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Compliance November 23, 2005
Bathroom Fall Not an Accident Related to Work
November 23, 2005 (PLANSPONSOR.com) - The US 7th
Circuit Court of Appeals agreed with a plan administrator in
denying accident benefits to an employee who fell in the
restroom.
Reported by Rebecca Moore
According to the court opinion Elvira Sisto was employed with Ameritech Corporation as a customer service representative. One morning when she reported to work she turned on her computer and went to the restroom while it booted up. She fell in the restroom and missed work due to injuries sustained by the fall.
The Ameritech Sickness and Accident Disability Benefit Plan, under its sickness provision, covers illnesses and injuries that are unrelated to work and provides benefits for a maximum of 52 weeks. The accident provision covers illnesses and injuries resulting from a work-related accident and provides benefits for as long as the disability lasts. The Plan awarded Sisto sickness benefits but denied accident benefits.
Sisto sued the plan for accident benefits. The US District Court for the Northern District of Illinois granted summary judgment in favor of the plan.
Since the plan stated that accidents will be considered work related when they occur “during and in direct connection with the performance of duties,” the appellate court decided that the plan’s denial of benefits was reasonable and affirmed the summary judgment of the district court.
The opinion can be read here .