There are two main factors that will determine whether or not you are eligible for workers’ compensation. These are the type of employee you are and the type of injury or illness you’ve sustained. To qualify for workers’ comp, your condition must have happened while you were performing job-related duties.
The Types of Employment That Qualify
If you are an employee of a company, you qualify for workers’ comp benefits. This includes full-time employees, part-time employees, temporary workers, and seasonal workers. There is no minimum period of time that you’re required to be with the company before you’re eligible. Any employee is eligible, period.
Freelancers, get ready for the bad news. Freelance workers, independent contractors, volunteers, and consultants are not eligible for workers’ comp benefits. The good news is you can get your own workers’ compensation insurance coverage. In certain situations, your injury or illness may be covered even if you work from home.
Often employers miscategorize workers. This can be on accident, such as someone who is just starting a business and doesn’t understand the laws. This can also be deliberate, which would apply to someone who owns a business and wants to save money by treating you like a 1099 independent contractor when you actually are an employee under the law.
These are some of the situations that could make you an employee, even if your employee says you’re a contractor:
- You must work in the office
- You must work certain hours
- You are under someone else’s direction
- Taxes are being withheld from your paycheck
Independent contractors are paid for the finished product. As long as you meet your deadlines, how, where, and when you complete the work is up to you. If you work so many hours for a company that you don’t have other clients, you may also be an employee.
If you were injured on the job and you believe you are an employee but your employer says you are not, you have rights. Before you accept your employer’s denial of workers’ comp benefits, you may want to speak to a lawyer. Visit here to learn more about workers’ compensation attorneys in your area.
The Types of Injuries and Illnesses that Qualify
If your illness or injury happened while you were performing work related to your job, you will most likely be covered. This includes conditions that happened in the workplace and outside of the workplace while you were carrying out duties related to your job, such as running errands, attending office functions, or being injured while telecommuting.
These are some of the types of injuries that are covered:
- Cumulative trauma disorders
- Repetitive stress injuries
- Illnesses from exposure to toxins
- Slip and fall injuries
- Injuries from machinery
- Automobile accidents
- Workplace violence
Conditions that happened while you were commuting or on your lunch break wouldn’t be covered. Business owners, partners, part-time domestic workers and gardeners, taxi drivers, intermittent workers, longshoremen, federal employees, and railroad workers are also not covered. In most cases, injuries that are related to stress or mental illness are not covered.
When a Workers’ Comp Claim May Be Denied
Some of the most common reasons claims are denied include the employer not believing you were injured at work or an injury that did not cause you to miss work or receive medical treatment. Some employers will not file a claim if your condition can’t be medically verified, such as unexplained chronic pain.
Some claims may be denied because there were no witnesses to the injury or there is no video footage from security cameras. If there are discrepancies in your report or you don’t cooperate with the process, you may also be denied. If it’s determined that you had a pre-existing condition that caused your injury, they will also use that to reject your claim.
Other reasons a claim can be denied are related to the employee’s actions. These are the main categories.
The Employee Was Under the Influence
According to one study conducted by the University of Buffalo Research Institute on Addictions, 2.1 million American workers have worked while they were under the influence of alcohol. The National Safety Council has reported that 75% of adults with a substance abuse problem are participating in the workforce. If you are one of them, your claim may be denied.
Misconduct
Employee misconduct is another reason your claim may be denied. This includes horseplay, breaking safety protocol, and any other situation in which it can be demonstrated that you knew the potential consequences of your actions but chose to risk your safety anyway.
Workplace Violence
If you were the instigator in an act of workplace violence, you can also kiss your workers’ comp claim goodbye. Only the victims of violence qualify for this coverage. If you were the aggressor and you received an injury, you’ll be responsible for your own damages.
What to Do if Your Claim Is Rejected
If your claim is denied, try, try again. According to Risk and Insurance, nearly 70% of denied claims end up being converted and paid within the first year after appealing. Only 5% of cases end up going to trial. The odds are in your favor, so it’s worth taking the time to contact your employer’s insurance carrier to see if you can work out a solution.
If this doesn’t fix your situation, you’ll need to get a lawyer who can help you request a hearing with the state’s board. You can also sue your employer if you believe they are deliberately interfering with your claim or refusing to file it.
If you decide to settle your claim, your lawyer will negotiate with the insurance carrier for a fair settlement, which will then be paid out as a lump sum or as a structured settlement. If you don’t think the settlement is enough, you can choose to go to trial, but this is a more expensive and riskier option. Your attorney can tell you what the best option is for your situation and don’t hesitate if you find yourself in one of the above mentioned cases.
