Adjuster X

Play Ball

An injury during a company event raises questions about the injured employee's behavior.
By: | May 6, 2015 • 3 min read

“Injured while chasing a fly ball in right field?” I asked aloud.

“Company picnic with a softball game,” replied my supervisor. “A guy named Mark Sullivan was hurt during the course of the game. Give this one a full work-up.”

I arrived at Pennfield Manufacturing early the following morning to meet with Liz, the HR manager. Liz told me that Mark was injured during the sixth inning of the softball game.

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She hadn’t witnessed the injury but she did see the aftermath. Sullivan had injured his right ankle and couldn’t walk as a result. He had to be carried off the field and driven to the ER.

Liz said employee attendance wasn’t required, but those who attended were able to leave work at 3 p.m. Those who didn’t had to stay until 5 p.m. No surprise, attendance was always robust. The company provided soft drinks and food. No alcohol was served, and employees were not permitted to bring their own.

I asked to meet with the employees who were closest to where Mark was at the time he was hurt. Bill Damon was playing centerfield that day.

“Why do you think Mark fell?” I asked. Damon shook his head.

“Clumsy I guess, or maybe he stepped in a hole. Really don’t know. I ran over and he was moaning in agony. Haven’t seen him since.”

“Was there any beer available at the game?” I asked. Bill looked sideways at me, “Penfield doesn’t allow alcohol at the picnic.”

I replied, “That’s not what I asked.” Bill said he had to get back to work.

Ron Davis was playing first base that day. I asked, “How many beers did Mark Sullivan drink during the game?”

“Don’t know,” said Davis.

I persisted, “It was hot and humid. He must have had a few.” Davis replied, “I have no idea. Wasn’t my turn to count.”

“You were pretty close to Mark when he fell. What did you see?” I asked.

Davis shrugged. “I saw him crumple to the grass, yelling about his ankle. By the time I got to him he was pounding on the turf with his fist saying he thought he broke it. Steve Ellis drove him to the ER. That’s all I know.”

“I’m asking how many cans of beer you consumed at the picnic softball game prior to your injury in the bottom of the sixth inning,” I replied.

Steve Ellis wasn’t at work that day, so I decided to interview Sullivan at his home. He was on crutches with his right lower leg in a soft cast.

“Ripped the ligaments in my right ankle. Doc said it’ll probably take a couple of months to heal completely.”

“What happened to cause your fall?” I asked. Sullivan looked toward me and replied, “I don’t know. I just twisted my ankle and toppled over while running for a fly ball.”

“Well, do you remember how many beers you had?” I asked. Sullivan hesitated. “I, ah … just what are you getting at?”

“I’m asking how many cans of beer you consumed at the picnic softball game prior to your injury in the bottom of the sixth inning,” I replied.

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“I know you guys had some coolers full of beer and that you were cracking a few each time your team was batting.”

“I don’t know, maybe three. But I wasn’t drunk and I didn’t fall because I had a few beers.”

I asked a few more questions and told Sullivan I’d call him.

The ER record confirmed the history of injury. There was no evidence that Sullivan was inebriated.

I called my supervisor, and said, “On the Sullivan/Penfield case, you can accept the claim and start payments. I thought I had enough to sustain a denial, but I whiffed on that pitch.”

This column is based on the experiences of a group of long-time claims adjusters. The situations they describe are real, but the names and key details are kept confidential. Michelle Kerr is the editor of this column and can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]