Workers injured on the job may receive coverage through a worker’s comp claim. But not every worker is eligible. This article will discuss the points of workers comp eligibility, so you know your rights.
What is Considered in Workers Comp Eligibility?
The Nature of the Accident
The nature of the accident is a crucial consideration in workers comp eligibility. Workers are entitled to workers comp if their injury was work-related. Two main types of injuries can occur at work as follows:
Traumatic Injuries or Illnesses: These are injuries or illnesses that develop over time such as repetitive stress injuries or illnesses due to exposure to toxic chemicals. They are difficult to pinpoint and prove. Employers may claim they were due to other causes.
Non-traumatic Injuries: Non-traumatic injuries happen right away. They include slips and falls, cuts, burns, back injuries, and more. They usually have witnesses and are easier to prove.
Your doctor’s report, witnesses, and other types of evidence will help determine if your injury is work-related. If you are having trouble proving your injury was work-related, you may need a lawyer.
Some circumstances may interfere with workers comp eligibility. You may not receive coverage if:
- Your injury was caused by your misconduct
- You purposely injured yourself or another person
- You were intoxicated when the injury occurred
- You were injured in the line of military duty outside of the United States
- You work from home and were injured due to non-work-related causes
- You are a prisoner of war protected under the Geneva Conventions being detained by the United States
If Your Employer Has Workers Comp
Workers comp eligibility is contingent on your employer having workers comp.
Every state except for Texas requires businesses to have worker’s comp. It is required regardless of how many employees work for the business, and what type of business it is. Even sole proprietorships and people who are self-employed may be required to get worker’s comp.
If you were injured on the job, and your employer does not have worker’s comp, they can get into trouble. You may sue them for damages. They will face other legal consequences as well.
Your Employment Status
Your workers comp eligibility is contingent on your employment status. You will receive worker’s comp from your company if you are a regular employee. However, you may not receive worker’s comp if:
- You are an independent contractor: Independent contractors may not have workers comp eligibility. They include freelancers, consultants, and volunteers. However, there are some exceptions to the rule. For example, volunteer firefighters are eligible for coverage. If you work as an independent contractor, consider purchasing your insurance so you are covered for work-related injuries.
- You are domestic workers: Domestic workers such as housekeepers, babysitters, cooks, maids, and caregivers are not typically eligible for worker’s comp. However, coverage may be available for full-time employees. For example, a maid who comes in every other week would not be eligible for worker’s comp. But a worker who comes in every day to care for the family or property would be considered a full-time worker.
- You are a temp worker: Temp workers are not covered by the worker’s comp managed by the company they are temping for. But the temp agency may offer worker’s comp to cover your damages.
- You are an agricultural worker: Despite agriculture being one of the most dangerous industries to work in, many states do not require coverage for agricultural workers. Fourteen states require all agricultural employers to carry workers’ comp without exception. Twenty-one states have limited workers comp. Insurance requirements depend on how many workers are employed, how often they work, the type of work they do, and other factors. Fifteen states do not require agricultural employees to carry workers comp. However, the employee may choose to purchase it.
- You are a seasonal or casual worker: Seasonal or casual workers who only work at a business part of the year may have workers comp eligibility. Requirements vary from state to state.
- You are an undocumented worker: An undocumented worker is a person who is not a U.S. permanent resident or citizen. In some instances, the individual’s immigrant status may be unresolved. These workers may be covered by worker’s comp. Laws vary from state to state.
- You are a federal employee: Federal employees are covered by worker’s comp. However, they must file an OWCP claim through the Federal Employees’ Compensation Act (FECA) or another federal statute. They are not covered by state policy.
- You are self-employed: Self-employed individuals do not need worker’s comp. This rule applies to everyone except roofers. Self-employed roofers must purchase worker’s comp due to the dangerous nature of the industry.
Confusion Over Independent Contractors
Many companies try to say their employees are independent contractors so they can get out of paying employer taxes and avoid workers comp eligibility requirements. The laws defining an independent contractor vary from state to state. But in most states, the guidelines are as follows:
- The worker is free to perform services as they please
- The worker performs work outside the hiring company’s usual course of business
- The worker customarily provides work independently
If you do not fall under the guidelines of an independent contractor, and your employer is trying to classify you as one to avoid purchasing worker’s comp insurance, you may be able to take legal action.
Workers comp eligibility applies to workers injured on the job that meet certain requirements. Check your local laws to find out if you are covered. May you get the best outcome for your claim.