Quick Answer: Under North Carolina workers’ compensation law, an injury by accident generally requires an unexpected event or interruption of the employee’s normal work routine that causes an actual injury. The accident must also arise out of and occur in the course of employment.
Merely experiencing pain or suffering an injury while performing ordinary work in the ordinary manner may not be enough. North Carolina law generally separates three questions: Was there an accident? Did the accident cause an injury? Was the accident sufficiently connected to the employment?
This distinction explains why a person can suffer a genuine medical injury at work and still have the workers’ compensation claim denied.
North Carolina’s primary definition of an "injury" appears in N.C.G.S. § 97-2(6). The statute generally limits coverage to an injury by accident arising out of and in the course of employment.
An employee ordinarily must prove three separate elements:
These phrases have different meanings.
A claim may fail if any one of these elements is missing.
One of the most confusing parts of North Carolina workers’ compensation law is that an injury and an accident are not necessarily the same thing.
A worker may suffer a real injury while at work without proving a legally recognized accident. Likewise, pain may be evidence that something is wrong, but pain alone does not establish that an accident occurred.
For most body parts (excluding the back and neck), normal work performed in the normal manner generally does not qualify as an injury by accident.
Examples may include:
The above examples legitimately occurred during work. However, the legal problem is that the worker may be unable to identify an unexpected event or interruption of the normal work routine.
Depending on the facts, a gradually developing condition might instead be evaluated as an occupational disease under N.C.G.S. § 97-53. A qualifying back injury may also be evaluated under the separate specific-traumatic-incident standard discussed later in this article.
North Carolina courts commonly describe an accident as an unlooked-for and untoward event that was not expected or designed by the injured employee.
An accident may be established when the employee’s normal work routine is interrupted and unusual conditions are introduced that are likely to produce unexpected consequences.
The event does not have to be dramatic. A relatively small deviation may be legally important if it materially changes how the employee was performing the work.
The central question is often not whether the employee’s work was difficult. The question is whether something unexpected happened or the employee was required to depart from the established work routine.
An employee does not necessarily prove an accident by showing that the work was strenuous, repetitive, or physically demanding.
Once an activity becomes a regular part of the job, an injury caused while performing that activity in the usual way may not qualify as an injury by accident.
This principle can produce results that seem unfair to injured employees. For example, a warehouse worker may regularly lift heavy objects throughout the day. If the worker lifts an ordinary object in the ordinary manner and develops a shoulder tear, the insurer may argue that no accident occurred even if the injury is genuine.
The analysis may change if:
The exact description of what happened can therefore determine whether the claim is accepted or denied.
A new task, unfamiliar assignment, or materially different method of performing work may constitute an interruption of the employee’s normal routine.
In Gunter v. Dayco Corp., 346 S.E.2d 395 (1986), the North Carolina Supreme Court considered an experienced employee who had recently moved into a different position involving greater exertion and twisting and jerking movements. The employee had only briefly performed the new job and had not yet become proficient or accustomed to its requirements. The Court upheld the finding that the new working conditions interrupted his normal routine and supported an injury-by-accident claim.
However, a new duty does not remain new forever.
Once the employee becomes proficient and accustomed to the activity, it may become part of the normal work routine. An injury that occurs later while performing the task normally may no longer satisfy the accident requirement merely because the duty was once unfamiliar.
For example, in Shay v. Rowan Salisbury Schools, COA 09-1587 (2010) an employee regularly used an elevator to reach her classroom. When the elevator stopped working, she began using the stairs. More than a month later, she felt a pop in her knee while climbing the stairs but did not slip, trip, fall, or twist. The Court of Appeals concluded that climbing the stairs had become part of her normal work routine and that no accident occurred.
These cases demonstrate that the analysis is highly fact specific. Relevant questions may include:
A sudden and unusual increase in workload, pace, or physical demands may interrupt the employee’s normal work routine.
For example, an employee may have a stronger argument for an accident if:
The comparison is generally made against the employee’s established work routine, not against what an average person might consider physically difficult.
Ongoing understaffing does not necessarily create a new accident every day.
If a workplace has been regularly understaffed for a substantial period, the increased workload may unfortunately become part of the employee’s normal routine. The worker may then have difficulty proving that a later injury resulted from an unexpected interruption rather than the usual conditions of employment.
