1.2 The three tests: work-related, new case, criteria

1 The decision tree, in three questions

The structure of the rule is deliberately sequential. If the case fails the first test, you never reach the second. That saves argument: a dispute about whether four stitches count as medical treatment is pointless if the injury happened while the employee was playing in the company softball game.

1. 1
   Is it work-related? — 1904.5. Presumed yes for anything in the work environment, unless one of nine exceptions applies.
2. 2
   Is it a new case? — 1904.6. New injury, or a fully recovered old one that a work event brought back.
3. 3
   Does it meet a recording criterion? — 1904.7 for the general criteria, 1904.8 to 1904.12 for specific case types.

Note what is not in the list. Not fault. Not whether the employee reported it on time. Not whether workers' compensation accepted the claim. Not whether the employee was doing something stupid. Recordability is a factual test about the work environment and the outcome, and nothing else.

2 Work-related: a presumption, not a judgment call

1904.5(a) is written as a presumption: you must consider an injury or illness work-related if an event or exposure in the work environment either caused or contributed to the condition, or significantly aggravated a pre-existing one — and “work-relatedness is presumed for injuries and illnesses resulting from events or exposures occurring in the work environment, unless an exception in § 1904.5(b)(2) specifically applies.”

Three words in there carry most of the weight. Contributed — the work does not have to be the only cause, or even the main one. Significantly aggravated — defined precisely in (b)(4), and we will come back to it. And specifically — the exceptions are a closed list of nine, and if your situation is not on it, the presumption stands.

The work environment itself is defined broadly in 1904.5(b)(1): “the establishment and other locations where one or more employees are working or are present as a condition of their employment”, including the equipment and materials used during work. That takes in the parking lot, the break room, the company truck and the customer's site.

3 The nine exceptions, and the traps in them

Two special situations get their own paragraphs. Travel status, in 1904.5(b)(6): injuries are work-related if the employee was engaged in work activities in the interest of the employer — travel to customer contacts, doing job tasks, business entertainment at the employer's direction — with carve-outs for personal detours and for a hotel treated as a home away from home. Working at home, in (b)(7): work-related if the injury occurs while performing work for pay and is directly related to the work rather than to the home environment. Dropping a box of work documents on your foot counts; tripping over the family dog on the way to a work call does not.

4 Significant aggravation, precisely defined

Pre-existing conditions are where most disputed cases live, and the rule handles them with unusual precision. 1904.5(b)(5) defines a pre-existing condition as one resulting solely from a non-work event or exposure outside the work environment. 1904.5(b)(4) then says a pre-existing condition has been significantly aggravated, for recordkeeping purposes, when a work event or exposure results in any of four things:

• Death, where the pre-existing condition would likely not have caused it but for the work event.
• Loss of consciousness, on the same test.
• Days away, restricted work or job transfer that would not otherwise have occurred.
• Medical treatment where none was needed before, or a change in the treatment made necessary by the work event.

That is a useful list precisely because it is mechanical. You are not asked to apportion causation between a twenty-year-old back problem and today's lift. You are asked whether the work event produced one of those four outcomes that would not otherwise have happened.

5 New case, and the chronic-illness rule

1904.6(a) defines a new case in two ways: the employee has not previously experienced a recorded injury or illness of the same type affecting the same part of the body, or they had one, recovered completely — all signs and symptoms disappeared — and a work event or exposure brought the signs or symptoms back.

The chronic-illness carve-out in (b)(1) matters in industrial hygiene: where signs or symptoms may recur or continue in the absence of workplace exposure — occupational cancer, asbestosis, byssinosis, silicosis — the case is recorded once and once only. But a recurrence caused by a fresh workplace exposure, such as an episode of occupational asthma, is a new case under (b)(2).

You are not required to ask a physician whether a case is new. But 1904.6(b)(3) is firm about what happens if you do: you must follow the recommendation, and where two professionals disagree you must decide which is the most authoritative — best documented, best reasoned — and record on that basis.

6 Writing the decision down

A recordability call made in your head is a call you will re-argue in eighteen months with no memory of why. Write three lines against every borderline case: which test was in question, what facts decided it, and which paragraph you relied on. It takes a minute and it survives the auditor, the successor safety manager and the deposition.

The discipline pays off twice over, because 1904.33(b)(1) obliges you to update stored logs for five years when a case changes classification — and a case whose original reasoning is written down is a case you can reopen intelligently rather than from scratch.