Whether a claim is compensable may depend on what type of injury/disease is alleged.  The four major types of workers’ compensation claims are:

  1. Injuries to body parts other than the back.
  2. Injuries to the back.
  3. Occupational Diseases
  4. Death

This article addresses the standard for proving compensability for injuries to body parts other than the back.

For a claim to a body part other than the back to be compensable it must meet the following elements:

  1. Injury
  2. By accident
  3. Arising out of the employment
  4. In the course and scope of the employment.
  5. A causal connection between the accident and injury.

The terms “injury” and “accident” are not synonymous. 

  • An injury that is not the result of an accident is not a compensable claim.
  • Similarly, an accident that does not result in an injury is also not a compensable claim.
  • The mere fact that an injury occurred does not in and of itself establish that an accident occurred.
  •  An accident is “an unlooked for and untoward event which is not expected or designed by the injured employee.”
  • Injuries that are not the result of any fortuitous occurrence, but are the natural and probable result of the employment, are not compensable.  No matter how great the injury, if it is caused by an event that involves both an employee’s normal work routine and normal working conditions it will not be considered to have been caused by an accident.  If the employee is performing his or her regular duties in the usual and customary manner and is injured, there is no “accident” and the injury is not compensable.
  • An accident involves the interruption of the work routine and the introduction thereby of unusual conditions likely to result in unexpected consequences.
  • There does not have to be an appreciable separation of time between the accident and resulting injury, but there must be some unforeseen or unusual event other than the bodily injury itself. 


The phrases “arising out of” and “in the course and scope of” are not synonymous. 

  • They involve two ideas and impose a double condition, both of which must be satisfied in order to bring a case within the North Carolina Workers’ Compensation Act.
  • However, they are not applied entirely independently.  In practice, the “course of employment” and “arising out of employment” tests are not applied entirely independently.  They are both parts of a single test of work-connection.  The deficiencies in the strength of one factor are sometimes allowed to be made up by strengths in the other.
  • An accident arises out of and in the course and scope of employment when it occurs while the employee is engaged in some activity or duty which he is authorized to undertake and which is calculated to further, directly or indirectly, the employer’s business.
  • The phrase “arising out of” the employment, refers to the manner in which the injury occurred.  It is a mixed question of law and fact.
  • The phrase “in the course and scope of” refers to the time, place, and circumstances under which an accident occurs.  It is also a mixed question of law and fact.
  • With respect to time, the course of employment begins a reasonable time before work begins and continues for a reasonable time after work ends and includes intervals during the workday for rest and refreshment.

If an employee makes a claim for an injury to a body part other than the back, and it is an injury by accident arising out of and in the course and scope of employment, the claim should be found to be compensable.  If one of the elements is missing, then the claim should not be compensable.