Who is Eligible for Workers’ Compensation?

Federal law requires that employers maintain a safe work environment for workers. However, accidents still happen at worksites across the United States every day. As a result, workers’ compensation insurance was created to cover employees who suffer on-the-job injuries. Since it was initially implemented in the early part of the 20th century, it has been expanded to include coverage of work-related illnesses.

Workers’ comp insurance provides medical care and income replacement payments to employees who are injured on the job. If a worker is killed in a work-related accident, the policy pays death benefits to the worker’s dependents. In exchange for these benefits, workers typically cannot sue their employers over work-related injuries or illnesses. The benefits are paid out regardless of who was at fault for the injury.

Workers’ compensation legislation is created and controlled by states, and each state has different regulations. Most states require that employers either pay into the state workers’ compensation system, purchase a private policy or become self-insured. Typically, the employer’s insurance responsibility depends on the type of business it conducts, the number of workers it employs and the kind of work the employees do. Oklahoma allows employers to opt out of the state system, but those who choose to do so must provide workers with equal benefits through another plan. Texas allows employers to go uninsured, but workers retain the right to sue their employer if they are injured on the job. A worker’s eligibility for workers’ compensation benefits is not affected by the method of insurance their employer chooses.

Workers’ Compensation Eligibility

Generally, there are two basic requirements that must be met in order to qualify for workers’ compensation benefits:

  • The worker must be employed by the company or individual who has the insurance policy.
  • The worker’s injury or illness must be work-related.

Which Employees Are Covered?

Not all workers are eligible to receive workers’ comp benefits from their employer. For example, workers who are classified as independent contractors, consultants or freelancers are not covered by a company’s insurance policy. If someone is a temporary worker or a salesperson, they could be categorized as either an independent contractor or an employee, depending on their duties. Employee classifications can be confusing, and employers sometimes misclassify employees as independent contractors, improperly denying them workers’ compensation benefits. In such cases, it may be possible to file an appeal.

Certain types of workers are also exempt from workers’ compensation coverage. These include:

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

Some states also have special rules for undocumented workers. Arizona, California, Florida, Montana, Nevada, New York, Texas and Utah all have laws that explicitly provide coverage for undocumented workers. On the other hand, states like Idaho and Wyoming have laws that deny coverage to such workers.

What Injuries and Illnesses Are Covered?

Generally, all job-related injuries and illnesses are covered by workers’ compensation insurance. If a qualified employee is injured or becomes sick while doing work on behalf of his or her employer, it is typically considered a job-related injury. For instance, an office worker who develops carpal tunnel syndrome or a warehouse worker who drops a heavy box on their foot would be covered under their employer’s workers’ compensation policy. An employee who becomes ill after being exposed to a toxic substance on a worksite or suffers mental trauma due to an event that took place at work would also be covered.

However, injuries that happen away from the worksite but in connection to a job could be harder to classify. Examples of these situations may include an employee who is injured at an offsite holiday party or a worker who is hurt while driving a company car. In order to determine if a particular injury is covered by workers’ compensation insurance, it may be helpful to consult with a workers’ compensation attorney.

Am I Eligible?

Workers who have suffered an injury or illness while on the job and are not listed in one of the exempted job categories are likely covered by their employer’s workers’ comp insurance. Injured or ill workers should report their condition to their employers as soon as possible because workers’ compensation claims must be filed within a certain time frame. A worker could lose their right to file a claim if they miss the deadline.

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

Workers are eligible for benefits even if they are responsible for their own injury. For example, a welder who suffers a burn because they forgot to wear protective gloves is still eligible to receive coverage. However, workers who intentionally harm themselves or suffer an injury due to on-the-job drug or alcohol use are not eligible for coverage. Workers’ compensation laws can be complex, time sensitive and significantly different from state to state. Seek the advice of a workers’ comp attorney before filing a claim.

Speak to an Experienced Workers’ Compensation Attorney Today

This article is intended to be helpful and informative. But even common legal matters can become complex and stressful. A qualified workers’ compensation lawyer can address your particular legal needs, explain the law, and represent you in court. Take the first step now and contact a local workers’ compensation attorney to discuss your specific legal situation.

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