By contrast, an abrupt staffing shortage or sudden increase in workload may present a stronger accident argument.
A fall itself is generally considered an accident. The employee usually does not have to identify a separate unusual event that caused the fall.
For example, in Hedges v. Wake County Public School System, 206 N.C. App 732 (2010), the Court of Appeals explained that the fall itself may be the unusual and unforeseen occurrence. A worker may therefore sustain an accident even while performing a normal task under normal conditions.
However, proving a fall does not always establish a compensable claim. The worker must still show that the accident arose out of the employment.
A fall may have a clear employment connection when the employee:
An unexplained fall is one for which the evidence does not identify either a workplace cause or a personal medical cause.
North Carolina cases recognize that an inference may arise in favor of compensability when a fall occurs in the course of work and no independent personal condition or outside force is shown to have caused it. The result depends heavily on the Industrial Commission’s factual findings.
An idiopathic fall is different. In this context, “idiopathic” generally refers to a fall caused by a condition personal to the employee, such as:
If the personal condition alone causes the fall and the workplace does not increase the danger, the injury may not arise out of employment.
In Watkins v. Trogdon Masonry, 203 N.C. App 289 (2010), the employee fell while at work after his leg gave way. The Commission found that the fall resulted from a personal physical infirmity and that no workplace hazard increased the risk or contributed to the injury. The Court of Appeals upheld the denial of benefits.
A personal medical event does not necessarily defeat every claim.
The outcome may differ when a personal condition causes the employee to fall into or from a workplace hazard.
Examples may include a seizure or fainting episode while the employee is:
In those circumstances, the employment may increase the severity or danger of the fall even if the personal condition initiated the event.
Yes. An intentional assault by another person may still be an accident from the injured employee’s perspective.
The important question is whether the assault arose from the employment or from a purely personal dispute.
A mixed dispute may require a detailed investigation. If the disagreement involved both personal and work-related issues, the Industrial Commission must determine whether the employment contributed sufficiently to the risk or cause of the assault.
A compensable injury is not necessarily limited to visible physical trauma.
North Carolina courts have recognized that a psychological condition may qualify when it results from a compensable workplace accident and otherwise satisfies the statutory requirements.
In Jordan v. Central Piedmont Community College, 476 S.E.2d 410 (1996), instructor developed post-traumatic stress disorder after being exposed to a violent fight between inmates. The Court of Appeals held that mental injuries are not categorically excluded from workers’ compensation coverage.
Psychological claims are nevertheless difficult and fact dependent. The employee must still establish:
An employee’s emotional reaction to an ordinary or expected workplace event may not establish an accident merely because the employee found the event upsetting.
No. Pain is important, but it is generally a symptom rather than the accident itself.
An employee ordinarily must establish:
For example, saying “my shoulder started hurting at work” may not explain whether an accident occurred.
A more complete and accurate history might explain:
“I was lifting the same type of box I normally lift, but this box was unexpectedly heavier. When I pulled it from the shelf, the contents shifted, my arm was forced backward, and I immediately felt sharp pain in my shoulder.”
The purpose is not to embellish or create an accident that did not happen. The purpose is to accurately identify every material fact about how the injury occurred.
A heart attack, heat-related illness, seizure, or similar medical event is not automatically compensable merely because it occurred at work.
These claims may involve questions such as:
Some of these cases may be evaluated as occupational diseases rather than ordinary injury-by-accident claims. Because the law is highly fact specific, they should not be reduced to a rule that every medical event at work is either always covered or never covered.
The injury by accident standard does not apply to back (and neck) injuries. Instead, North Carolina law applies a separate standard for back injuries that is easier to prove.
Under N.C.G.S. § 97-2(6), an injury to the back may be compensable when it arises out of and in the course of employment and is the direct result of a specific traumatic incident of the work assigned.
A back injury does not require an unusual interruption of the normal work routine. The employee must instead identify a work-related incident occurring within a judicially recognizable period of time.
Assume a warehouse employee regularly lifts 50-pound boxes.
If the employee lifts an ordinary box in the ordinary way and develops a shoulder tear, the claim may be denied because nothing unexpected interrupted the normal routine.
