Want to know if you qualify for workers compensation insurance coverage if you have an accident or contract an illness while on the job? Read on to understand all the details of who qualifies for workers comp.
Eligibility Requirements
There are four simple eligibility requirements to receive workers comp benefits:
- You must be an employee.
- Your employer has a Workers Comp insurance policy.
- The accident/illness must be work related.
- You must adhere to the deadlines set by your state for reporting the incident and filing a workers compensation claim.
There are also some special rules and exemptions for certain types of employees, as discussed later.
For the most part, a significant portion of employers, but not all, are required to carry workers compensation insurance coverage as part of their business insurance. Depending on the laws of each state, the employer’s responsibility in providing coverage generally depends on a number of factors, including how many employees they have, what type of business it is, and what type of work the employees re doing.
Most states require any employer with one of more employees to carry insurance coverage but some states set the minimum number somewhere between 2 and 5 employees. A small number of states treat agriculture and construction businesses differently, while others allow charities to choose not to participate in the worker’s compensation system. Texas alone has made worker’s comp insurance coverage optional for almost all private employers.
Worker’s compensation insurance is generally purchased on the private insurance market, or in some states, from a state fund. But, many large employers, most notably state and local governments, assume the financial risks, and self insure their employees.
You must be an Employee
Not all workers are employees when it comes to worker’s comp eligibility. Specifically, independent contractors such as freelancers, consultants, and other gig type workers (think Uber) are generally not entitled to worker’s comp benefits. Of course many workers, like the Uber driver, insist they have been mislabeled as independent contractors and believe the employer should classify them as employees for worker’s comp coverage.
For the most part volunteers are not covered by worker’s comp, but exception exist. For example, some states consider volunteer fire fighters as employees for the sake of coverage.
Accident / Illness must be Work Related
If you were doing something that benefited your employer and were injured or became ill as a result, then it is generally considered work related. For example, if you slipped and fell while stocking shelves, developed hand or wrist problems from typing all day, or became ill from exposure to toxic or hazardous materials, then your accident/illness would be considered work related.
Meet Reporting Deadlines
You might lose your right to file a worker’s comp claim if you wait too long to report it. Each state has different reporting requirements, so make sure you get your claim filed early.
Exempted Workers
Just because you meet these eligibility requirements does not mean you will qualify for worker’s comp benefits. There are certain types of workers that are not covered, including:
- Domestic Workers: Most states do not require private employers to carry worker’s comp for employees that work in a private home, such as nannies, housekeepers, or caregivers. Some states treat these people differently if they are full time vs. part time, and a few states also exclude the gardener as well as workers remodeling your private residence.
- Lease or Loaned Employees: If you work for a temp agency or staffing company and have an accident or illness while assigned to another “special” employer, you are generally covered by worker’s comp. Where it becomes unclear is which party is responsible for the coverage: the agency or the “special” employer. More often than not, the worker is considered an employee of both, and then the insurance carriers battle out who needs to pay.
- Casual / Seasonal Workers: As long as the work performed by these workers in not a natural part of the employers business, most states exclude this casual work from worker’s comp.
- Farm / Agriculture Workers: Several states exempt farm and agricultural workers from worker’s comp coverage, but this generally only applies to smaller farms. Some states however, specifically include farm workers including both migrant and seasonal laborers.
- Undocumented Workers: Illegal immigrants who do not have legal standing to work are still covered by most states, but this is still an area of ambiguity where the law is still evolving.
Final Thoughts
For the most part, if you are being paid to work for someone, they are responsible for anything that happens to you while on the jobs. Exemptions exist for independent contractors and freelance workers, as well as certain classes of people who mostly work for private parties in their homes, or on a temporary basis. If you are injured on the job, make sure you file your claims with the state as soon as possible, so that you qualify for medical care and possibly get paid for lost time away from the job.
