disputing the claim. The claimant could try to allege his injury resulting from repetitively climbing in and out of the truck (over a period of time), though if he does that, he would need medical evidence to support an injury resulting from that mechanism of injury. If he is not alleging a repetitive injury, but also cannot identify a specific incident, I would certainly recommend disputing the claim.
Q. An employee was volunteering at a fair when she fell and busted the side of her eye. Would this be covered by WC?
A. The standard Worker’s Compensation policy does not provide coverage for volunteers. There must be an employment relationship with the insured in order to have coverage. An employment relationship requires an agreement to provide remuneration for services rendered. You state that “an employee who was volunteering at the State Fair.” This suggests that the “employer” may have been providing “volunteers” to the State Fair. If this was the circumstance, you may have to examine further whether or not the employer required their employees to volunteer or provided some incentive to do so. If so, we may have to look deeper to determine whether coverage exists.
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