## Facts

- Phyllis Milledge worked as a housekeeper for The Oaks, a nursing home.
- Shortly before her shift, Milledge parked in the employer’s parking lot and twisted her ankle while exiting her car.
- She finished most of her shift but sought medical care the same day; x-rays showed a sprained ankle.
- Her condition worsened over the next weeks, resulting in infection that ultimately required a below-the-knee amputation.
- After the employer’s carrier denied benefits, Milledge filed a workers’ compensation claim.
- A single hearing member denied the claim; the Full Board adopted that denial; the court of appeals affirmed.
- The Indiana Supreme Court accepted review and considered whether the injury was compensable.

## Issues

1. Whether an employee’s unexplained injury sustained while arriving for work on the employer’s premises “arose out of” and “in the course of” employment under Indiana workers’ compensation law.
2. Whether an unexplained workplace accident should be treated as a neutral risk subject to the positional-risk doctrine.
3. Whether subsequent medical complications (including amputation) were compensable consequences of the initial injury.

## Decision

- The Indiana Supreme Court reversed the Workers’ Compensation Board’s denial of benefits and remanded.
- The Court held the injury occurred “in the course of” employment because it happened on the employer’s premises while Milledge was arriving for her scheduled shift.
- The Court held the injury also “arose out of” employment because an unexplained accident is a neutral risk and is compensable under the positional-risk doctrine when employment placed the worker at the location of injury.
- The Court accepted the claimed amputation as a compensable consequence of the original injury where medical evidence linked the complications to the ankle injury.

## Legal Principles

- “In the course of” employment addresses time, place, and circumstances; arriving for work on the employer’s premises generally satisfies this requirement.
- “Arising out of” employment concerns causation and can be analyzed by classifying the risk as employment-related, personal (idiopathic), or neutral.
- Unexplained workplace accidents are neutral risks.
- Under the positional-risk doctrine, a neutral-risk injury is compensable if it would not have occurred but for the employment placing the employee in the position where the injury occurred.
- In unexplained-accident cases, the employee need not prove a specific workplace defect; absent proof of a personal/idiopathic cause, the neutral risk is attributed to employment under positional risk.
- Medical sequelae that flow from a compensable workplace injury may also be compensable.

## Conclusion

An unexplained injury occurring on the employer’s premises while an employee is arriving for work is a neutral-risk event that satisfies the “arising out of” requirement under the positional-risk doctrine, making the injury and its medically linked complications compensable under Indiana workers’ compensation law.


Milledge v. The Oaks, 784 N.E.2d 926 (Ind. 2003)