Are You Eligible for Workers' Compensation Benefits?

If you were hurt or became ill as a result of your work, you may be entitled to workers' compensation benefits, including payments for medical bills and a few lost wages. As long as you’re eligible, you will receive compensation no matter who was guilty of the injury. In exchange for this protection, you lose the proper to file a lawsuit against your employer for damages (except during a few situations once you can sue outside of the workers’ comp system).

Typically, there are four basic eligibility requirements for workers' comp benefits:

• You must be an employee.
• Your employer must carry workers' comp insurance.
• You must have a work-related injury or illness.
• You must meet your state's deadlines for reporting the injury and filing a workers' comp claim.

There are special rules for a few categories of employees, including domestic workers, agricultural and farm workers, casual or seasonal workers, and workers placed with an employer by temp agencies.

Let's take a closer look at the basic eligibility requirements and some of the special rules.

Requirement One: Employer Must Be Covered By Workers' Compensation

Generally speaking, the overwhelming majority of employers—but not all of them—are required to possess workers' compensation coverage. State laws vary, but an employer's responsibility to supply coverage generally depends on what percentage employees it's, the sort of business it's, and therefore the sort of work employees are doing. Most states require any employer with a minimum of one employee to possess coverage, but some states set a minimum of two to 5 employees. A few states have different requirements for agricultural or construction businesses, and a few allow charities to cop out of the workers’ comp system. Texas stands out by making workers’ comp coverage optional for nearly all private employers (Tex. Labor Code § 406.002 (2018).)

Many employers buy workers' comp insurance albeit they are not legally required to try and do so. Typically, state laws allow these exempt employers to "opt-in" to the workers' comp system. In that case, their employees may receive benefits for work-related injuries, but they won’t be able to file a lawsuit against the employer.

Employers usually buy workers’ comp insurance on the private market or, in some states, from a state fund. However, many large employers—especially state and native governments—assume the financial risk for his or her employees’ workers’ comp benefits (known as self-insurance).

The federal has its own workers' compensation system. If you're a federal employee, you want to look thereto system instead of your state system for benefits. Learn more about the federal workers’ compensation system. Federal law also has separate rules for compensating injured maritime workers and injured railroad workers.

Requirement Two: You Must Be an Employee

Not all workers are employees when it involves workers' compensation eligibility. In particular, independent contractors (like freelancers, consultants, or members of the “gig” economy) typically aren’t entitled to workers' comp benefits. But of course, many workers—including drivers for Uber, Lyft, and other ride-hailing services—claim that they’ve been misclassified as independent contractors when the hiring firm should have classified them as employees. Employers often misclassify workers as independent contractors to avoid paying payroll taxes or workers’ comp premiums. Even if you signed a 1099 form as an independent contractor, you would possibly still qualify as an employee for workers’ comp. But your dispute will probably find yourself in court. Although the rules vary from state to state, courts will generally look at the amount of control you have over your work and other details of your working relationship with the company or person that hired you.

Volunteers usually aren’t entitled to workers' comp benefits, but there are some exceptions. For instance, some states specifically cover volunteer firefighters, or they offer organizations the choice of covering their volunteers.

Requirement Three: Injury or Illness Must Be Work-Related

Generally speaking, if you were doing something for the advantage of your employer and were injured or became ill as a result, then it's work-related. For example, your injuries are clearly work-related if you hurt your back while loading boxes as part of your warehouse job, develop carpal tunnel syndrome as a result of typing on the work, or become ill because of exposure to hazardous chemicals at the worksite. This issue may be harder to figure out in some other situations, like if you were injured during your lunch break, at a company-sponsored social event, or while horsing around with co-workers.  

(Learn more about the principles for deciding when injuries or illnesses are work-related.)

Requirement Four: Reporting and Filing Deadlines

Even if you meet the opposite qualifications, you may lose your right to receive workers’ comp benefits if you don’t meet the deadlines in your state for reporting the injury to your employer and filing a workers’ comp claim. (Learn more about workers’ compensation time limits.)

Domestic workers. Many states don’t require workers’ comp coverage for workers working privately homes, like housekeepers or child caregivers, while other states exclude these workers on condition that they’re part-time. A few states also exclude gardeners and workers doing remodeling privately homes.

Agricultural and farmworkers. Several states exempt agricultural and farm workers from workers' comp coverage, but those exemptions often apply only to small farms. But some states, like Texas, specifically include farmworkers, including certain migrant and seasonal laborers (Tex. Lab. Code Ann. § 406.162).

Leased or loaned employees. If you’re an employee of a staffing or temp agency and are injured while on assignment with another employer (sometimes called the “special employer”), you should be covered by workers’ comp as long as the injury was work-related. But the question of who’s chargeable for the coverage—the agency or the special employer—can depend upon state law and also the circumstances. Often, temp workers are considered employees of both the lending agency and also the special employer, leaving the 2 insurance companies to fight out who’s chargeable for benefits.

Casual or seasonal workers. Some states exclude casual or seasonal workers from workers' comp, but this exemption may apply only if the work wasn’t part of the employer’s regular business or profession.

Undocumented workers. Immigrant employees who don’t have legal status to work are covered under workers’ comp in most states—including California, Texas, and Florida—whether explicitly in the laws or through court decisions. (Cal. Labor Code §3351, Fla. Stat. Ann. § 440.02, Tex. Labor Code § 406.092 (2018).) This is an evolving part of the law, however, as legislators in certain states try to exclude undocumented immigrants from workers’ comp protection.

Speaking With a Lawyer

If your employer claims that you’re not eligible for workers’ comp benefits—because you’re an independent contractor, you fit in one of the other exemptions, or the employer isn’t required to provide coverage—you should consider consulting with a lawyer. Employers and insurance companies routinely deny valid workers’ comp claims and do everything they will to limit their liability. An experienced workers’ compensation attorney can help even the playing field and protect your rights.

Read more about: Worker compensation coverage