Do I Qualify for Workers' Compensation Benefits?

Have you been injured unexpectedly on the job? Are you now facing mounting medical bills and missed wages? Navigating the workers' compensation system can be overwhelming, especially if you’re unsure whether you qualify. At Lehmbecker Law, we understand the complexities of workers' compensation claims and are here to help you get the benefits you need.

In this post, we'll break down the essential factors that determine qualification for workers' compensation benefits, empowering you to make informed decisions during this challenging time.

Workers' Compensation Eligibility Requirements

If you’re injured on the job or come down with an illness after being exposed to chemicals at your place of employment, you may be eligible for workers’ compensation.

Workers’ compensation allows injured workers to receive benefits for weekly compensation and permanent impairment, payment for medical treatment related to the injury or illness, and vocational rehabilitation.

Not everyone is eligible for workers’ comp, however. Eligibility depends on several factors, some of which might not apply in your situation.

To be eligible for workers’ compensation, you must meet the following requirements.

Your Employer Must Have Workers' Compensation Insurance

While it varies by state, type of organization, and number of employees, most employers are legally required to cover their employees.

If your employer doesn’t carry workers’ compensation insurance, there are still ways to obtain compensation for a work-related injury. You may be able to file a claim with your state, which may have a special fund allotted for handling uninsured workers’ compensation claims. Not every state has such a fund, however.

You Must Be Classified as an Employee

You must be an employee to qualify for workers’ compensation. That may sound obvious, but not everyone who works for a company is officially classified as an employee.

For instance, you aren't eligible for workers' comp if you work as an independent contractor, such as a freelancer or consultant. Volunteers also aren’t employees, though there are exceptions to this rule — volunteer firefighters are eligible in some states, and certain states allow companies to cover volunteers.

Sometimes, a company may misclassify an employee as an independent contractor when they should really be classified as an employee. If this happens, the employee may still be able to receive workers’ compensation.

Your Injury or Illness Must Happen While on the Clock

To receive compensation, your injury must happen while you are “on the job”.

You probably aren't eligible for workers' compensation if you get into a car accident while commuting to work, but if you are in the course of employment when you are in a motor vehicle accident you will be covered. If you work on a construction site and strain your back while carrying a heavy load, you should also be covered.

In some situations, however, the connection may not be as clear-cut. For example, an employee who sustains an injury during a company retreat may be eligible for workers’ compensation, as may an employee who is on a business trip and is injured after hours. These sorts of cases are generally more difficult to determine.

A work-related injury or illness doesn’t ever have to be the employer’s fault, nor does it have to occur on company property.

Types of injuries covered by workers’ comp include accident-related injuries, sickness caused by exposure, and occupational disease.

By contrast, stress-related injuries, self-inflicted injuries, injuries sustained due to drug or alcohol use, injuries caused by horseplay or fighting, and injuries sustained while committing a crime are ineligible for workers’ compensation.

You Must Meet the Mandatory Reporting and Filing Deadlines

Adhering to the required reporting and filing deadlines is crucial for ensuring timely access to benefits in the event of a workplace injury or illness. In Washington State, you must meet specific deadlines to initiate the claims process effectively.

First, the employee must report their work-related injury or illness to their employer promptly. While Washington law doesn't specify an exact timeframe for reporting, it's recommended that you inform your employer as soon as possible after the incident occurs. Delayed reporting could potentially impact the outcome of your claim.

After reporting the injury, the employee must file a workers' compensation claim with the Washington State Department of Labor & Industries (L&I) within one year of the date of injury or the date you became aware of its connection to your job. Failing to meet this deadline will result in the denial of your claim.

Special Workers' Comp Rules for Certain Workers

Even if you meet the standard eligibility requirements outlined previously, your eligibility for workers' compensation benefits in Washington State may come down to your employment category and specific exemptions delineated by state law. Here are some noteworthy exemptions and special rules that apply to certain groups of workers.

Domestic Workers

Like many other states, Washington doesn’t mandate workers' compensation coverage for employees working in private households, such as housekeepers or childcare providers. However, the application of this exemption may vary based on factors like employment status and the nature of work performed (Wash. Rev. Code § 51.12.020).

Agricultural and Farm Workers

While several states exempt agricultural and farm workers from workers' comp coverage, Washington has specific provisions regarding coverage for these employees, particularly concerning the size and nature of the farm.

Leased or Loaned Employees

If you're employed by a staffing agency and sustain an injury while working for another employer (referred to as the "special employer"), determining liability for workers' comp coverage can be complex. The allocation of responsibility between the agency and the special employer often hinges on state statutes and the circumstances surrounding the injury.

Casual or Seasonal Workers

Certain states exclude casual or seasonal workers from workers' compensation coverage, particularly if the work falls outside the regular scope of the employer's business. In Washington State, such exemptions may apply depending on the nature and duration of employment.

Workers’ Compensation Alternatives

Several alternative options are available for workers who sustain injuries on the job and either aren’t covered or are ineligible for workers’ compensation.

They include:

• Federal employees: Non-military federal employees have recourse through the Federal Employees' Compensation Act (FECA) for injuries sustained in the course of their employment.
• Mariners and seamen: Those employed in maritime roles can pursue claims under the Jones Act, also known as the Merchant Marine Act, if their injuries result from employer negligence.
• Traditional maritime occupations: Workers engaged in traditional maritime occupations, such as shipbuilders and longshore workers (excluding crew members), may find coverage under the Longshore and Harbor Workers' Compensation Act (LHWC).
• Railroad workers: Employees in the railroad industry are covered for workplace injuries under the Federal Employers Liability Act (FELA).
• Coal miners: Current and former coal miners suffering from mining-related injuries are entitled to benefits under the Black Lung Benefits Act (BLBA).

In rare situations, you may also be able to sue your employer to recover the funds needed to deal with your injuries or illness.

Get Professional Assistance Applying for Workers’ Comp Benefits

Workers' compensation is a vital resource for employees who suffer work-related injuries or illnesses. Understanding the eligibility requirements and resulting process can be complex, but with the right guidance, you can access the support you need to recover and move forward.

At Lehmbecker Law, we’re committed to advocating for the rights of injured workers in Washington State. If you or someone you know has been hurt on the job, don't hesitate to contact us for a free consultation. We're here to help you understand your rights and pursue the compensation you deserve.