Workers Compensation Eligibility – Is Your Injury Covered?

For every 100 full-time employees in the US, 2.8 workers got injured or ill on the job in 2018. Private employers alone reported 2.8 million injuries or illnesses that year.

As if that’s not bad enough, these figures are only for the “reported” cases. Experts believe that as many as half of severe injury cases are swept under the rug.

If you’ve sustained an injury or illness on the job, you need to report it to your employer right away. It’s highly likely that you meet workers compensation eligibility requirements. If so, then you should have this insurance which should cover your medical bills and lost wages.

The question is, what exactly makes you eligible for workers’ compensation benefits? Who qualifies for workers’ compensation in the first place?

We’ll answer all these questions in this post, so be sure to keep reading!

What is Workers’ Compensation and What Benefits Does It Provide?

Workers’ compensation helps ensure that injured or ill employees receive prompt medical treatment. It provides monetary compensation to workers who incur a work-related injury or disease. This compensation includes coverage for medical bills and payment for lost wages.

Workers’ comp also benefits employers by protecting them from lawsuits. There are no “guilty” parties here since workers’ comp is a “no-fault” type of coverage.

Workers’ comp is basically a mutual exchange between a worker and an employer. In exchange for guaranteed benefits, employees forfeit their ability to sue their employers.

Who is Eligible for Workers’ Comp?

As of 2017, 140.4 million US workers had workers’ comp coverage. In the same year, the labor force consisted of an average of 160 million workers. This means that workers’ comp covered about 87.5% of all US employees.

The main reason for this extensive use of workers’ comp is that it’s the law in all states except Texas. Yes, it’s only in Texas where employers aren’t required to get this coverage for their workers.

Still, each state has its own requirements for who should have workers’ comp. For instance, in California, all employers — even those with a sole employee — need to carry this insurance. The same goes for Colorado, Hawaii, Idaho, and many other states.

In other states, workers’ comp is only required for employers with at least three workers. These include Georgia, New Mexico, North Carolina, and Wisconsin.

State laws also determine workers’ comp eligibility based on the workers’ status. For example, most states don’t consider contractors as employees. A select few, including Louisiana and Las Vegas, consider them as employees though.

Another basis for workers’ comp eligibility is the type of work the employee does. For example, Missouri only requires workers’ comp for five or more employees. However, it’s a requirement for all construction businesses, even if it only has one worker.

The Most Important Factor that Determines Workers Compensation Eligibility

Let’s assume that you meet all the eligibility criteria to receive coverage. The question now is, which types of injuries or illnesses will you get coverage for?

So long as the injury or the illness occurs because of your work, your workers’ comp should kick in. Some of the most prevalent types of work-related injuries are overexertion and falls. Injuries caused by getting struck by or trapped between objects are also common.

As for illnesses, respiratory diseases are among the most common occupational ailments. In fact, studies have shown that up to 60% of all diseases are work-related lung illnesses. If your job caused your lung disease, you should receive workers’ comp benefits.

Occupational skin diseases, including allergic and irritant dermatitis, are also common. This can result from exposure to hazardous chemicals or toxins.

The most important thing here is that the injury or illness should be work-related. It should have occurred in the course of your employment. If you got injured or ill while doing something for your employer, you should get compensated. 

What about Injuries or Illnesses that Take Time to Develop?

You don’t need to get injured or sick right away to qualify for workers’ comp benefits. Workers’ compensation fully compensates injuries and illnesses that develop over time.

These conditions fall under “repetitive stress injuries” or “cumulative trauma disorders”. These can take months, even years to develop and manifest symptoms. They often affect the nerves, muscles, tendons, and ligaments.

Two examples of such ailments are tendonitis and carpal tunnel syndrome.

Are Psychological or Mental Disorders also Covered?

It should be provided that a work-related incident caused your condition. However, many stress-induced job-related ailments could be difficult to prove. In this case, it’s best to seek the legal aid of a workers compensation attorney.

What If the Injury Didn’t Happen at the Workplace?

Workers’ compensation applies to injuries that you sustain outside of the workplace too. It only needs to have occurred while you’re carrying out a task for your employer.

Let’s say your boss asked you to meet and pick up clients in town. As you’re driving, you got hit by another driver or you lost control of the car which led to you getting injured.

In this situation, your workers’ comp should cover your medical bills. It should also pay for lost wages, in case you can’t go to work because of severe injuries.

What if you get injured or ill while attending a company event? Maybe you tripped and fell down the stairs. Perhaps you ate something that didn’t agree with you and you’ve developed diarrhea.

If the event was mandatory, then you should still receive benefits. However, you may not get covered if the injury or ailment occurred after the gathering.

How to Get Workers’ Comp Benefits After an Injury or Illness

While workers’ comp coverage entitles you to benefits, you need to abide by specific rules. It’s possible to have a workers’ comp claim denied if a worker fails to meet the filing requirements. This failure is one of the reasons behind 7% of claims getting denied in 2017.

Avoid such risks by following these steps on how to get workers’ comp benefits after you get injured or ill at work.

1. Seek Medical Treatment ASAP

By doing so, you’ll have higher chances of recovering from your injury or illness. Also, all states require medical certification that a worker got injured or ill on the job. You need to submit these documents when you file your workers’ comp claim.

Depending on your employer, you may need to see a specific doctor, so check with your boss first. In emergency situations though, you can see any doctor in an emergency department. Workers’ comp laws also allow you to get a second opinion if the first one doesn’t work out.

What’s important is to seek medical treatment as soon as possible. You should do this even if you don’t think the injury is severe. Many injuries and illnesses, such as brain injuries, have delayed symptoms, after all.

2. Report the Accident to Your Employer ASAP

For your workers’ comp coverage to kick in, you should first meet the reporting deadline. Again, this varies widely from state to state, so be sure you know what the rules in yours are. This can range from 7 to 30 days, but some, like South Dakota, have a 3-day deadline.

3. File a Claim within the Statute of Limitations

These are the set deadlines on how much time you have to file an actual workers’ comp claim. The above is only for reporting your accident to your employer. These statutes are for filing the claim itself with your state’s workers’ comp agency.

Most states allow workers to file a claim within one to two years from the time of the injury. In Vermont and West Virginia, however, workers only have six months to file the claim.

The deadlines are usually longer for occupational diseases that take time to develop. For example, the statutes on asbestos-related claims only start after the diagnosis. Once diagnosed, workers then have at least one year to file the claim.

4. Keep Seeing Your Doctor and Follow Your Treatment to a T

Once you’ve filed the claim, you can now focus on getting better. It’s crucial that you follow your doctor’s recommendations and take your medications. Your employer (or their insurer) can take action against you if they find out you aren’t.

Secure Your Workers Comp Benefits by Following Your State’s Laws

As a hardworking employee, you have every right to get compensated for a job injury or illness. However, you need to satisfy these workers compensation eligibility criteria first.

To ensure that you receive workers’ comp benefits, follow all the above steps to making a claim. Pay particular attention to your state’s deadlines and statutes too. Going beyond these timelines can result in your claim becoming invalid.

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