Workers Compensation:

Eligibility for Workers' Compensation

Most workers are eligible for workers’ compensation, but some workers are excluded. Independent contractors, casual workers, farm workers, railroad employees, maritime employees, business owners, domestic employees in private homes and unpaid volunteers are among those excluded. Federal government employees receive workers compensation benefits under a separate federal law. Also, some states do not require workers compensation coverage of employers with less than a certain number of employees. To make sure you are covered, check the workers’ compensation laws of your state.

Injured workers can determine their eligibility for workers’ compensation with the help of the Department of Labor in their state. This agency can answer any questions and help employees file their claim. However, in general, injured workers need to substantiate or claim:

  • The injury or illness was not incurred by willful or serious misconduct on your part
  • The injury or illness was not sustained before employment with your current company

Each of these grounds can disqualify an injured employee from receiving workers’ compensation. In addition, legal charges can be pressed against the worker for filing a false claim.

Determining Workplace Injury Risk

The worker must prove that the injury occurred while working and stemmed from the nature or responsibilities of the position. In addition, the employee must show that the risk of injury was increased by working. Such risk typically can be placed into one of the following categories:

  • Risk Directly Related to Employment: For example, a man working in a warehouse gets his fingers caught in a machine. His injury would be directly related to employment because he would not have been hurt if he was not at work. His job required him to be near this machine. Therefore, he would be eligible for workers’ compensation benefits.

  • Personal Risk: An employee who developed lung cancer after smoking for 40 years would not be eligible for benefits. Because the cause of the illness was based on a personal choice, the employee cannot receive workers' compensation unless they can prove the disease was related to employment.

  • Neutral Risk: These cases are hard to determine, as the contributing factors are often unclear. Instances of “neutral risk” include a construction worker who suffered heatstroke at work, a daycare worker assaulted by a parent after work or an employee injured in a hurricane or other natural disaster. After increased risk has been shown, the worker must prove that the injury was connected to employment. Remember that the injury does not have to occur during the worker’s shift to qualify him or her for benefits.

Even if you are unsure which category your injury falls into, you should speak with a workers' compensation attorney. A lawyer can determine if you are eligible for benefits and can help build a strong case on your behalf.