4123.01; R.C. 4123.54
Chief of Operational Policy, Analytics & Compliance (Signature on file)
Injury Management policies, directives and memos regarding compensability
that predate the effective date of this policy.
of this policy is to ensure BWC staff recognize and understand the required
elements of a compensable injury. (Requirements related to determining the
compensability of an occupational disease are contained in the Occupational
policy applies to BWC field staff.
medical finding that the progress of a pre-existing condition has been
substantially hastened by the injury or occupational disease.
Aggravation: A medical finding that
a condition that pre-existed an injury or occupational disease is worsened by
the injury or occupational disease and has an adverse impact, no matter how
injury developing gradually over time as a result of the performance of an
injured worker’s job-related duties.
subsequent loss or impairment of bodily functions developing in a part or
parts of the body not originally alleged, but due to the original injury.
by .R.C. 4123.01(C) – Harm or damage suffered by an injured worker (IW), caused
by external accidental means or accidental in character and result, received in
the course of, and arising out of the IW’s employment.
As defined by R.C. 4123.01(F) - A disease contracted in the course of
employment, which by its causes and the characteristics of its manifestation or
the condition of the employment results in a hazard which distinguishes the
employment in character from employment generally, and the employment creates a
risk of contracting the disease in greater degree and in a different manner
from the public in general.
Any traumatic damage or attack on the physical structure of the body, which
results in a wound, tear or abnormal condition.
Precipitation: A medical finding that
a dormant pre-existing condition manifested itself due to the work-related
injury or occupational disease.
of the evidence: A
standard of proof which is met when a party’s evidence on a fact indicates that
it is “more likely than not” that the fact is as the party alleges it to be.
That which, in a natural and continuous sequence, unbroken by any intervening
cause, produces injury, and without which the injury would not have occurred.
motion injury: A
family of muscular conditions resulting from repeated movements performed in
the course of normal work activities, usually the result of unnatural or
awkward motions such as twisting the arm or wrist, overexertion, incorrect
posture or muscle fatigue.
A medical finding that a condition that pre-existed an injury or occupational
disease is worsened considerably in amount, value or extent solely because of
the injury or occupational disease.
A. General Policy
Statement: It is the policy of BWC to determine an injury is compensable when,
by a preponderance of the evidence, it is shown that:
1. The IW:
a. Suffered a physical
b. Has a psychiatric
injury that arose from a compensable physical injury or forced sexual conduct
(See the Psychiatric Conditions policy for further information); and
2. The injury was
accidental in nature; and
3. The injury was
sustained in the course of and arising out of employment.
B. Occupational Disease: A
disease may be compensable as an injury or as an occupational disease. To
determine if a disease meets the definition of, and/or is compensable as an
occupational disease, refer to the Occupational Disease policy.
C. Elements of a
1. The physical or mental
injury must be of the following type:
a. An injury directly
caused by the work related accident;
b. An aggravation or
substantial aggravation of a pre-existing condition (refer to Aggravation
and Substantial Aggravation of a Pre-existing Injury policy for more
c. A flow-through injury;
d. A pre-existing
condition whose progress has been accelerated/hastened by the work-related
acceleration of the pre-existing condition must be a substantial period of time
(e.g., causing death two years sooner than would have been expected without the
acceleration is a direct and proximate result of the work-related injury; or
e. The precipitation of a
pre-existing condition (e.g., an IW has latent tuberculosis which becomes
active due to a renewed exposure in the workplace).
2. The injury must be
accidental in nature:
a. BWC will determine an
injury is accidental in nature when caused by external accidental means or
accidental in character and result (i.e., the accidental injury is unintended
b. An accidental injury
(e.g., a roofer falls through a damaged roof and sustains contusions); or
(derived from Village v. General Motors Corp., (1984) 15 Ohio St 3d
129). Gradual accidental injuries include:
a) Cumulative trauma - The
injury occurs over a short period of time with no particular incident that can
be pointed to as causing the injury (e.g., a worker in an automotive
manufacturing plant incurs a back injury after several days of lifting and
installing car batteries); and
b) Repetitive motion
injuries – (Often used interchangeably with the term cumulative trauma), an
injury caused by repeated motions performed in the course of normal work
c. A condition that
develops gradually and is a cumulative effect of repetitive motion or repeated
exposures may be a compensable injury or may be a compensable OD pursuant to
the Occupational Disease policy, depending upon the facts of the claim.
