Nigel Haskett, 21 at the time he was shot, is or was an employee of a McDonald's franchise in Little Rock, Arkansas. On August 26, 2008, Haskett physically restrained a man and expelled him from the restaurant to end his battery of a female patron. Perry Kennon, the alleged attacker, went to his car, retrieved a gun and shot Haskett several times as he stood in front of the door to prevent Kennon's re-entry.
Police and the public have hailed Haskett's actions as heroic. But the franchisee's workers' compensation carrier is not swayed by such sentiment - they have denied Haskett's claim for workers' compensation benefits outright, claiming that his injuries did not "arise out of or within the course and scope of his employment" (as reported on rawstory.com).
The "Course and Scope" Rule
Few provisions surrounding workers' compensation coverage are agreed on by multiple states, much less every state. But every state does abide by the three-test "course and scope" rule. To be compensable, the injury must "arise out of and be in the course and scope of employment." Each of these terms is more specifically defined as follows:
• "Arising out of…" indicates a causal connection between the furtherance of the employer's business and the injury. If the employer benefits in some way from the activity, then the injury or illness suffered in the pursuit of that activity is considered to "arise out of" the employment.
• "In the course…" is a function of the timing and location of the injury or illness. The implication is that the injury must occur during operations for the employer, or "during employment," and at the employer's location or a location mandated or reasonably expected by the employer.
• "Scope of employment…" serves to more specifically define the first two tests by: 1) analyzing the motivations of the employee; 2) analyzing the employer's direction and control over the actions of the employee; and 3) analyzing the employer's ability to foresee the activities of the employee. Employee actions which ultimately lead to an accident or injury must be motivated, in whole or in part, by the "desire" to further the interests of the employer. Motivation or desire can be out of fear that failure to perform will result in the loss of a job, or from a more altruistic desire to do well for the employer. The basis for the motivation or desire is irrelevant; it is the fact that the motivation exists that leads to compensability. Further, the actions must, to some extent, be at the presumed direction of the employer or potentially foreseen by the employer.
Comparing Haskett's Actions with the "Course and Scope" Tests
Do Haskett's actions meet the requirements of each test? Comparing his actions with each requirement will clarify whether the workers' compensation carrier is correct in its denial or not.
Arising out of…: Does protecting patron safety benefit the business and further the business' objectives? Haskett's attorney stated his belief in an interview with a Little Rock television station that these actions accomplished both. If it can be proven that the employer and the business did or would somehow benefit from Haskett's actions, his injury may be judged to have "arisen out of" his employment.
Presumably, McDonald's business objective is to prepare and serve food while maintaining a safe and clean environment for its employees and customers. The question of whether wrestling someone out of the restaurant to prevent them from attacking another person qualifies as being a part of that objective. If customers feel safe, they are likely to eat at the restaurant.
Although a definitive "yes" to the question of "arising out of…" is tough to give, Haskett's actions border on furthering the business' objectives. It appears that his being shot arose out of his employment and satisfies the first test.
In the Course of…: This test is much easier to assign a definitive "yes." Haskett was on the premises of his employer, he was "on the clock" and presumably working at the time (not on break). No question that the injury occurred during the course of his employment.
Scope of employment: Compensability of Haskett's injury is on shaky ground when compared against the "scope of employment" test. This test has three qualifiers: 1) the motivation of the employee must be to further the employer's business; 2) the employer must have some direction and control over the employee's actions; and 3) the situation and actions must be foreseeable by the employer.
Employee's motivation: It is not likely that Haskett was motivated by the employer's business objectives. While his motivation was admirable, the protection of a seemingly defenseless individual, it does not meet the first test.
Direction and control of the employer: While the employer, in a letter to the press, supports and applauds Haskett's dedicated actions, neither he nor any manager directed Haskett to act as he did. The second qualifier is also not met.
Employer's ability to foresee the situation and actions: The question as to whether the situation was foreseen by the employer is somewhat gray based on the differing accounts provided by the two parties. According to McDonald's, part of employee training and orientation is a directive to not "try to be a hero." The employee handbook specifically states that the police are to be called and the employee is to not engage a robber or other such individuals. Haskett states in news reports that he never received this training.
