An occupational accident has three constituent elements:
- Consequence or, in other words, the damage that has a causal link to the accident; and
- Conditions in which the accident occurred.
Definition of accident
An accident refers to a sudden and unforeseen event arising from an external factor that causes the employee to be injured or to develop an illness.
* An external factor means a factor independent of the injured person that causes the claim event, such as a slippery street, a pothole, an object falling on top of a person or a sharp object grabbed accidentally. An external factor may also refer to acid, virus or bacteria.
* Sudden means that the incident is rapid and immediate (such as a trip, a fall or a crash). The duration of the incident is very short.
* Unpredictable means that the incident is beyond the control of the employee, i.e. unexpected and unlooked for from the perspective of the person concerned. If an employee deliberately injures himself or herself, it is not an accident.
In addition to the accident, certain injuries and illnesses manifesting over a short period of time are also deemed to have been caused by the accident, even when the requirement for sudden incident may not be met. Compensation is conditional upon the exposure having taken place within 24 hours prior to the injury or onset of illness and the matter not concerning an occupational disease. These include:
- skin abrasions caused by friction;
- injury or illness caused by a corrosive substance;
- injury or illness caused by breathing a gas, vapour or fumes;
- frostbite, hypothermia, thermal burn and heat-related illnesses caused by abnormal thermal conditions;
- injury or illness caused by radiation; and
- injury or illness caused by significant variation in physical pressure.
Muscle or tendon pain is compensable as an accident, even when a definite external factor cannot be shown, provided that the pain manifested when the employee was performing a straining work-related motion.
Compensation for muscle or tendon pain is only compensated in certain circumstances, at work and in recreational sports.
Compensation is paid for up to six weeks from the onset of pain. Compensation is not paid if it is discovered that the employee has an earlier injury or illness which manifested or caused symptoms during the work.
Assault or injury caused intentionally by another person is also deemed to be an accident. However, the reason for the assault will affect compensability.
If the reason was the injured person’s work assignment or if it took place during the injured person’s leisure time, compensation will be paid in any circumstance.
If the injured person's family relations or other matters related to his or her private life were the main reason for the assault, it will not be compensable as an occupational accident.
If the reason for the assault remains unclear or it cannot be demonstrated whether the assault arose from a work assignment or from private life, it will only be compensated in the specific circumstances laid down in certain acts. Such circumstances are related to the location of the working area, the course of travel between home and the workplace or to a training event.
Consequence and causality
An injury or illness or the consequent death of the injured person is compensable as an occupational accident.
There must be a causal link between the compensable injury or illness and the accident at work.
In most cases, establishing causality is unproblematic. However, sometimes an assessment of possible causality is a matter of likelihood. In this case, questions such as whether the accident was intense enough and had a suitable mechanism to cause the injury or disease concerned have to be considered. Causality considerations are based on medical knowledge and experience on the emergence mechanism of injuries and diseases.
Only in rare cases can causality be positively established by using medical methods. Compensation for injuries caused by accidents can be paid if a likely medical causal link between the accident and an injury can be found. Reasons for causality have to be stronger than reasons against causality. A medical likelihood for a certain injury to be caused by the incident is not alone a sufficient basis for compensation.
The Workers’ Compensation Act has two additional provisions which define the preconditions for compensability of certain consequences. The first concerns the consequence of aggravation of an injury or illness the injured person had before the accident. The second concerns compensation for certain types of mental shock reaction.
The third element of the definition of occupational accident concerns the circumstances in which the occurred accidents are compensated:
Accident at work is considered an accident that has happened to an employee during the course of their work. The content of the accident is determined by the tasks assigned to the employee and the methods of work. For example, the assignment may involve working with machines, installation work or participation in meetings. No demands for the time and place of work have been laid down in law. The working area may be fixed or work can be performed at home or remotely. Compensation for accidents that happen in connection with work is also paid in these cases.
Performance of the duties of a local union representative, occupational safety representative or other employee representative in accordance with the law or a collective agreement, performance of tasks on behalf of the employer and travel due to work are comparable to work. Travel also includes a minor deviation from the itinerary due to childcare, visit to a grocery store or any other similar reason.
Accidents that take place in the location of the working area but not in the course of work are considered to be occupational accidents if they occur during the course of activities normally associated with being in the working area. The working area is a place where the assignment is performed, for example a permanent workplace, installation place or meeting place. The location of the working area includes the areas in which the employee moves around due to the work assignments and performance of work, such as canteens, break rooms, dressing rooms and washrooms.
