Workers’ compensation is an insurance product that exists to protect both employee and employer when an employee is injured or becomes ill on the job. In exchange for accepting workers’ comp benefits, an employee agrees not to sue the employer for the covered illness or injury.

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Most work-related injuries and illnesses are covered by workers’ comp, but several factors come into play when determining whether a worker is entitled to benefits. If you have been injured in the workplace, are you eligible for workers’ comp benefits?

Does your employer carry workers’ compensation coverage?

Not all businesses carry workers’ comp. Although laws vary from state to state, the employer’s size and type of business usually determine whether workers’ comp is a requirement. In some states, even having one employee makes workers’ comp a requirement, while other states only require it for a minimum of three employees. In certain cases, a business may be excluded from the requirement if it is a registered charity.

What if my employer is in violation of state law?

In particularly problematic situations, employers fail to carry workers’ comp despite state requirements. This is, of course, a violation, and the employer will likely face penalties for failing to obtain proper coverage.

According to Nick Fogel, a Colorado-based attorney with the firm of Burg Simpson, most states require employers to list their workers’ compensation carrier with the state’s division of workers’ compensation.

“If an employer does not possess the required workers’ compensation insurance, employees risk not having access to applicable benefits in the event of an on the job injury. This can leave employees with no means to pay for medical treatment and with no access to wage loss or financial benefits,” said Fogel. “Employees working for an uninsured employer risk medical uncertainty and financial ruin in the event of an occupational injury. An employer that does not maintain adequate workers’ compensation insurance may be subject to penalties and fines levied by the state.”

If you are unsure whether your employer carries workers’ compensation coverage, an experienced workers’ comp attorney can help.

Are you an employee?

So you’ve determined that your employer carries workers’ comp insurance. As long as you are an actual employee of the business, your chances of being eligible for benefits are quite good. If you are an independent contractor, such as a freelance graphic designer or IT specialist, you are not entitled to workers’ comp benefits. In most cases, the same is true for volunteers. For the vast majority of workers, employment status (contract, employee, volunteer, etc.) is quite clear. However, some situations can be more challenging to decipher. If you are unsure whether your employment status qualifies you for this type of coverage, an experienced workers’ comp lawyer can help you determine your options.

Is your injury or illness actually work-related?

Let’s say your employer carries workers’ comp and you are an employee of the company. If your injury or illness is covered by workers’ comp, you should be entitled to full benefits. But proving that your injury or illness was caused by a work-related activity isn’t always an easy task. For example, you may develop a chronic respiratory issue due to long-term chemical exposure at work, only to have your employer claim that the condition is likely related to your history as a smoker.

Do I meet other criteria?

Once you have determined that your employer has coverage and that your injury is covered, you will need to satisfy other requirements before filing for benefits, and these requirements vary from state to state. For example, in Massachusetts, you must be disabled for a minimum of five calendar days prior to filing a claim. Further, in MA you have four years from the date of injury, or from your realization that the injury was sustained on the job, to file your claim.

When to seek legal advice

Rest assured that a workers’ comp lawyer can help you protect your rights if your employer is challenging your workers’ compensation claim. Even if you are eligible for workers’ compensation, your ability to obtain benefits in a timely manner can become challenging if you make any errors during the application process. 

As with all insurances, workers’ comp carriers will do whatever they can to avoid paying on fraudulent or excessive claims. To reduce this risk, they require a complex application process, which can be overwhelming, especially in the midst of dealing with a medical issue or injury. This is where a skilled workers’ comp attorney can make all the difference in the world. He or she can ensure that your application is thoroughly completed and that all requirements are satisfied.