Who Is Eligible for Workers’ Compensation?

Most employees are eligible for workers’ compensation for work-related injuries or illnesses. However, you must follow strict filing requirements to get your benefits under state law. States control workers’ compensation legislation, and each state has different eligibility requirements.

If you want to know about your eligibility for workers’ comp benefits, talk to an experienced workers’ compensation lawyer.

Workers’ Compensation Overview

Federal and state laws require employers to maintain a safe work environment for workers. However, accidents still happen at worksites across the country. States have passed workers’ compensation laws to cover employees who suffer job-related injuries. Workers’ comp provides medical care and benefits when you’re unable to return to work.

Workers’ comp insurance provides medical treatment to treat workplace injuries and illnesses. Workers’ comp also includes wage replacement benefits when you can’t earn an income. Your average weekly wages determine your wage benefit amount. Other benefits may include vocational rehabilitation to help the injured employee get back to work.

You can’t do other work while you are getting benefits. You can get partial benefits for limited work, but additional income will take away from your benefits.

Injured workers get workers’ comp regardless of whether the employer was at fault for the injury. In exchange for these benefits, you can’t sue your employer over work-related injuries. You can only file a personal injury claim against your employer in limited situations.

Insurance responsibility depends on the type of business, the number of workers, and the kind of work the employees do. Most states require employers to do one of the following:

• Pay into the state workers’ compensation system
• Purchase a private policy from an insurance company
• Be self-insured employers for workers’ comp claims

In some states, businesses can only buy worker’s compensation coverage through the state program. Other states allow employers to opt out of the state system. However, they must still provide workers with equal benefits through another plan. A few states allow employers to go uninsured. However, these workers retain the right to sue their employer if they suffer a workplace injury.

Workers’ Compensation Eligibility

Generally, there are four basic requirements to qualify for workers’ compensation benefits:

• You must be an employee at the time of the injury
• Your employer must have workers’ compensation benefits
• You must have had an injury on the job or a work-related illness
• You must report your injury and file your claim with the state Division of Workers’ Compensation within the deadline

You can’t claim workers’ comp for a non-work-related injury. Trying to get benefits for an injury suffered outside the job can be workers’ compensation fraud.

There are other exceptions to coverage for workplace injuries. Generally, you aren’t covered for intentionally causing your own injuries. You also can’t get benefits if you were under the influence of drugs or alcohol at the time of the injury. Check your state’s worker’s comp eligibility requirements.

Which Employees Have Workers’ Comp Coverage?

Not all workers are eligible to receive workers’ comp benefits from their employer. Most states don’t require coverage for independent contractors, consultants, or freelancers. Employee classifications can be confusing. Employers sometimes misclassify employees as independent contractors. If you think your employer improperly classified your employment, talk to a workers’ comp lawyer. You can file an appeal to get coverage for a workplace injury.

Most federal employees have coverage through a separate federal workers’ comp system. Certain types of workers are exempt from workers’ compensation coverage, including:

• Agricultural and farm workers
• Domestic workers
• Casual or seasonal workers

Some states extend coverage to undocumented workers. Other states explicitly deny coverage to these workers.

What Injuries and Illnesses Fall Under Workers’ Comp?

Generally, workers’ compensation insurance covers all job-related injuries and occupational illnesses. If you suffer an injury or become sick while working on behalf of your employer, it’s typically considered a job-related injury.

Covered workplace injuries include accidents and long-term occupational diseases. For example, a warehouse worker who drops a heavy box on their foot would generally qualify for their employer’s workers’ compensation policy. An employee who becomes ill after exposure to a toxic substance on the job is also covered.

However, injuries that happen away from the worksite but in connection to a job could be harder to classify. For example, does an injury at an offsite holiday party qualify as a work-related injury? To determine if workers’ compensation insurance covers a particular injury, talk to a workers’ comp lawyer.

Am I Eligible for Workers’ Compensation Benefits?

Suppose you suffer an injury or illness while on the job; you are likely covered by your employer’s workers’ comp insurance. You should report your injury to your employer as soon as possible. You have to file a workers’ compensation claim within a certain time frame. You could lose your right to file a claim if you miss the deadline.

You have the right to seek workers’ compensation benefits without fear of retaliation. Federal law forbids employers from harassing or otherwise discriminating against you for filing a valid claim.

Most full-time and part-time workers are eligible for benefits even if they are responsible for their own injury. For example, a welder who suffers burns because they forgot to wear protective gloves may still be eligible for coverage.

Get Help From a Workers’ Comp Lawyer

Workers’ compensation laws can be complex and vary from state to state. If you have questions about workers’ comp eligibility, get legal advice from a workers’ comp lawyer.