You were injured and you believe, or know, your injury was work-related. Are you eligible to file a worker comp claim?

Insurance Claim Form Document Application Concept

There are some requirements you must meet to file a workers comp claim such as:

• You must be employed by the company you feel is responsible.
• Your employer must carry workers comp insurance
• Your injury or illness must be work-related
• You must fill out your workers comp claim correctly within the state-approved time limit

We’ll break down each of these requirements in this article.

What are the Requirements for Filing a Workers Comp Claim?

You Must Be an Employee

To file a workers comp claim, you must be employed by the company you feel is responsible. If you work as an independent contractor for the company, things get complex.

In most cases, independent contractors are not eligible to file a workers comp claim. However, there are some companies, like Lyft and Uber, that have gotten in trouble for classifying their employees as independent contractors to avoid paying employee taxes.

You may also file a workers comp claim with a firm you signed a 1099 with. However, you may face challenges collecting your benefits. You may have to go to court.

Volunteers are also typically not eligible for workers comp benefits, but there are some exceptions. For example, many states offer workers comp coverage to volunteer firefighters. Other organizations have the option to cover their volunteers.

Your Employer Must Carry Workers Comp Insurance

Most employers are required to have workers insurance. However, requirements vary from state to state depending on how many people the company employs and the industry.

Many state laws require any business with at least one employee to have workers comp. Others won’t require insurance unless you have two to five employees.

Some states have different requirements based on industry, such as the agricultural or construction industries. Texas stands out from other states by making workers comp optional for private companies.

Many companies purchase workers comp insurance even if they are not required to do so. They choose to buy the insurance because it protects them from getting sued by employees who are injured on the job.

Federal employees have a different workers comp claim system guided by the federal government. They are covered by the Federal Employees Compensation Act (FECA).

FECA is similar to other workers comp programs in that it requires filing a workers comp claim. If the claim is approved, you may receive compensation for your injuries and lost wages. The only difference is that you must file the claim directly through FECA. Your case will be decided by the Office of Worker’s Compensation Programs (OWCP).

The FEC Act covers all federal workers except maritime workers, black lung coal miners, railroad employees, and members of the U.S. military. Those workers are covered by separate worker’s comp laws.

Your Injury or Illness Must Be Work-Related

Doctor helping a patient with a fractured leg

Workers can only file a workers comp claim for injuries and illnesses that are work-related. Here are some examples of injuries and illnesses that qualify:

• You became sick from breathing in the toxic chemicals you work with
• You were injured at work due to a specific incident such as a fall
• You incurred a repetitive stress injury (RSI) due to performing the same tasks over and over. RSIs are likely to occur in factory workers, computer workers, and people who work with heavy machinery.

Sometimes it’s difficult to prove that your injury is work-related, especially if the injury is an RSI or an illness. Your employer may try to say that your injury was due to other activity. A doctor’s examination should reveal whether your injuries are work-related.

If you have trouble getting compensated in your workers comp claim because your employer insists your injury didn’t happen at work, you may need a lawyer.

You Must Fill Out Your Claim Correctly within the State-Approved Time Limit

There are many reasons why a worker’s comp claim can be denied. Workers often fill out forms incorrectly. They may not submit their claim within the required time limit. Sometimes claims are rejected because the court did not think your injury was work-related, or for another reason.

If your claim was filled out incorrectly, you may be able to resubmit it. You can have a lawyer help you to ensure it’s submitted correctly the second time.

A lawyer may also assist you if you feel the court ruled unfairly on your worker’s comp claim.

If you did not submit your workers comp claim on time, you may not have any recourse.

Workers that May Not Be Eligible for Workers Comp

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There are special workers comp rules that apply to certain workers as follows.

• Domestic Workers: Most states won’t require worker’s comp for employees who work in people’s homes like gardeners and housekeepers. Some states will only exclude part-time domestic workers.
• Agricultural Workers: Some states exclude agricultural and farm workers who work on small farms.
• Temp Employees: Temp workers are covered by workers comp. However, there may be some discrepancy concerning who they receive coverage from- the temp agency or the agency they were providing temp services to. Often the two companies will have to work out who is responsible.
• Seasonal Employees: Some states exclude seasonal employees from workers comp. However, the exclusion will only be applied if the worker is taking care of responsibilities that do not fall under the employer’s usual scope of business.
• Undocumented Workers: Undocumented immigrant workers are covered by worker’s comp in most states whether through laws or court decisions. However, some legislators are trying to exclude employees who do not have legal status.

Now that you know what it takes to receive coverage for a workers comp claim, you can decide whether to move forward with your case. We wish you luck getting the compensation you deserve.