For us, workers' comp may not work

Badly injured on his way to work, this doctor learned that his employer's workers' comp plan wouldn't cover him.

By Larry Donald Howard, MD
Internist/Chattanooga, TN

As with many physicians, there's a thin line between my professional and my personal life. Even when I'm mowing the lawn or eating out with my family, I get medical calls on my pager, and respond to them. So I think of myself as always "on the job." Recently, however, I learned that I'm not—at least not legally.

My story begins in 1996, when I was employed by a medical group owned by a large hospital corporation. I'd been on vacation and checked in with my answering service the day before I went back to work. One message was from a nursing home where—as part of my job—I served as medical director. The nurse there informed me that several newly admitted patients needed to be seen as soon as possible. (For some reason, the physician covering for me had been too busy to see them.)

The next morning on my way to the nursing home, I called my office on my cell phone from the highway. My nurse urged me to stop by to go over some paperwork that had stacked up in my absence. I told her I'd deal with it after I saw the nursing home patients.

Less than a mile after passing the exit to my office, a car coming in the opposite lane spun out of control, crossed the median, and hit my car, pushing it into a tractor-trailer. The combined impacts smashed my roof, broke all the windows, and left my car demolished on the grassy median.

I ended up in the ER with massive facial injuries, and severe damage to my left eye. Over the following weeks, I underwent facial reconstruction and a vitrectomy, but I ultimately lost my left eye. I also experienced progressive dystonia from the head injury, which caused cramping in my right arm, and loss of fine motor control in my right hand. That proved frustrating when I returned to work and tried to write progress notes or do delicate procedures.

For the next two years, I was covered by my employer's self-insured workers' compensation plan. But in August 1998 I was informed that my contract would not be renewed when it expired in November. The reason: because of my injuries I was unable to see enough patients to justify my salary.

Then came another surprise. When my contract expired, my workers' comp coverage was terminated. I filed a lawsuit to have it reinstated, but the local judge granted summary judgment for my former employer. Because I hadn't stopped at my office before heading for the nursing home, he said, the accident did not occur "within the course" of my employment, and was therefore not compensable.

I appealed to the state's Special Workers' Compensation Appeals Panel, which ruled in my favor, finding that an injury "is in the course and scope of employment, for workers' compensation purposes, if it has a rational connection to the work, and occurs while the employee is engaged in the duties of his employment."

My employer appealed that ruling to the Tennessee Supreme Court, however, which reversed it, ruling that since my accident occurred while traveling to or from work, it wasn't covered.

I believe that decision is unfair because the court took an unreasonably narrow view of the amorphous parameters of a physician's work. When and where does our work start? Only when we reach the office parking lot? What about the evenings, weekends, and holidays when we're on call? By the very nature of our profession, the boundaries of our work environment are dictated by the priorities of patient care. Decisions about workers' comp coverage should be based on whether the injury occurs under circumstances that are directly related to the doctor's employment, not on some artificial definition.

Based on my experience, I encourage all physicians to investigate their state laws to determine exactly when and where an injury is covered under "the course of employment." If you're lucky, you'll never need to know. But why wait for an accident before you find out?

 

Larry Howard. For us, workers' comp may not work. Medical Economics May 23, 2003;80:49.