If the employee performs the same lift and experiences an immediate pop and sharp pain in the lower back, the employee may be able to establish a specific traumatic incident even though the lift itself was routine.
The results are different because a different standard applies to the back injury than the shoulder injury.
The first description of the event is often among the most important evidence in the case.
Useful evidence may include:
After a workplace injury, an insurance adjuster may ask the employee to provide a recorded statement describing what happened. The statement may later become important evidence when the insurance company decides whether to accept or deny the claim.
A common mistake is for an injured worker to say only:
“I was just doing my normal job.”
That statement may be truthful, but it may also be incomplete. For most body parts, North Carolina law generally requires more than proof that an injury occurred while the employee was working. The insurance company may focus on whether an unexpected event or interruption of the normal work routine occurred.
The adjuster will usually ask enough questions to gather information about the claim, but the adjuster is not necessarily going to explain the legal importance of identifying a shifted load, unexpected weight, slip, stumble, equipment malfunction, unusual pace, unfamiliar assignment, or other departure from the normal routine. The adjuster is also not required to help the injured worker use the particular language that may support compensability.
For example, there may be an important difference between saying:
“I was lifting a box and my shoulder started hurting.”
and accurately explaining:
“I was lifting a box that appeared normal, but it was unexpectedly heavier than the boxes I usually handled. The contents shifted when I pulled it toward me, forced my arm backward, and I immediately felt sharp pain in my shoulder.”
The second statement does not add facts or use artificial “magic words.” It gives the complete factual description needed to evaluate whether an unexpected event interrupted the employee’s normal work routine.
An injured worker should never exaggerate, guess, or change the facts to make a claim sound compensable. However, the worker should avoid reducing the event to a vague statement such as “I was just doing my job” when something unusual actually occurred.
Before giving a recorded statement, take time to recall:
A recorded statement should be truthful, accurate, and complete. Because the statement will affect whether benefits are paid, an injured worker should speak with a workers’ compensation attorney before agreeing to provide one.
Medical providers often document a short description of how the injury occurred.
If that record merely says “shoulder pain at work,” the insurer may argue that no accident was reported.
If the accurate history explains that the employee slipped, the load shifted, equipment malfunctioned, or another unexpected event occurred, the medical record may better document the legal and medical basis of the claim.
An employee should never exaggerate or invent facts. The description should be truthful, complete, and consistent.
An insurance company may deny the claim because:
A denial does not necessarily mean the worker was untruthful or was not hurt. It may mean the insurance company disputes whether the facts satisfy North Carolina’s technical legal definition.
One of the biggest misconceptions I see is that proof of an injury automatically establishes a workers’ compensation claim.
An employee may have an MRI showing a tear, a doctor recommending surgery, and significant work restrictions. The insurance company may still deny the claim because it disputes whether an accident occurred.
The employee is often focused on the medical result: “I need surgery - how can they question I'm hurt?”
The insurance company may be focused on the legal question: “How exactly did the injury happen?”
Both questions matter.
The best time to identify and document the accident is immediately after it occurs. Months later, it may be difficult to reconstruct the condition of the floor, the weight of an object, the position of equipment, the workload, or what a coworker observed.
North Carolina workers’ compensation does not automatically cover every injury that happens at work.
For most body parts (other than the back and neck), an employee must prove an unexpected event or interruption of the normal work routine, an actual injury caused by that event, and a sufficient connection between the accident and the employment.
A fall may itself constitute an accident. New duties, increased work demands, equipment malfunctions, assaults, and other unusual events may also qualify. However, ordinary work performed in the ordinary manner may not meet the standard, and a purely personal medical condition may prevent the accident from arising out of employment.
If your claim has been denied because the insurance company contends that no accident occurred, the exact facts, initial reports, medical histories, witnesses, and applicable legal standard should be reviewed carefully.
For a more detailed explanation of the North Carolina workers compensation claims process, read Galbavy Law’s dedicated page that covers a broad range of workers' compensation issues.
To discuss a disputed work-injury claim with a North Carolina Board Certified Workers’ Compensation Specialist, contact Galbavy Law.
This article is provided for general informational purposes and is not legal advice. Workers’ compensation claims depend on the specific facts, medical evidence, date of injury, forms filed, and applicable North Carolina law.
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