Activities normally taking place in the working area include meals, exercise during breaks, training and recreational events.
Employees who largely work in a place of their own choosing or at home are not covered against accidents in the location of the working area.
An accident that happens during travel between home and the workplace is compensable as an occupational accident if it takes place during activities normally associated with travel, and the journey is associated with normal commuting to work.
‘Home’ means the employee’s permanent, temporary or holiday home. ‘Workplace’ means the space assigned by the employer where work is normally performed, with the exception of extraordinary assignments (permanent workplace).
The commute between home and the workplace may include a minor deviation from the itinerary due to childcare, visit to a grocery store or any other similar reason.
Employees who work in a place of their own choosing or at home are not covered against accidents during the commute between home and the workplace.
An accident that happens outside the location of the working area is compensable as an occupational accident if it takes place during normal activities associated with a meal or recreational break. This is a normal break associated with work and taken in the vicinity of the location of the working area. ‘Working area’ is the place in which each and any task is performed. ‘Vicinity’ means a place which the employee is able to visit during the time reserved for the meal or recreational break, including the travel time.
‘Normal activities’ associated with meal and recreational breaks include activities such as eating, buying lunch or going for a walk.
Employees who work in a place of their own choosing or at home are not covered against accidents during meal and recreational breaks.
An accident that happens during a training event outside the location of the working area is compensable as an occupational accident if the training event is associated with work and organised or approved by the employer, and the accident takes place during an activity which is part of the training. The event includes the travel between home or the workplace and the event. Accidents that happen during a training event held at the workplace are deemed to have taken place in the location of the working area.
Training must be related to work. The employer’s express approval is not required if, according to the workplace practice, the employees can choose their work-related training.
As a rule, the activities that can be deemed part of the event include the event programme and any activities that are generally assumed to be included in the type of event in question.
An accident that happens during a recreational event outside the location of the working area is compensable as an occupational accident if the event is associated with work and organised or approved by the employer, and the accident takes place during an activity which is part of the event. The event includes the travel between home or the workplace and the event.
The recreational event must be related to work and organised or approved by the employer. Any pay received during the event or the timing of the event are irrelevant.
As a rule, the activities that can be deemed part of the event include the event programme and any activities that can generally be assumed to be included in the type of event in question.
Accidents that happen during activities maintaining the ability to work are compensable as occupational accidents if the employer has organised the activity under the Act on Occupational Health Care and together with the occupational health service. Travel between home or the workplace and the activity is also covered.
...when the reason for the appointment is the actual or suspected claim event
Accidents that happen during health care appointments are compensable as occupational accidents if the reason for the appointment is an injury or illness caused by an actual or suspected occupational accident or disease.
...when the reason for the appointment is a sudden illness during the working hours, appointment under the Act on Occupational Health Care, other obligations arising from work or the employer’s order
An accident that happens in connection with a medical appointment when an employee has fallen ill suddenly during the working hours and has immediately sought medical attention is compensable as an occupational accident. An accident that happens during the travel to or from the appointment is also compensated. During the working hours, the employee may leave a permanent workplace, other workplace or remote workplace for a medical appointment.
Similarly, health care appointments related to occupational health care provided by the employer under the Act on Occupational Health Care, other obligations arising from work or the employer's order are also covered. However, the cover does not include any appointments related to the occupational health care, provided by the employer, that go beyond the extent required by the Act on Occupational Health Care.
Patient injuries sustained during the appointment are not compensated.
An accident that happens during exercise is compensable as an occupational accident if the purpose of the exercise is to meet specific requirements regarding the employee’s physical condition. In addition, the exercise must be approved by the employer and take place during the employee’s working hours.
The special requirements apply to certain occupations such as soldiers, police officers and firefighters. The cover extends to exercise and the activities normally associated with it, such as dressing, washing and travel.
An accident is compensable as an occupational accident if it happens in the employee’s accommodation, provided because the employee performs work in conditions that expose him or her to exceptional accident risk, and the accident is caused by a factor related to these conditions.
Exceptional accident risk can be caused by events such as earthquakes or conditions in a theatre of war. Only accidents that occur when the employee is in the designated place of accommodation, such as a hotel room, are compensated. For example, the cover does not extend to leisure time spent outside the hotel.