The Two Tests: AOE and COE Explained
What Is "Arising Out of Employment" (AOE)?
This test asks: Did your job cause the injury? The injury must have a direct connection to your work duties, workplace conditions, or job-related activities.
Examples That Meet AOE:
- ✓ Warehouse worker injures back lifting heavy boxes
- ✓ Office worker develops carpal tunnel from typing all day
- ✓ Construction worker falls from scaffold
- ✓ Factory worker inhales toxic fumes from machinery
- ✓ Nurse injured by violent patient
- ✓ Retail worker slips on wet floor in store
Examples That Don't Meet AOE:
- ✗ Tripping over your own shoelace (not job-related hazard)
- ✗ Heart attack from personal health condition unrelated to work stress
- ✗ Injuring yourself intentionally or while intoxicated
- ✗ Hurt during personal errand on lunch break off-site
What Is "In the Course of Employment" (COE)?
This test asks: Were you doing something work-related when injured? Generally, this means during work hours, on work premises, or performing job duties.
Situations That Meet COE:
- ✓ During regular work shift on company property
- ✓ On work break but still on work premises
- ✓ Traveling between job sites for work
- ✓ Running work errand for employer
- ✓ Attending required training or company event
- ✓ Working from home during scheduled work hours
Special Situations & Gray Areas
Pre-Existing Conditions That Get Worse
California law is worker-friendly here. You don't need to prove work caused the condition—only that work made it worse. This is called "aggravation" or "acceleration."
Example: You have mild arthritis in your knee. You get a job requiring constant kneeling and climbing. Six months later, your knee pain becomes severe and requires surgery. Even though arthritis existed before, your job activities accelerated the condition. This qualifies for workers' comp.
What insurance companies claim: They'll argue your condition is "degenerative" and would have happened anyway. Don't let this scare you. Your attorney can prove the job's contribution through medical evidence.
Cumulative Trauma (Repetitive Stress Injuries)
Not all injuries happen in one dramatic accident. Cumulative trauma develops gradually from repeated movements or ongoing workplace conditions:
- • Carpal tunnel syndrome from typing
- • Hearing loss from loud machinery
- • Back pain from years of lifting
- • Shoulder tendinitis from overhead work
- • Respiratory disease from chemical exposure
These are 100% covered. You have one year from the date you knew (or should have known) the condition was work-related to file your claim.
Mental Health & Psychiatric Injuries
Psychological injuries are covered but face higher scrutiny. California requires:
- • At least 51% of the cause must be actual work events (not personnel actions like performance reviews or job termination)
- • You must have worked for the employer for at least 6 months (exceptions for sudden trauma)
- • The stress must be beyond normal workplace stress
Psychiatric Claims That Often Succeed:
- ✓ Witnessing coworker's death or serious injury
- ✓ Violent assault by customer, patient, or coworker
- ✓ Repeated sexual harassment creating hostile work environment
- ✓ First responder exposed to traumatic events (police, fire, EMT)
Lunch Breaks & Company Events
On-premises lunch breaks: If you stay on company property during lunch, injuries are often covered. Courts reason you're still under employer control.
Off-premises lunch breaks: Not covered unless you were running a work errand.
Company-sponsored events: Holiday parties, team-building activities, and required training sessions are covered even if outside normal work hours.
The Commute Exception
The "going and coming rule" says your regular commute isn't covered. However, these situations ARE covered:
- • Your job requires frequent travel between multiple sites
- • You were running a work errand on the way to/from work
- • Your employer pays for your commute or provides transportation
- • You have no fixed workplace (traveling salesperson, field technician)
- • You were called in for an emergency outside normal hours
What About Employee Misconduct?
California's workers' comp system is "no-fault"—even if you violated a safety rule or made a mistake, you're still covered. The only exceptions:
When Coverage May Be Denied:
- • Intoxication: You were under the influence of drugs or alcohol (employer must prove this was the primary cause)
- • Intentional self-harm: You hurt yourself on purpose
- • Fighting: You started a fight for personal reasons unrelated to work (but defending yourself is covered)
Even if you weren't wearing required safety equipment or took a shortcut, you're still covered. Insurance companies will try to deny based on this—don't fall for it.
How Insurance Companies Fight These Claims
Expect the insurance adjuster to challenge your claim using these tactics:
- 1. "That's a pre-existing condition" – They'll dig through medical records looking for prior treatment. Your lawyer proves work aggravated it.
- 2. "You were off the clock" – They'll claim the injury happened during lunch or before your shift. Witness statements and time records disprove this.
- 3. "Not job-related" – They'll argue the activity wasn't part of your job duties. Your job description and supervisor testimony refute this.
- 4. "Degenerative condition" – For joint/back injuries, they'll blame aging. Medical experts can distinguish normal aging from work injury.
Real-World Examples
✓ Covered: Warehouse Knee Injury
Situation: Maria, 52, worked in a warehouse for 8 years. She had mild knee arthritis before the job. After years of kneeling to scan boxes on low shelves, her knee pain became severe and required surgery.
Outcome: Covered. Even though arthritis pre-existed, the job's repetitive kneeling accelerated the condition. Medical records showed progression correlated with job duties.
✗ Not Covered: Lunch Break Accident
Situation: Tom left company property during lunch to pick up dry cleaning. He was rear-ended at a stoplight two blocks from work.
Outcome: Not covered. Tom was on a personal errand off company property. This falls under the "going and coming" rule exception.
✓ Covered: Parking Lot Slip & Fall
Situation: Jennifer slipped on ice in the company parking lot while walking to her car after her shift ended.
Outcome: Covered. She was still on company property and hadn't fully left work. Employer controls the premises and has duty to maintain safe conditions.
✓ Covered: PTSD from Workplace Violence
Situation: Carlos, a retail manager, was held at gunpoint during an armed robbery. He developed PTSD and couldn't return to work.
Outcome: Covered. This was a sudden traumatic event directly arising from his job. Psychiatric injuries from workplace violence are compensable.
What to Do If You're Unsure
If you're questioning whether your injury qualifies, file the claim anyway. Here's why:
- • You have only 30 days to report the injury to your employer (or risk losing benefits)
- • A denial isn't final—you can appeal with medical evidence
- • Insurance companies deny legitimate claims all the time; don't self-reject
- • A free consultation with a workers' comp attorney costs you nothing
Important: Don't rely on your employer to tell you if something is covered. Employers are not lawyers and often have incentive to discourage claims (it raises their insurance premiums). Get advice from a workers' comp attorney, not HR.
When to Contact a Lawyer
You should speak with a California workers' comp attorney if:
- • Your claim was denied or you received a denial notice
- • The insurance company is questioning whether your injury is work-related
- • You have a pre-existing condition and work made it worse
- • Your injury is cumulative (developed over time)
- • You're claiming a psychiatric or stress-related injury
- • Your employer is pressuring you not to file a claim
- • You're unsure if the "AOE/COE" tests apply to your situation
Consultations are free. We only get paid if we win your case (typically 15% of settlement). There's no risk in getting expert advice.