10.6 Compensable Injuries Copy

Compensable injury means an injury that arises out of and in the course and scope of employment for which compensation is payable under this subtitle.

Course and scope of employment means an activity of any kind or character that has to do with and originates in the work, business, trade, or profession of the employer and that is performed by an employee while engaged in or about the furtherance of the affairs or business of the employer. The term includes an activity conducted on the premises of the employer or at other locations.

The term does not include:

Transportation to and from the place of employment unless:

• The transportation is furnished as a part of the contract of employment or is paid for by the employer;
• The means of the transportation are under the control of the employer; or
• The employee is directed in the employee’s employment to proceed from one place to another place; or
• Arose out of voluntary participation in an off-duty recreational, social, or athletic activity that did not constitute part of the employee’s work-related duties, unless the activity is a reasonable expectancy of or is expressly or impliedly required by the employment; or
• Arose out of an act of God, unless the employment exposes the employee to a greater risk of injury from an act of God than ordinarily applies to the general public; or
• The employee’s horseplay was a producing cause of the injury.

Travel by the employee in the furtherance of the affairs or business of the employer if the travel is also in furtherance of personal or private affairs of the employee unless:

• The travel to the place of occurrence of the injury would have been made even had there been no personal or private affairs of the employee to be furthered by the travel; and
• The travel would not have been made had there been no affairs or business of the employer to be furthered by the travel.

Exceptions

An insurance carrier is not liable for compensation if:

The injury:

• An insurance carrier is not liable for compensation if:
• Was caused by the employee’s willful attempt to injure himself or to unlawfully injure another person;
• Arose out of an act of a third person intended to injure the employee because of a personal reason and not directed at the employee as an employee or because of the employment.

Benefits

An insurance carrier shall pay death benefits to the legal beneficiary if a compensable injury to the employee results in death.  The amount of a death benefit is equal to 75 PERCENT OF THE EMPLOYEE’S AVERAGE WEEKLY WAGE.

An insurance carrier may pay death benefits through an annuity if the annuity agreement meets the terms and conditions for annuity agreements adopted by the commission by rule. The establishment of an annuity under this subsection does not relieve the insurance carrier of the liability for ensuring that the death benefits are paid.

Benefit means a medical benefit, an income benefit, a death benefit, or a burial benefit based on a compensable injury.

Health Care includes all reasonable and necessary medical aid, medical examinations, medical treatments, medical diagnoses, medical evaluations, and medical services. The term does not include vocational rehabilitation. The term includes:

• Medical, surgical, chiropractic, podiatric, optometric, dental, nursing, and physical therapy
• Services provided by or at the direction of a doctor;
• Physical rehabilitation services performed by a licensed occupational therapist provided by or at the direction of a doctor;
• Psychological services prescribed by a doctor;
• The services of a hospital or other health care facility;
• A prescription drug, medicine, or other remedy; and
• A medical or surgical supply, appliance, brace, artificial member, or prosthesis, including training in the use of the appliance, brace, member, or prosthesis.

Medical Benefit means payment for health care reasonably required by the nature of a compensable injury and intended to:

• Cure or relieve the effects naturally resulting from the compensable injury, including reasonable expenses incurred by the employee for necessary treatment to cure and relieve the employee from the effects of an occupational disease before and after the employee knew or should have known the nature of the disability and its relationship to the employment;
• Promote recovery; or
• Enhance the ability of the employee to return to or retain employment.

Occupational Disease means a disease arising out of and in the course of employment that causes damage or harm to the physical structure of the body, including a repetitive trauma injury. The term includes a disease or infection that naturally results from the work-related disease. The term does not include an ordinary disease of life to which the general public is exposed outside of employment, unless that disease is an incident to a compensable injury or occupational disease.

Repetitive Trauma injury means damage or harm to the physical structure of the body occurring as the result of repetitious, physically traumatic activities that occur over time and arise out of and in the course and scope of employment.

Wages include all forms of remuneration payable for a given period to an employee for personal services. The term includes the market value of board, lodging, laundry, fuel, and any other advantage that can be estimated in money that the employee receives from the employer as part of the employee’s remuneration.