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How To Qualify For Workers' Compensation Benefits

Workers' compensation benefits, which include payments for medical expenses, wage replacement benefits, vocational rehabilitation, and other benefits, may be available to you if you were injured or became ill as a result of work. 

Regardless of who was at fault for the injury, you are entitled to workers’ compensation as long as you are qualified. In exchange for this protection, you forfeit the ability to file a lawsuit for damages against your employer. This exchange between the employer and employee became known as The Grand Bargain

If you want to learn more about the eligibility requirements for workers’ compensation benefits, continue reading this guide below. 

What Are My Rights If I’m Injured At Work?

Workers' compensation laws in each state safeguard a variety of rights for injured employees, including the right to:

  • Submit a workers' compensation claim without fear of reprisal, such as being let go, demoted, or fired as a result of your claim;
  • File an appeal if your claim was denied;
  • Receive medical treatment and all the other workers' compensation benefits for which you are eligible; and
  • Have a workers’ compensation lawyer to help you with the legal proceedings and negotiate on your behalf. 

There are other workers' compensation rights, such as the right to choose your own doctor or switch doctors, that are state-specific.

Do I Have To Be Injured At My Workplace To Be Covered By Workers’ Compensation?

No, you don’t have to be injured at your workplace in order to receive your workers’ compensation benefits. Your injuries are covered as long as they occurred while you were working and were caused by your job. 

For instance, if you are injured while traveling on business, performing a work-related task, or even attending a mandatory business-related social function, you will be covered by workers’ comp. For more information on what conditions entitle you to receive workers’ compensation benefits, visit this article by Disability Help.

Despite the nuances in how each state's laws define work-related injuries, the coverage for workers’ comp is very much similar. You can check out this article to learn more about work-related injuries and occupational diseases.

Workers’ Compensation Eligibility Requirements

Generally, there are four basic requirements you must meet in order to be eligible for workers’ comp benefits:

  • You must be an employee (excluding freelancers, part-time workers, and independent contractors);
  • Your employer must have a workers’ compensation insurance policy;
  • Your injury or illness must be work-related or occupational; and
  • You must meet your state’s deadlines for reporting the injury and filing a workers’ compensation claim.

Keep in mind that domestic workers, agricultural and farm workers, casual or seasonal workers, and workers placed with an employer through temp agencies are all subject to special rules.

Let's take a deeper look at the basic eligibility requirements as well as some of the exceptions.

You Must Be An Employee To Qualify For Workers’ Compensation Benefits

When it comes to workers' compensation eligibility, not all workers are considered employees. Independent contractors (such as freelancers, consultants, or participants of the "gig" economy) are often not entitled to workers' compensation benefits.

However, many workers, including Uber, Lyft, and other ride-hailing service drivers, argue that they were misclassified as independent contractors when the hiring company should have classified them as employees.

Employers frequently misclassify their employees as independent contractors in order to avoid paying payroll taxes or workers' compensation premiums. Even though you signed a 1099 tax form as an independent contractor, you may still be considered an employee for workers' compensation purposes. 

However, your issue will very certainly end up in court. Although the rules vary by state, courts will generally consider the degree of control you have over your work as well as other aspects of your working relationship with the company or the person who hired you.

Volunteers are typically not eligible for workers' compensation benefits, but there are certain exceptions. Some states, for example, specifically cover volunteer firefighters, while others allow organizations to cover their volunteers.

Injury Or Illness Must Be Work-related Or Occupational

In general, if you were accomplishing any tasks or fulfilling any duties for your employer's benefit and were injured or fell ill as a result, it is considered work-related. 

For instance, if you hurt your back while lifting boxes as part of your warehouse job, get carpal tunnel syndrome as a result of long hours of typing on the job, or become sick as a result of prolonged exposure to hazardous chemicals on your work, your injuries are clearly work-related.

However, this issue may be more difficult to resolve if you were hurt on your lunch break, during a company-sponsored social event, or when joking around with coworkers. 

If you want to know more about the list of injuries that are not covered by workers’ compensation, you may check out this article.

Meet Workers’ Compensation Reporting And Filing Deadlines

Even if you manage to meet all of the other requirements, you may still lose your right to workers' compensation benefits. If you fail to meet your state's deadlines for reporting the injury to your employer and filing a workers' compensation claim, you are automatically ineligible to collect your workers’ compensation benefits. 

Keep in mind that each state imposes different deadlines for filing a workers’ compensation claim. However, generally speaking, claims for work-related injuries must be filed within one year from the date of injury. Claims for occupational illnesses must be submitted within two years after receiving written notice from your authorized healthcare provider that your existing condition is work-related. 

In order to ensure you submit your requirements and claims on time, you may visit your state’s Department of Labor website detailing the timeframe for filing a claim. 

Special Workers’ Compensation Rules For Specific Groups Of Workers

Even if you meet all three of the general eligibility requirements outlined above, you may still not be eligible for workers' compensation payments if you belong to one of the categories of workers exempt under state law. The most common types of exempt workers include:

Domestic Workers 

Numerous states do not require workers' compensation coverage for workers employed in private homes, such as housekeepers or child caregivers. However, other states only exempt domestic workers if they are part-timers. Gardeners and home improvement employees are also excluded from receiving workers’ comp benefits in several states.

Agricultural And Farm Workers 

Several states exempt agricultural and farm workers from workers' compensation coverage; however, these exemptions frequently only apply mainly to small farms. On the other hand, certain states, such as Texas, specifically include farmers and agricultural workers, including migrant and seasonal workers (Tex. Lab. Code Ann. 406.162).

Leased Or Loaned Employees 

If you work for a staffing or temp agency and are injured while on assignment with another employer (sometimes known as a "special employer"), workers' compensation should cover your medical expenses. 

However, state laws and the specific situation may dictate whether the agency or the special employer is in charge of providing your workers’ comp coverage. Temp workers are frequently considered employees of both the lending agency and the special employer, allowing the two insurance firms to battle over who pays the benefits.

Casual Or Seasonal Workers 

Some states do not cover casual or seasonal employees under workers' compensation, but only if the work was not related to the employer's primary line of operation.

Undocumented Employees

In most states, including California, Texas, and Florida, immigrant workers who lack legal authorization to work are covered under workers' compensation, whether expressly stated in the state’s laws or through judicial rulings (Tex. Labor Code 406.092 (2022), Fla. Stat. Ann. 440.02, Cal. Labor Code 3351). 

This section of the legislation is changing, however, as lawmakers in several states attempt to exclude undocumented immigrants from workers' compensation provisions. 

Are you set to receive your workers’ compensation settlement? Find out whether your workers’ compensation benefits are taxable in this article by Disability Help.

Victor Traylor
An expert to the field of Social Justice, Victor formed Disability Help to connect ideas and expertise from the US with rising global cultural leadership, building networks, fostering collaboration, long-term results, mutual benefit, and more extensive international perception.
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