Workers' Compensation Eligibility
Those who sustain job-related injuries can usually make a claim for workers' compensation benefits. These benefits cover lost wages and expenses related to medical care. However, you must be eligible for workers' compensation. Generally, workers' compensation eligibility is determined by your status as an employee (as opposed to a contractor, for example); whether the injury or illness was in fact work-related; and other factors, such as the type of work you do (some domestic workers may not be eligible).
For example, anyone working with a company as an independent contractor is not actually an employee and thus not covered by their workers' comp insurance policy. Also, the injury itself may have been sustained outside the workplace or was a result of "horseplay" and not one's official work duties. It's important to understand the workers' compensation eligibility requirements in your state before filing a claim.
Specifics often vary by state, but this article provides a general overview of workers' comp eligibility requirements. See FindLaw's Workers' Compensation Basics section for additional articles.
Are You an Employee?
It may sound like an obvious question, but it's only those classified as "employees" that are eligible for workers' comp benefits. Now, there may be instances where an employee is misclassified as an "independent contractor" (or IC). If you are a consultant or a freelancer, the company for whom you're working is not actually your employer and you most likely would be considered an IC. Independent contractors often are required (through contract) to use arbitration for disputes, including injury claims.
If you have been injured at work and believe you have been misclassified as an IC, you should talk to an attorney immediately. See Being and Independent Contractor vs. Employee for more information.
Do You Fall Under an Exempt Category?
Even if the facts of your claim are undisputed, your workers' compensation eligibility may be denied if your employment situation is exempt.
The most common categories exempt from workers' compensation requirements under state laws include:
- Undocumented workers
- Seasonal workers (such as migrant farm workers)
- Domestic workers, including nannies and caretakers
- Agriculture workers
If you are employed through a temp or staffing agency that leases you to another employer, then the agency may be responsible for workers' compensation coverage (not the company for which the work product is being done).
Is Your Employer Required to Carry Workers' Comp Insurance?
Generally, most employers are required to carry workers' comp insurance. State laws determine whether an employer must carry workers' compensation insurance based on the number of employees; the type of business; and the type of work being performed.
Most states require employers with at least one employee to carry insurance, but some states exempt small businesses with fewer than three employees. But keep in mind that some employers may purchase workers' comp insurance even if they aren't required to, since it helps protect them from lawsuits.
See Workers' Compensation Links for state-specific resources or speak with an attorney if your employer states otherwise.
Are You Eligible for Something Other than Workers' Comp?
If you're not eligible for workers' compensation, you may have other options. Depending on your employment situation, you may be able to claim compensation for work-related injuries through something other than workers' comp. In some very rare circumstances, including injuries that were intentionally inflicted in the workplace, you may be able to sue your employer.
Other alternatives to workers' comp include:
- Federal employees (non-military) may seek relief through the Federal Employees' Compensation Act (FECA)
- Mariners/seaman may file claims for injuries stemming from employer negligence through the Jones Act (also called the Merchant Marine Act)
- Employees in traditional maritime occupations, such as shipbuilders and longshore workers (excluding crew members of any vessel), may be covered under the Longshore and Harbor Workers' Compensation Act (LHWC)
- Railroad workers may be compensated for workplace injuries under the authority of the Federal Employers Liability Act (FELA)
- Current and former coal miners who suffer from a mining-related injury are covered by the Black Lung Benefits Act (BLBA)
Is the Injury Work-Related?
It's not always clear whether an injury that seems related to the job is actually compensable under workers' compensation eligibility rules. For an injury to be considered "work-related," a causal relationship between the injury and the employment relationship must be established. For instance, an employee who breaks his leg during an official company retreat at a ski resort would be able to claim that it was work-related. But injuries that occur during the morning commute, for instance, are not covered.
Confused? Get Free Legal Advice on Your Workers' Comp Claim
There are a number of factors to consider when determining workers' compensation eligibility, including an understanding of your state's laws. If you have been injured in the workplace, have an attorney review your claim at absolutely no cost to you. An attorney will be able to determine whether you're eligible for a claim or whether your claim has been wrongfully denied.