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Workers’ Compensation: 4 Requirements to Be Eligible For Your Claim

Almost all states mandate employers to provide insurance coverage to their employees from their first day on the job. If you have suffered an injury or illness on the job, you will likely be able to file a workers’ compensation claim, regardless of fault.

Workers’ compensation benefits typically cover medical bills, rehabilitation costs, and lost wages. All these factors can help determine and calculate workers’ compensation payouts.

But before you can proceed with the claim, you must meet specific criteria. There are typically four basic requirements to be eligible to file a workers’ comp claim. They are as follows.

You Must Be an Employee

To qualify for workers’ comp coverage, you must be considered an employee of a particular company. While this sounds obvious, it is important to note that certain categories of workers do not classify as employees and are not covered under the workers’ compensation policy.

These include that independent contractors like consultants are not considered employees.

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Likewise, volunteering for a company does not entitle workers to obtain compensation benefits.

However, there are often legal exemptions to this rule. One example is volunteer firefighters or EMTs, who qualify for workers’ compensation in several states, including California and New York.

The Injury or Illness Is Job-Related

Establishing whether the injury or illness occurred on or due to the job can often be tricky.

To be eligible for compensation, you must be performing a work-related task for your employer due to which or during which the injury or illness occurred. You can also be eligible for coverage if you were injured in an auto accident while performing a job-related errand.

If you have a pre-existing medical condition that worsens while at work, it would be considered unrelated to the job and not provide coverage under the workers’ comp policy. Likewise, commuting to or from the job does not fall under the scope of employment.

Accidents that occur at the workplace are typically work-related and are covered by workers’ compensation. But there are several gray areas.

Suffering an injury during lunchtime or outside work hours at the job site might make you ineligible to seek compensation. Likewise, getting hurt at a social event organized by the company can make it challenging to determine your eligibility for workers’ comp benefits.

Your Employer Carries Workers’ Compensation

The majority of businesses and companies in all U.S. states must have workers’ compensation insurance for their employees by law. Most states legally require employers to have workers’ insurance, even with one employee. The insurance policy covers employees from their first day at work, providing medical and income benefits in case of harm.

However, some states do not mandate small businesses with less than three employers to have workers’ comp insurance. Some small businesses purchase workers’ comp insurance for protection against lawsuits, even if they are not legally required to have insurance.

Meet the Deadlines

You are legally required to report your injury or illness to the employer within a certain period. That could be up to three months or as little as two weeks, depending upon the state.

After reporting the injury, every state requires you to file for workers’ comp benefits within a specific time limit. That is two years following the injury or illness for most states, known as the statute of limitation.

Failing to meet this deadline could deprive you of your right to seek compensation benefits.

Other Rules

You might not be able to file for workers’ compensation despite meeting the above criteria. That is true if you belong to a category of employees exempt from insurance benefits under state laws. These include domestic workers like caregivers, agriculture or farm workers, and undocumented workers.

Final Words

If you are involved in a workplace accident, you must seek legal representation by hiring a skilled and experienced personal injury attorney. Your lawyer will fight for your best interest and help navigate the complex legal process while providing legal alternatives to securing fair compensation, like filing an appeal.

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