Do you qualify for workers’ comp?

Do you qualify for workers' comp?

In order to qualify for workers’ compensation benefits, at least three things must be true. First, is the obvious: your injury or illness must be work-related. Second, you must be an employee. And third, your injury or illness needs to be “accidental.” But each of those requirements comes with its own set of requirements and exceptions.

  1. Your injury or illness must be “work-related.”

The term “work-related” is an easy way of saying that your medical condition must arise out of your employment and it must have occurred within the course and scope of your employment.

For an injury to arise out of the employment, the injury must have been sustained while you were performing a task that is connected with the performance of your job. That’s pretty easy to figure out when you hurt your back lifting a heavy box filled with things for work, but it’s not always so obvious. For example, if you hurt your back bending over to tie your shoelace, that would probably not arise out of the employment even if it occurred at work – because the act of tying your shoes has nothing to do with your job (unless, maybe, you work at a shoe store).

An injury or illness occurs in the course and scope of employment when it is sustained at the workplace while you were on the clock. This is usually pretty straightforward and covers most incidents that take place at the job site. But again, the issue can be less clear if you are hurt during an off-site event or while travelling for work.

Some cases are more difficult to determine if they are work-related. For example, illnesses or repetitive injuries are both covered by workers’ comp as long as they arise out of and in the course of employment. Repetitive injuries (sometimes called cumulative trauma injuries) happen to workers who do the same job tasks over and over until it causes a medical problem, such as carpal tunnel syndrome or tendinitis. An illness, such as a chemical exposure or disease, is also covered as long as it was sustained during the performance of the job.

The question of whether an injury or illness is work-related can be very fact-specific. If you’re still not sure if your situation qualifies for workers’ compensation benefits, you should contact a lawyer right away.

  1. You are an “employee.”

Workers’ comp is only available to an employer’s employees. Generally speaking, an employee is someone who performs work for another in exchange for pay.

But not every person who performs work is necessarily an employee. For example, businesses often retain the services of independent contractors or sub-contractors who might not be employees. Similarly, “gig economy” workers – such as Uber or Lyft drivers, or anyone else who is self-employed – would not be considered an employee for workers’ compensation purposes. Volunteers are also not typically considered employees, though exceptions usually exist for volunteer firefighters.

Determining whether you are an employee or an independent contractor can sometimes be difficult, especially when the employment relationship isn’t well-defined. This can occur when people are hired to perform labor at another’s home, such as a home aide worker doing a job exclusively for one person. Consider the following statements which, if true, might suggest that you are not an employee: you hold yourself out as operating your own business; you have control over the way you perform your work; you have control over the time when you do the work; you hire or pay your own assistants; you are personally responsible for the satisfactory completion of your work; you are contractually responsible if you fail to perform the work; or, you are not required to work exclusively for the employer.

  1. Your injury or illness is “accidental.”

Workers’ compensation does not cover injuries that are the result of an intentional act. That means that if you purposefully or recklessly cause your own injury, you will not be eligible for workers’ comp benefits. It also means that if you suffer a heart attack or some other medical condition that is the result of the aging process, it would not be covered. Workers’ compensation laws also exclude coverage for injuries that are the result of the employee’s own intoxication or willful misconduct.

Keep in mind that workers’ compensation insurers will often deny claims for any of the above reasons – sometimes even without knowing all of the true facts and circumstances. If you feel that you have been wrongfully denied workers’ compensation benefits, contact a lawyer today. At Edgewise Law we have years of experience handling these types of issues and would be happy to speak with you to clarify your rights.

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