What Is AOE/COE in a Workers’ Compensation Case?

In a California workers’ compensation case, the terms AOE (Arising Out of Employment) and COE (Occurring in the Course of Employment) are used to determine whether an injury is work-related and eligible for benefits. If an injury meets both conditions, the worker may qualify for medical treatment and disability benefits through workers’ compensation.

What Does AOE/COE Mean?

• Arising Out of Employment (AOE): The injury must be directly caused by the worker’s job duties or work environment.
• Occurring in the Course of Employment (COE): The injury must have happened while the worker was performing job-related tasks.

Both conditions must be met for a claim to be accepted. If either is missing, the claim may be denied.

Examples of AOE/COE Injuries

Injuries That Typically Qualify

• A worker injures their back while lifting heavy boxes at work (AOE and COE apply).
• A delivery driver is injured in a car accident while making a work-related delivery (AOE and COE apply).
• A construction worker falls from scaffolding at a job site (AOE and COE apply).

Injuries That May Not Qualify

• A worker is injured while commuting to and from work (not covered, unless an exception applies).
• An employee is hurt during a voluntary company event (may not be covered, depending on the circumstances).
• A worker suffers a heart attack at work, but medical evidence shows it was unrelated to job duties (AOE does not apply).

How Employers and Insurance Companies Dispute AOE/COE

Employers and insurance companies may try to deny a claim by arguing that:

• The injury was not caused by work (pre-existing condition or off-duty incident).
• The worker was engaging in misconduct when the injury happened.
• The injury occurred outside of work hours or off company property.

If an AOE/COE dispute arises, a Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) may be needed to review medical evidence and provide an independent opinion.

What to Do If Your AOE/COE Claim Is Denied

If an insurance company disputes that an injury is work-related, the worker can challenge the denial by filing a case with the California Division of Workers’ Compensation (DWC). A workers’ compensation attorney can help gather medical records, witness statements, and other evidence to prove the injury qualifies under AOE/COE.

Need Help With an AOE/COE Dispute?

If your workers’ compensation claim has been denied due to an AOE/COE dispute, legal representation can help you fight for the benefits you deserve. Contact the Law Offices of Norman J. Homen today for a free consultation.