Workers' Comp Benefits: Are You Eligible?

Most employees are eligible for workers’ comp, but your injury must qualify as “work-related.”

If you're injured or get sick on the job, you probably have the right to workers' compensation benefits, including payments for your medical expenses and some lost wages. Under state laws, employees generally are entitled to workers' comp benefits regardless of who was at fault for their injuries; in return, they give up the right to sue their employers for damages.

To be eligible for workers' comp, you must meet your state's deadlines for reporting your injury and filing a workers' comp claim. You also must satisfy the following requirements:

  • You must be an employee.
  • Your injury or illness must be work-related.
  • Your employer must have workers' comp insurance.
  • Your job must be the type that is covered by workers' comp.

You Must Be an Employee

The workers' comp system is designed to protect employees who suffer work-related injuries. It doesn't protect workers who are not employees, such as independent contractors and volunteers.

However, just because you're labeled an independent contractor doesn't necessarily mean that you are one. Whether workers are employees or independent contractors in the eyes of the law typically doesn't depend on what they're called or how they're classified for tax purposes. Instead, it depends on how much control they have over their work. If you have been improperly classified as an independent contractor, but you can prove that you are, in fact, an employee, you're probably entitled to workers' comp benefits.

Volunteers generally aren't entitled to workers' comp coverage, but some states make exceptions for certain types of volunteers, such as volunteer firefighters or police officers.

Your Injury or Illness Must Be Work-Related

To recover workers' comp benefits, you need to show that your injury or illness is "work-related." An injury generally is considered work-related if you were doing something for the benefit of your employer and you were injured or became ill as a result. The injury doesn't need to take place at your worksite, but it must take place during the course of your employment.

An injury typically is not considered work-related if:

  • the injury occurred during your lunch break
  • the injury happened during your commute to or from work, or
  • the injury happened because you were drunk or using illegal drugs, or while you were committing a serious crime (this is an exception to the general rule that workers' comp is a "no-fault" system).

An injury is typically considered work-related if:

  • the injury occurred during your lunch break, if you were eating lunch on the company premises
  • the injury happened during your commute to or from work, if you were driving a company car, were required to bring your own car for business use during the workday, were running special errands for your employer, or were on a business trip, or
  • the injury occurred during a company-sponsored event such as a picnic or baseball game.

Example. Lydia, a salesperson, suffers an injury from a car accident while driving from her office to her client's place of business. Lydia will likely be covered by workers' comp because her trip was business-related and occurred during the workday. However, if she were injured while driving home in her car after her workday was over, she probably wouldn't be entitled to workers' comp.

Your Employer Must Have Workers' Compensation Insurance

The vast majority of employers are required by state law to carry workers' comp insurance, but there are exceptions. For example, very small employers (between two to five employees, depending on the state) are not required to offer workers' comp coverage in some states. A few states don't require charities to purchase workers' comp insurance. Texas is the only state that does not require private employers to purchase workers' comp insurance.

If you're injured on the job and your employer doesn't have workers' comp insurance despite a state requirement, you can file a personal injury lawsuit against your employer in civil court. Some states have an uninsured employers fund, and in those states, you can make a claim against the state fund instead.

Your Job Must Be Covered by Workers' Comp

Certain types of workers are exempt from or otherwise not covered by state workers' comp coverage. While these job categories vary from state to state, the most common exceptions to state workers' comp include:

  • domestic workers, such as housekeepers or caregivers
  • some agricultural workers and farmworkers
  • casual or seasonal workers
  • real estate agents
  • members of the clergy
  • taxi drivers, and
  • federal employees, railroad workers, and maritime workers, who have their own workers' comp or other system of compensation.

When to Hire a Workers' Comp Lawyer

If your employer claims that you're not eligible for workers' comp benefits, you should consider consulting with a workers' comp lawyer.

Hiring a workers' comp lawyer won't cost you anything out of pocket. In most states, workers' comp attorneys charge a percentage of your benefits if you win your case, and nothing if you lose.

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