3. The injury must be
sustained in the course of and arising out of employment:
a. BWC will find:
An IW is
in the course of employment when performing duties on behalf of the employer (
i.e., the IW was engaged in activity consistent with the contract for hire and
logically related to the employer’s business at the time of injury or
contraction of an occupational disease).
arises out of employment when, based on the totality of the evidence, it is
shown the injury was caused by the employment.
b. In determining whether
an injury was sustained in the course of and arising out of employment, BWC
will consider, but not be limited to, the following factors:
location of the accident – Did the injury occur at a site under the employer’s
control (i.e., “zone of employment”)?
the IW was at the location of the accident - Would the IW have been at the
location where the injury occurred but for the IW’s employment?
iii. The nature of the
employment – Did the employment itself create a risk distinctive in nature or
quantitatively greater than the risk to the general public (i.e., a “special
hazard” of employment)? and
iv. Whether the IW was
commuting to or from a fixed work site:
a) Generally, an injury
sustained by an IW commuting to and from the IW’s fixed work site is not in the
course of or arising out of the employment (the “coming and going rule”).
b) The coming and going
rule may not apply when:
The IW has
a fixed or semi-fixed work site but is required to travel to one or more other
locations for work purposes;
does not have a fixed work site and the travel is interrelated with the nature
of the employment;
iii) The injury occurs on
property controlled by the employer (e.g., parking lot, ingress or egress from
the work site).
D. Special Circumstances
1. Act of Nature
a. An injury caused solely
by natural phenomena (e.g., flood, earthquake, tornado) is not compensable; but
b. The injury may be
compensable if the act of nature activated a hazard unique to the employment and
the hazard caused the injury.
c. Example: While
reporting from the site of a hurricane a news reporter is injured by blowing
2. Physical Altercation
a. An injury caused by a
fight or other physical altercation a worker is involved in and that is of a
purely personal nature is not compensable; but
b. An injury from a fight
or other physical altercation over a work-related matter may be compensable; or
c. An injury to another
worker not involved in the fight or physical altercation may be compensable for
a. An injury incurred from
horseplay is not compensable; but
b. If the IW was an
innocent bystander not involved in the horseplay but injured due to it, the
injury may be compensable for that worker.
4. Natural Physical
Condition and Intervening Hazard of Employment
a. If an injury is caused
solely by a non-work related natural physical condition, it is not compensable;
b. If, in the course of
injury from the non-work related condition there is an intervening hazard
unique to the workplace, which causes another injury, the injury caused by the
intervening hazard may be a compensable allowed condition.
c. Example: A truck
driver has a heart attack due to a non-work related condition and crashes his
truck into a guardrail. The injuries from the crash may be allowable
5. Intoxication, Under the
Influence and Rebuttable Presumption
When an IW tests
positive on a qualifying chemical test or refuses to be tested and the
requirements of R.C. 4123.54 have been met, BWC will apply the rebuttable
presumption that the IW’s injury was caused by the IW’s intoxication or due to
being under the influence of a controlled substance not prescribed by a
physician. See the Intoxication, Under the Influence and Rebuttable
Presumption policy for further information.
6. Exposure to Blood or
Other Potentially Infectious Materials
BWC will not allow a
claim for exposure to a potentially infectious material if there is no accompanying
physical injury. However, post-exposure medical diagnostic services and preventive
treatment may be paid by BWC when the requirements of 4123.026 are met. See the
Exposure to Blood or Other Potentially Infectious Materials for further
7. Recreational or Fitness
It is the policy of BWC
that an injury or disability incurred in voluntary participation in an employer
sponsored recreation or fitness activity is not compensable if the IW signed a
waiver of the IW’s right to workers’ compensation or benefits prior to engaging
in the recreation or fitness activity.
8. Additional Allowance
See the Additional
Allowance policy for requests made after the initial allowance of a claim.
BWC staff may refer to
the corresponding procedure for this policy entitled “Compensability” for