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 country every day. As a result, workers’ compensation laws were created to cover employees who suffer job-related injuries. Workers’ comp provides medical care and benefits for the time when the worker is unable to return to work.

States control workers’ compensation legislation and each state has different regulations. If you want to know about your eligibility for workers’ compensation benefits after a job injury, talk to an experienced workers’ compensation lawyer where you live for more information.

Workers’ Compensation Overview

Workers’ comp insurance provides medical treatment and income replacement payments to employees who are injured on the job. Wage benefits are based on the average weekly wage of the worker. Other benefits may include vocational rehabilitation to help the injured employee get back to work.

If a worker is killed in a work-related accident, the policy pays death benefits to the worker’s family members and dependents. The benefits are paid out regardless of who was at fault for the injury. In exchange for these benefits, workers typically cannot sue their employers over work-related injuries or illnesses.

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. Most states require that employers either pay into the state workers’ compensation system, purchase a private policy from an insurance company, or become self-insured employers. A worker’s eligibility for workers’ compensation benefits is not affected by the method of insurance their employer chooses.

In Wyoming, businesses can only buy worker’s compensation coverage through the state program. States like Oklahoma allow 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.

Workers’ Compensation Eligibility

Generally, two basic requirements must be met to qualify for workers’ compensation benefits:

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

If you try and claim workers’ comp for a non-work-related injury, you could be committing workers’ compensation fraud.

Which Employees Are Covered?

Not all workers are eligible to receive workers’ comp benefits from their employer. In some states, a company’s insurance coverage does not cover workers classified as independent contractors, consultants, or freelancers. For example, in Connecticut, sole proprietors without other employees are not required to have workers’ compensation insurance.

Employee classifications can be confusing and employers sometimes misclassify employees as independent contractors, improperly denying them workers’ compensation benefits. In these cases, filing an appeal to get coverage for a workplace injury may be possible.

Certain types of other workers may also be exempt from workers’ compensation coverage, including:

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

Some states also have special rules for undocumented workers. Arizona, California, Florida, Montana, Nevada, New York, Texas, and Utah have laws that explicitly provide coverage for undocumented workers. Other states like Idaho have laws that deny coverage to these workers.

What Injuries and Illnesses Are Covered?

Generally, all job-related injuries and occupational illnesses are covered by workers’ compensation insurance. If a qualified employee is injured or becomes sick while doing work on behalf of their employer, it is typically considered a job-related injury.

For example, an office worker who develops carpal tunnel syndrome or a warehouse worker who drops a heavy box on their foot would generally be covered under their employer’s workers’ compensation policy. An employee who becomes ill after exposure to a toxic substance or suffers mental trauma due to an event at work may 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 injured at an offsite holiday party or a worker who is hurt while driving a company car. To determine if workers’ compensation insurance covers a particular injury, consulting with a workers’ compensation attorney may be helpful.

Am I Eligible for Workers’ Compensation Benefits?

Workers who have suffered an injury or illness while on the job are likely covered by their employer’s workers’ comp insurance. Injured workers should report their condition to their employers as soon as possible because workers’ compensation claims must be filed within a certain time frame. Workers 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.

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. However, workers who intentionally harm themselves or suffer an injury due at work while under the influence of drugs or alcohol may be denied coverage.

Workers’ compensation laws can be complex, time-sensitive, and significantly different from state to state. Seek the legal advice of a workers’ comp attorney before filing your claim.