Understanding Eligibility For Workers' Compensation

Posted on: 4 May 2015


On-the-job injuries can take time and effort to properly recover from. Fortunately, you may be able to have the expenses of your recovery taken care of with workers' compensation benefits. Under state law, most employers are required to carry workers' compensation policies, which provide injured workers with compensation for medical expenses and lost income.

Before you can benefit from workers' compensation, it's important to understand the various basic eligibility requirements that must be fulfilled beforehand.

Does Your Employer Have Coverage?

Your eligibility for workers' compensation benefits depends greatly on whether your employer carries this coverage. Although employers are normally mandated by state law to provide such coverage, there are some exceptions:

  • In some states, companies with fewer than three employees are exempt from having coverage.
  • Certain state laws allow charitable organizations to forgo workers' compensation coverage.

Your employer will usually have workers' compensation coverage. If your employer tells you otherwise (in most cases by claiming an exemption from state statutes), then you may want to consult your attorney for further action. Penalties for not having workers' compensation coverage vary among states, but it's usually considered a civil offense unless otherwise noted by your state's labor board.

Are You An Employee?

If you work for a company as an employee and receive hourly wages or a salary, then you're likely eligible for workers' compensation benefits. However, there are a few exceptions that may affect your eligibility:

  • Volunteers are usually not eligible for workers' compensation benefits unless those benefits have been explicitly extended to cover volunteer workers. You may run into this situation if you work as a volunteer firefighter or an auxiliary police officer.
  • Independent contractors are also not eligible for workers' compensation benefits. The following section offers a detailed explanation of independent contractor status and how it affects your eligibility for benefits.

What If You're an Independent Contractor?

Unfortunately, independent contractors do not qualify for workers' compensation coverage, nor are employers required to extend their coverage to independent contractors. This is due to the simple fact that an independent contractor isn't under the direct employ of the company in question – they don't receive wages or a salary (but are instead paid per job), plus they're not under the direction or supervision of their employer.

Because of this, unscrupulous employers often tried to classify their employees as independent contractors. Fortunately, there is a strict standard that helps distinguish independent contractors from regular employees:

  • Independent contractors receive payment upon completion of the job, whereas an employee receives hourly wages or a salary.
  • Independent contractors are responsible for deducting their own state and federal taxes from their earnings, whereas an employer makes those deductions on an employee's behalf through payroll. They're also responsible for perks typically given to employees as incentives (such as 401k plans, health insurance, etc.).
  • Independent contractors are usually under contract to complete a job using their own equipment and without the supervision or direction of the company they're contracted with.

If you are an employee and discover that you've been classified as an independent contractor, then you may want to discuss the issue with your local labor board and your attorney.

Is the Injury Work-Related?

In order for an injury to be eligible for workers' compensation, it must meet three important criteria:

  • It has to occur over the course of your job duties.
  • It must be severe enough to warrant a claim.
  • It cannot have occurred while under the influence of alcohol or drugs.

By that standard, minor cuts and scrapes aren't enough to trigger a workers' compensation claim, but a serious fall resulting in fractured or broken bones or headaches caused by chemical exposure may warrant a claim. In other words, injuries that can't be taken care of with simple first aid may be eligible for a claim.

Most claims are also eligible as long as you're acting within your job duties, even if said work occurs outside of the office. For instance, if you're injured in an auto accident while making a delivery or visiting a customer, then you may have a valid workers' compensation claim. On the other hand, you may not have a valid claim if you're injured in an accident while commuting, since such activity does not specifically involve your work duties.

Keep in mind that physical injuries aren't the only types of injuries covered under workers' compensation benefits. Cumulative injuries such as carpal tunnel syndrome, occupational diseases and psychiatric injuries such as post-traumatic stress disorder (PTSD) may also warrant a workers' compensation claim. If you are curious whether you qualify for workers' compensation or not, then ask an attorney from a firm like Kuzyk Law