If such warning and direction is in the employee handbook, which probably contains a signed statement that it was read in its entirety by Haskett, then the employer did foresee the possibility for a dangerous situation and gave strict instruction for employees to not engage. It was the anticipation and instruction of the employer that the employee stay out of harm's way. The third qualifier also falls against Haskett and in favor of the workers' compensation carrier.
Haskett's injury was NOT in the "scope of employment." His actions met none of the three "scope" requirements and he fails the third test.
Not Compensable
Sadly, two-out-of-three is not good enough; all three "course and scope" tests must be passed. The workers' compensation carrier may be correct in their denial of workers' compensation benefits for this injury.
Some arguments for compensability of this injury say that Haskett would not have been injured "but for" his being at work; this argument falls short because workers' compensation is not solely based on proximate cause. Just being "at work" is not enough to garner protection.
Based on the letter of the law, this is not a compensable claim when compared to the three-test "course and scope" requirement. Perhaps Haskett and his attorney can show "implied consent" or "ratification" of his actions since the employer did not try to stop him from throwing Kennon out of the store; or pull him inside when he stood at the door to prevent the attacker's reentry. The employer's inaction may be considered "at the employer's direction."
Regardless, this will likely go to trial before it is finally settled. It is impossible to know what any jury will do; so stay tuned.
NOTE: The definition of "course and scope" was taken from the soon-to-be-released book "The Insurance Professional's Practical Guide to Workers' Compensation: From History through Audit." This guide details how the modern workers' compensation system operates in the statutory, contractual and juridical world in which the coverage exists. Legal and contractual concepts are concretely demonstrated using simple and accurate explanations. What has been historically shrouded in "legalese" can now be confidently and correctly explained to clients in understandable terms. Unlike many workers' compensation texts, this book rarely delves into specific policy language.
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My vote - This claim should be paid....FWIW.
The claims department of this carrier should direct their efforts at Workers Compensation Fraud rather than find a way to deny a claim for an employee that was at work, and in good faith trying to provide a safe environment for patrons of the business.
Can't wait to read the book.
I believe stopping a customer from being assaulted would further the employer's business which is #1 under "Scope of Employment."
It would appear, at least on the surface, that this employee took the action they took because the other party posed an immediate perceived threat to the store, its employees and its patrons. Any business operator would hope that every fit employee would have the initiative to "get involved appropriately", depending on the severity of the situation. Sometimes things happen very quickly and there needs to be some leeway (grace) for the split second decisions people make under such stressful situations, even when it turns out that they might have made a better decision, given more time to do so.
The jury will certainly find this young person's injuries compensable.
Whoever the carrier is will surely find that it has made a gross error in its initial decision to fight this claim. I believe they will discover (in retrospect) that they were out of touch with the realities of our society today, but there is still time for this carrier to show grace by reversing their decision.
If we want our society to "step up" and take action for what is good, just and right, the rest of us had better be ready to "back" the heroes that step forward for the greater good.
Dana Coates provides risk management consulting to importers, wholesalers and retailers and has been a licensed casualty insurance broker for over 30 years. www.tsbic.com
IT SEEMS THAT THE SPIRIT OF THE LAW GETS LOST IN THE LEGAL MUMBO JUMBO OF WORKERS COMP DEFINITIONS
PROTECTING PERSONS AND PROPERTY BY AN EMPLOYEE SHOULD BE AN EXCEPTION AMONGST WORKERS COMP LAWS
WOULD THEY RATHER JUST LET THE INDIVIDUAL CONTINUE TO PUMMEL THE PATRON OR IS IT NOT THE DUTY ( WHETHER LEGAL OR MORAL ) OF ANY EMPLOYEE TO ATTEMPT TO PROTECT THEIR PATRONS
Suit shoud be brought against the insurer seeking punitive damages for malicious intent in wrongful denial.
An example needs to be set against this type of purely self-ingratiating avarice by insurers.
I agree with other posters' comments that this carrier needs to step up to the plate and do the right thing. There is no way a jury will find this employee's injuries non-compensable almost without regard for the policy (or statute) language.
If the work comp carrier were also the GL carrier, would they not then have an interesting quandary? If the employee had not acted to stop the assault, what kind of claim would they be facing?
At least with work comp, their damages are somewhat limited. If the assailant had succeeded in severely injuring the patron, perhaps even returning to the restaurant with his weapon and inflicting further damage, would the GL carrier be happy then? I think not. Would the Work Comp carrier perhaps have seen even greater damages inflicted upon other employees who were just going about their regular work? Would that make them happy?
