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.
Norman J. Homen
Norman Homen is a California attorney with over 30 years of experience representing clients in workers’ compensation and Social Security disability matters.
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