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Conditions That Entitle Injured Employees To Receive Workers' Compensation Benefits

Last updated: April 9, 2023

No matter how careful an employee and their employer try to be, the possibility of an accident in the workplace will always be there. If you become ill or hurt due to your job, you may be able to cover your medical bills, disability limitations, and lost wages through workers’ compensation benefits.

In this article, we will discuss the essential things to know about workers’ compensation, including eligibility requirements and the types of health conditions it covers.

Eligibility Requirements For Workers’ Compensation

Eligibility Requirements For Workers’ Compensation

In general, workers’ compensation benefits cover illnesses and diseases that an employee acquires from on-the-job exposure. It can range from traditional occupational conditions like black lung disease to the COVID-19 virus.

However, workers' compensation, including temporary disability benefits, is not freely given to anyone. There are eligibility requirements you must meet, and here are four of them:

1. You Must Be An Employee

Technically speaking, not all workers are classified as employees. Workers can also be defined as independent contractors, freelancers, or consultants. If you belong to these categories, you are not entitled to workers’ comp benefits.

However, if you feel you are misclassified as an independent contractor but function as an employee, you may appeal for workers’ compensation by bringing the matter to court. You must prove your working relationship with the company and their control over your work. These cases will be discussed, and the decision may vary depending on your state.

In some cases, you may also be eligible for workers’ compensation even if you are only a volunteer. Some states and organizations opt to protect their volunteers, especially when the task is risky.

2. Your Employer Must Have Workers’ Comp Insurance

Another requirement to meet is on the side of the employer — they must have workers’ compensation coverage in their insurance policy. Workers’ comp insurance is required for employers — for most, if not all, industries.

The governing rules of workers’ comp still depend on the state. For instance, some states require coverage even with a single employee. In some states, the requirements are between two to five employees. Furthermore, many companies opt to get workers’ comp even when they are not required.

3. Your Injury Or Illness Must Be Work-Related

The main requirement of workers’ compensation is that the illness or injury occurred in the workspace. In general, work-related illness or injury is defined as “arising from employment and occurring during the course of employment.”

There are some situations where defining work-related injuries may be confusing, so here are guidelines to remember:

  • If you get hurt during lunch break, and you are at the company’s premises, the injury will be considered work-related
  • If you get hurt during lunch out of the office, the injury will not be eligible for workers’ comp
  • If you are hurt during your commute to work, workers' comp won’t cover your injuries unless you are driving a company vehicle, doing errands, traveling on a business trip, and traveling as part of the job
  • Employees working from home will only be covered for their injuries if proven that the injury came from a work-related task
  • You won't receive workers' comp if you were injured because you were drunk or taking prohibited drugs at work
  • Some states will also not provide workers’ comp benefits if you hurt yourself or someone else deliberately did so at work

4. You Must Meet The Report Submission Deadlines

Though it may sound simple, this last step can lead you to lose your right to workers’ compensation benefits, even if you meet the other requirements. Each state assigns a deadline for filing a workers’ comp claim, so you should carefully review fine details to ensure you won’t miss the deadline.

As a guide to filing for workers’ comp claims, you should consider the following steps:

  1. After getting injured at work or receiving a diagnosis of an illness you got from the job, report the findings to your employer immediately. Many states set the requirements for reporting within 10 to 90 days.
  2. The next step is filing a workers’ comp claim to your state’s workers' comp agency. The deadline is usually within one to three years after the injury.
  3. Then, the insurance company will connect with you to conduct an independent medical examination and verify the extent of health damages.

However, there are some exemptions to these requirements. If the injury led to a coma, required prolonged treatment and multiple surgeries, or required prolonged quarantine, the time limits set by the state can be extended.

Workers’ Compensation Rules For Special Employee Categories

Though there are eligibility requirements for workers’ compensation, certain workers don’t meet the qualifications and are considered special employees. Here are some things to learn about them:

1. Undocumented Workers

Immigrant workers who do not have permits to work in the country can still be covered by workers’ comp in many states, including California, Florida, and Texas. Some states haven’t joined in, and their legislators are still discussing the issue.

2. Domestic Workers

Most states do not require workers’ comp for workers employed in private residences. In some states, on the other hand, housekeepers and child caregivers will only be covered if they work full-time.

3. Leased Or Loaned Employees

Though employees from staffing agencies are technically leased or loaned out, they will still be covered by workers’ comp if they encounter an injury while on the job. The responsibility for the workers’ comp payment can either be the agency or the company client, depending on the state laws.

Common Types Of Injuries & Illnesses That Are Eligible For Workers’ Comp Benefits

According to the Bureau of Labor Statistics, there were 2.7 million nonfatal workplace injuries and illnesses reported by private industry employers in 2020.

Within these numbers are many common types of injuries and diseases that affect employees across the states, which include:

1. Burns

Burns result from injuries due to electricity, sunlight, steam, radiation, chemicals, and other forms of heat. They are common in the manufacturing and restaurant industries. In some cases, burns can also occur internally if employees inhale fumes and smoke.

2. Fractures

Fractures can be described as breaks in the bone from overuse or force trauma. Workers at high risk for fractures are those who work manual labor and are commonly exposed to equipment and machinery. Nonetheless, a fracture is an issue that can happen to anyone anywhere.

3. Lacerations

Deep cuts or tears in the skin are classified as lacerations. These wounds can happen to virtually any industry, but they are more common in food production, restaurants, machine shops, and manufacturing companies.

Lacerations often occur because employees lose concentration, work in a messy environment, fail to prepare their safety gear, and rush to complete tasks. 

4. Cumulative Or Continuous Trauma

One problem faced by many types of workers is repeating the same task for a long time. With this, they overwork the same body part — muscles, tendons, or joints — and lead to cumulative or continuous trauma. When these workers maintain decades-long manual labor positions that overwork their bodies, preventing these injuries is nearly impossible.

5. Sprains And Strains

Sprains occur in a person’s ligaments and happen when they are stretched or torn. These injuries happen when employees fall, twist, or pull their bodies too much. The most common reason is improper lifting techniques and not observing the OSHA ergonomic guidelines.

The Takeaway

Workers’ compensation benefits are available for employees who encounter injuries and illnesses while on the job. However, receiving these benefits requires meeting the requirements, particularly establishing that the illness or injury happened at work.

If you are an employee with a work-related illness or injury, you can consult a workers’ compensation lawyer to help you along the process.

For more free resources and advice for people with disabilities, explore the rest of Disability Help today!

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