How to Get Workers' Compensation Benefits: Eligibility Requirements

If you're injured or become ill as a result of your job, you could be eligible for workers' compensation benefits, including reimbursement of medical bills and lost wages.

You don't have to prove your employer was at fault for your injury in order to receive workers' comp benefits. In exchange, you lose the right to file a lawsuit against your employer for damages (except in a few situations when you can sue outside of the workers' comp system).

Workers' Compensation Eligibility Requirements

You must meet four basic requirements in order to qualify for workers' comp benefits:

• Your employer must carry workers' compensation coverage.
• You must be an employee.
• You must have a work-related injury or illness.
• You must meet your state's deadlines for reporting the injury and filing a workers' comp claim.

Below we'll discuss each of these requirements in a little more depth. Note that many states have special rules for certain types of workers, including domestic workers, agricultural and farm workers, casual or seasonal workers, and temporary workers.

Employer Must Be Covered By Workers' Compensation

Most but not all employers are required to have workers' compensation coverage. State laws vary, but an employer's responsibility to provide coverage generally depends on how many employees it has, the type of business it is, and the type of work employees are doing.

The majority of states require employers with at least one employee to have coverage, but some states set a minimum of two to five employees. A few states have different requirements for agricultural or construction businesses, and some allow charities to opt out of the workers' comp system. Texas is the only state that makes workers' comp coverage optional for almost all private employers.

Many employers purchase workers' comp insurance even if they aren't legally required to. Typically, state laws allow exempt employers to "opt in" to the workers' comp system. In that case, their employees may receive benefits for work-related injuries, but they won't be able to file a lawsuit against the employer.

Employers usually buy workers' comp insurance on the private market or, in some states, from a state fund. However, many large employers—especially state and local governments—assume the financial risk for their employees' workers' comp benefits (known as self-insurance).

The federal government maintains its own workers' compensation system. If you're a federal employee, you must look to that system rather than your state's system for benefits. Federal law also has separate rules for compensating injured maritime workers and railroad workers.

You Must Be an Employee

Not all workers are employees when it comes to workers' compensation eligibility. In particular, independent contractors (such as freelancers and "gig workers") usually aren't entitled to workers' comp benefits.

Many workers—including drivers for Uber, Lyft, and other ride-hailing services—claim that they've been misclassified as independent contractors when the hiring firm should have classified them as employees. Employers often misclassify workers as independent contractors to avoid paying payroll taxes or workers' comp premiums.

Even if you signed a 1099 tax form as an independent contractor, you might still qualify as an employee for workers' comp. But your dispute will probably end up in court. Although the rules vary from state to state, courts will generally look at the amount of control you have over your work and other details of your working relationship with the company or person that hired you.

Volunteers usually aren't entitled to workers' comp benefits, but there are some exceptions. For instance, some states specifically cover volunteer firefighters, or they give organizations the option of covering their volunteers.

Injury or Illness Must Be Work-Related

Determining whether your illness or injury was work-related isn't always easy, particularly in the work-from-home era. In general, if you were doing something for the benefit of your employer and were injured or became ill as a result, then it's work-related. That's true even if you're working from home or another location, although these sorts of cases can be harder to prove.

For example, your injuries are clearly work-related if you hurt your back while loading boxes as part of your warehouse job, develop carpal tunnel syndrome as a result of typing on the job, or become ill due to exposure to hazardous chemicals at the work site.

On the other hand, if you were injured during your lunch break, at a company-sponsored social event, or while horsing around with co-workers, you'll have to show that your actions were for the benefit of your employer. (Learn more about the rules for deciding when injuries or illnesses are work-related.)

Reporting and Filing Deadlines

Even if you meet the other qualifications, you could lose your right to receive workers' comp benefits if you don't meet the strict deadlines in your state for reporting the injury to your employer and filing a workers' comp claim.

Special Workers' Comp Eligibility Rules for Certain Employees

Even if you meet all three of the general eligibility requirements described above, you may not qualify for workers' comp benefits if you fall into one of the categories of workers who are exempt under state law. The most common types of exempt workers include:

• Domestic workers. Many states don't require workers' comp coverage for employees working in private homes, such as housekeepers or child caregivers, while other states exclude these workers only if they're part time. A few states also exclude gardeners and workers doing remodeling in private homes.
• Agricultural and farm workers. Several states exempt agricultural and farm workers from workers' comp coverage, but those exemptions often apply only to small farms. But some states, like Texas, specifically include farmworkers, including certain migrant and seasonal laborers.
• Leased or loaned employees. If you're an employee of a staffing or temp agency and are injured while on assignment with another employer (sometimes called the "special employer"), you should be covered by workers' comp as long as the injury was work-related. But the question of who's responsible for the coverage—the agency or the special employer—can depend on state law and the circumstances. Often, temp workers are considered employees of both the lending agency and the special employer, leaving the two insurance companies to fight out who's responsible for benefits.
• Casual or seasonal workers. Some states exclude casual or seasonal workers from workers' comp, but this exemption may apply only if the work wasn't part of the employer's regular business or profession.
• Undocumented workers. Immigrant employees who don't have legal status to work are covered under workers' comp in most states—including California, Texas, and Florida—whether explicitly in the laws or through court decisions. This is an evolving part of the law, however, as legislators in certain states try to exclude undocumented immigrants from workers' comp protections.

Contact a Workers' Comp Attorney

If your employer claims that you're not eligible for workers' comp benefits—because you're an independent contractor, you fit in one of the other exemptions, or the employer isn't required to provide coverage—consider consulting with a lawyer.

Employers and insurance companies routinely deny valid workers' comp claims and do everything they can to limit their liability. An experienced workers' compensation attorney can help even the playing field and get you the compensation you're entitled to.