Workers’ Compensation Eligibility

If you are injured on the job, come down with an illness through being exposed to chemicals at work, or develop a work-related trauma over time, you may be eligible for workers’ compensation. This means receiving, through your employer’s insurance, benefits for weekly compensation and permanent impairment, payment for medical treatment related to the injury or illness, and vocational rehabilitation.

However, not everyone is eligible for workers’ compensation. Eligibility depends on several factors, such as whether or not you are a contracted employee and whether or not your employer carries workers’ compensation insurance.

In order to be eligible for workers’ compensation, you must meet the following requirements:

1. Be an Employee

To qualify for workers’ compensation, you must be an employee. That may sound obvious, but not everyone who works for a company is classified as an “employee.” If you work as an independent contractor—for example, as a freelancer or a consultant—you are not eligible for workers’ compensation. Volunteers are also not employees, though there are exceptions to this rule—volunteer fire fighters are eligible in some states, and certain states also allow companies to cover volunteers.

Sometimes, a company misclassifies employees as independent contractors when they should really be classified as employees. If this is the case, the employee may still be able to receive workers’ compensation.

2. Not Be an Exempt Worker

Certain types of workers are exempt from workers’ compensation laws. These include agriculture workers, domestic workers (like caretakers and nannies), seasonal workers (like migrant farm workers), and casual workers (meaning people who work for a company only sporadically). Undocumented workers are eligible in some states, but not in others.

Interstate railroad workers and crewmembers working on vessels are not eligible for workers’ compensation, but instead are required to sue their employers for injuries sustained on the job. Federal employees should seek workers’ compensation through the federal system rather than the state.

Additionally, employees that work through a staffing or temp agency may have to obtain workers’ compensation through the agency, rather than the company for which they work; however, though this differs from state to state.

3. Be Covered by Workers’ Compensation Insurance

While it depends on the state, type of organization, and number of employees, most employers are legally required to cover their employees. Since it helps to protect them against lawsuits, many employers carry workers’ compensation insurance even if it isn’t a requirement.

If your employer does not carry workers’ compensation insurance, there are still ways to obtain compensation for a work-related injury. You can either sue your employer, or file a claim with your state, which may have a special fund allotted for handling uninsured workers’ compensation claims. Not every state has this fund, however.

4. Have a Work-Related Injury

To be eligible for compensation, you must have an injury directly related to your work. This means your injury must be caused by your job. If you get into a car accident while commuting to work, you are probably not eligible for workers’ compensation. But if you work on a construction site and strain your back while carrying an especially heavy load, you are probably eligible. 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 commutes to work in a company vehicle; these cases, however, are generally more difficult to determine.

A work-related injury or illness does not necessarily have to be the fault of the employer, nor does it have to occur on company property—as long as there is a causal connection to the worker’s job and the injury sustained.

Types of injuries covered by workers’ compensation generally include accident-related injuries, sickness caused by exposure, occupational disease, and trauma injuries occurring over time. By contrast, stress-related injuries, self-inflicted injuries, injuries sustained during drug or alcohol use, injuries caused by horseplay or fighting, and injuries sustained while committing a crime are not eligible for workers’ compensation.

Workers’ Compensation Alternatives

In addition to workers’ compensation, there are several options for workers who sustain injuries on the job and aren’t covered or aren’t eligible. In rare situations, you can sue your employer.

If you are a federal employee, you can seek compensation through the Federal Employees’ Compensation Act (FECA). If you work as a mariner or seaman and you sustain an injury through employer negligence, you can file a claim through the Jones Act (also known as the Merchant Marine Act). Workers in other traditional maritime jobs may find coverage through the Longshore and Harbor Workers’ Compensation Act (LHWC). Coal miners may be covered under the Black Lung Benefits Act (BLBA), and railroad workers may be covered under the Federal Employers Liability Act (FELA).