5 Eligibility Requirements For Worker’s Compensation

Have you been injured on company property during your working hours? If so, you may be entitled to worker's compensation.

Worker’s compensation insurance protects workers against financial losses caused by accidents in the workplace. The laws apply to physical injuries and illnesses that develop because of hazards in the workplace. When reviewing the workplace conditions, the employer takes risk mitigation steps and corrects any OSHA violations.

OSHA violations are often the culprit in workplace injuries and accidents. If a worker gets hurt because of the violations, the company is liable and could face serious penalties.

After a worker injury or accident, the employer must complete a worker’s compensation claim. All workers must be eligible for coverage according to the five eligibility requirements.

  1. The Claimant Must Be An Employee

Under worker’s compensation laws, the injured worker must be legally classified as an employee. An employee is defined as a worker that has an existing employee-employer relationship within the business. The claimant must be under the supervision of an employer or manager and have an employment contract that dictates the exact job duties required by the worker.

An employer assigns the worker’s schedule, chooses how often the worker performs the work duties, and has the legal right to control the terms of employment. The worker is not an independent contractor who is self-employed, doesn’t control their own work schedule, isn’t supervised by a manager, and has the right to define their own job duties. If the injured party needs clarification about their rights as a worker, they can contact a Workers’ Comp Lawyer Near Me for more information.

  1. The Employer Must Be Required to Carry Workers Compensation Insurance

Federal laws require any business that has more than one worker to purchase and maintain worker’s compensation insurance coverage. The insurance covers the medical expenses for all treatment and medical services for the worker’s injury. It provides monetary benefits for injured workers while they are recovering and cannot return to work.

Under the laws, the employer isn’t required to purchase worker’s compensation insurance if they have only one worker. If the individual worker is injured, they may not have access to worker’s compensation coverage because their employer isn’t legally required to get the insurance.

Under the circumstances, the worker would have to seek compensation through another legal avenue. If the accident and resulting injury are the fault of the employer, the worker could file a personal injury claim if the business owner doesn’t offer compensation when liable.

  1. The Injury Must Be a Work-Related Injury or Illness

As the expression conveys, it must be a work-related injury or illness in that the worker sustained or developed it as a result of performing their job duties. After an accident happens or a worker is injured, the event is investigated.

After human resources file the claim, a claim’s adjuster asks questions about the accident and how the worker sustained the injury or developed the illness. Physical injuries happen when machinery is faulty, workers make mistakes, or when there is a hazard in the workplace. Occupational illnesses happen when the workers are exposed to hazards such as asbestos.

The investigation by the claims adjuster must show that the physical injury or illness happened due to no fault of the worker. If they have a physical injury, the worker must have complied with all safety protocols, safety policies, and company policies.

Workers must follow policies for proper work attire, such as wearing slip-resistant shoes. If the worker wasn’t complying with these rules and regulations, the worker could lose their eligibility for worker’s compensation.

  1. The Claimant Must Meet All Deadlines for Filing

When filing a worker’s compensation claim, the worker must notify their immediate supervisor within 30 days about the accident and their injuries or illness. If the claim is not filed within the first month, the worker is no longer eligible. The medical doctor that provides treatment for the injured worker has ten days to submit the medical report to the insurer.

If the employer refused to file a worker’s compensation claim, the worker must seek medical treatment to document their injuries. They should contact an attorney promptly to get video footage of their accident to substantiate their claim that they have a work-related injury. The injured worker has no longer than one year from the date of the accident to file a legal claim against their employer or the worker’s compensation insurer.

  1. The Event That Caused the Injury Must Be Within the Workplace

The injury must happen within the defined workplace. This means the worker must sustain their injury or illness inside or outside the defined workplace, and this includes the parking lot and any spaces connected to the company’s property. If the worker completes work tasks at an off-site workplace, the worker could still get coverage under the insurance since it is a space where they complete job duties.

The worker cannot claim the injury if they entered a restricted area without permission and proper personal protective equipment. Employers define workplaces in terms of where the employees are allowed to go to perform their work duties. The regulations can exclude areas where the worker wasn’t permitted to go and chose on their own accord to go.

If they work in off-site workspaces, the worker is not covered in areas outside of the space. If they aren’t traveling in a company vehicle, the worker isn’t covered. If the workers travel in a work vehicle, the work vehicle could be defined as a part of the workplace since the workers must use the vehicle to travel to new workspaces.

Worker’s compensation insurance is required for all employers who hire more than one worker. After a worker sustains an injury or develops an occupational disease, the employer must start an insurance claim.

A claims adjuster reviews and investigates the accident and the worker’s injuries. They must determine according to the law and the terms of the insurance policy that the worker is eligible for these benefits. The worker must be an employee as defined by law. The injuries must have resulted from performing their work duties, and the injury must happen within the workplace. By reviewing all eligibility requirements, the worker determines if they have a legal right to coverage and monetary benefits.

Hannah Foreman
Hannah Jaehnig is a professional freelance creative writer. She has been writing professionally since 2014 and writing for entertainment for much longer! She has a bachelor’s degree in Creative Writing with a minor in History. She hopes to one day publish a fiction book. In the meantime, she’ll write about fashion!
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