Perhaps we do need an exception for employees taking steps to protect property and persons.
www.pltidbits.com
For those of you who don't know what TPA means, get out of the business now.
There are various reasons that people do not like our industry. One of them is the ridiculous legal hairsplitting on some claims. This kid is not some malcontent employee who claimed to fall in some backroom or warehouse when no one was around.
Our industry takes enough of a public relations beating as it is - most unwarranted. An exception should have been made on this claim due to the very public circumstances. As an agent who writes mainly commercial accounts, this type of claims work irritates me to no end.
As agents, we take the brunt of the anger when a company claims office decides to split hairs. We lose not only the trust of clients who must then fight with the company over the claim, but often their business as well.
And, do not come in here and answer me with, 'you don't know what you're talking about.' I cut my teeth in this industry on the claims end before going to law school. I handled thousands of claims as an adjuster. I took Workers Compensation Law while in law school knowing I would one day re-enter the insurance industry. I know full well that exceptions can be made in extraordinary cases. This is one such case.
My feeling is that the insurer is going to take a beating if it is foolish enough to let this case go to trial - as well it should. This type of cold-reasoned claims work is the reason our industry gets put under scrutiny. You want more federal and state regulation? Keep handling claims of this nature without regard to the overall circumstance.
This kid is not trying to perpetrate fraud. He protected the business he was working for and was on its grounds during his work shift. Because he was shot in defense of the business and a customer of the business, and not shot while standing behind the register handing out burgers should be irrelevant.
Come on, insurer. Help this kid. Pay this claim. Do no throw him, the company, the agent, and industry under the bus over what amounts to legal hairsplitting.
That said, it seems to me that paying this claim under the Work Comp statutes would keep McDonald's costs finite compared to the employee entering the court system. Additionally, he attempted to mitigate claims costs by stopping an attack that will surely lead to litigation. Isn't cost mitigation a basic tenet of insurance?
I'd like to see McDonald's try to fire someone for NOT interveningthe next time an attack occurs. I think this decision is disingenuous and short-sighted.
Why do insurance companies insist on making headlines for being stupid?
Pay the damn claim, the kid was employed, on the clock and protecting a patron in the restaurant. I know with the "Change" that has occurred since 1/20/09, we all can be happy now. But in real life, there are still scum bags in this world who act irrationally and sometimes you find someone who stands up for the true victim. Why split hairs and penalize the kid for protecting the patron in his restaurant?
back and forth on the other side of the adajacent intersection. The employee clocked out of his
convenience store employer's premises, crossed the street and asked, "can I help you."
Shot in the head by the assailant, similar questions were posed in the aftermath. After reviewing the situation, the insurer settled out
of court. That's where this case belongs ... in front of a jury who can consider if a "best behavior" employee manual provision should be the ultimate test of whether an employee who has the best interests of everyone involved should be penalized for protecting the employer's premises and customers.
This is despicable on McDonalds & the carriers' part
Had the young man walked away & let the intended victim die, what good would that have done McDonalds ?
There is something rotten about what just happened here
-Is it any wonder that a vast (yes: VAST) segment of the population hate insurance companies
Including the deceaseds' family.
When the general public reads this article they immediately think insurance companies are screwing the public again. They do not understand what a TPA is. Irrespective of the type of insurance McDonalds carries, the TPA is wrong for trying to split hairs. Whether company owned or franchised owned store, this should have not made headlines for identifying what's "appropriate" coverage.
If, or rather when, this plays out in the courts, the employee will likely be paid; and his attorney will likely sue for bad faith as well - which will far exceed the $300,000 in medical bills being sought (per other news reports).
Oh, and GL will not respond because of the workers' compensation and employers' liability exclusions contained in the CGL form. The same tests of in the course of employment do not exist in the CGL - they completely exclude coverage for an employee regardless of the surrounding circumstances; besides, how was the employer negligent for the injury?
Continuing the work comp exclusion, the carrier or provider could claim "abandonment of employment" as well as outside of scope.
Don't let your passion run away with you.
Understand, I hope he will and believe he should be paid; but from a pragmatic, legal view, the denial can be supported.
Construct arguments for payment, not just opinions based on emotion. Implied consent was recommended in the article - let's, as a community, come up with others that may help the employee.