CMP.6.3.020 Conditions of Liability

(a) Liability under this Ordinance shall exist against an Employer where the following conditions occur

(1) The Employee sustains the injury in the course of his/her employment

(2) Where, at the time of the injury, both the Employer and Employee are subject to the provisions of this Ordinance.

(3) Where, at the time of the injury, the Employee is performing service growing out of and incidental to his/her employment

(4) The premises of the Employer include the premises of any other person on whose premises the Employee performs service.

(5) Any Firefighter or First Responder Volunteer, responding to a call for assistance outside the limits of his/her village, unless that response is in violation of law, is performing service growing out of and incidental to employment

(6) Every Employee whose employment requires the Employee to travel shall be deemed to be performing service growing out of and incidental to the Employee's employment at all times while on a trip, except when engaged in a deviation for private or personal purpose. Any accident or disease arising out of a hazard of such service shall be deemed to arise out of the Employee's employment

(7) Within 14 days of notice of an injury to Employer, the Claims Administrator/Managed Care Provider will either pay or formally deny the Employee's claim.

(b) Exclusions

To qualify for Worker's Compensation benefits under this Ordinance, an injury, illness or death must arise out of and in the course of the Employee's employment with the Employer. No benefits under this Ordinance shall be allowed for any injury, illness or death caused by or arising for the following:

(c) Gross negligence by the injured Employee.

(d) Disobedience, refusal or failure by the injured Employee to use a safety device or appliance furnished by the Employer which if used would have reasonably prevented or significantly reduced the likelihood of the injury, illness or death.

(e) Horseplay engaged in by the injured Employee, which significantly contributes to the injury, illness or death.

(f) The injured Employee's intoxication, use of any illegal substance or abuse of any prescription medication which contributes to the Employee's injury, illness or death. Any Employee suspected of being under the influence of alcohol or drugs when the injury occurs shall be subject to drug testing conducted by the Lac Courte Oreilles Health Center or other appropriate drug testing facility.

(g) Self-inflicted injury, including suicide.

(h) A pre-existing condition, including a degenerative condition, established by medical evidence, whether pre- or post-injury, which significantly causes, aggravates, or otherwise contributes to the disability or need for medical treatment.

(i) The Employee's failure, prior to commencement of employment, to disclose a physical condition, which prevented the Employee from safely performing the work for which the Employee was hired or which was a substantial contributing factor to the injury.

(j) Act by a third person or fellow employee intended to injure the Employee for personal reasons, and not directly against the Employee as an Employee or because of employment