Are You Eligible for Workers’ Compensation Benefits?

In 2019 alone, private employers in the US reported 2.8 million non-fatal job injury and illness cases. Back in 2018 and 2017, they reported the same figures. This makes 2019 the third year that the private sector has seen such high numbers of work incidents.

So, it’s no wonder that workers’ compensation is mandatory in most states. It’s because of these laws that such policies cover 140 million US workers.

However, only employees who satisfy workers’ compensation eligibility requirements may receive benefits.

So, if you’ve injured yourself at work, it’s imperative to know if you qualify for coverage. We’ll discuss everything you need to know in this guide, so be sure to keep reading.

Your Employer Has Workers’ Compensation Insurance

Of the 50 US states, Texas is the only one that doesn’t require employers to carry workers’ comp insurance. Even then, many Lone Star State employers avoid the risks, so they still purchase coverage. In all other states, workers’ comp is a legal duty of most employers.

With that said, your employer likely has workers’ comp coverage, too. If so, your employer must post a notice about the policy in a visible area in the workplace. This could be beside a time clock, on a message board, or in the pantry or break room.

You can also check in with your manager or the human resource department. They should inform you about the steps to take to report your injury and the forms you need to fill out.

An Injury That Occurred in the Line of Work

A key workers’ comp eligibility factor is to have a work-related injury or illness. This means your job had something to do with the injury you sustained or the disease you developed.

In many cases, it’s easy to determine work injuries since they occurred in the job site itself. Falls are perfect examples of such incidents. In 2019 alone, falls in the workplace injured 244,000 workers who then required days off work.

However, a work injury or illness doesn’t need to have occurred in the actual workplace.

For example, let’s say your manager asked you to take the company car to meet up with clients. However, as you were on your way,  you got involved in a car crash wherein you sustained injuries. Since you were doing something on behalf of your employer, then you should get coverage.

Another example is if you develop a gastrointestinal condition during a company gathering. This may occur as a result of improperly prepared or handled food at the venue. Either way, since your employer held the event, their policy should cover your illness.

Any injury or disease you develop outside of that event will no longer be part of the coverage, though.

A Promptly Reported Injury or Illness

Workers’ compensation requirements include immediate reporting of the injury or illness. In many cases, the recipient of the notice can be a manager, supervisor, or HR staff. What’s important is that the worker reported the incident within the allowed period.

It’s crucial to note that states have varying reporting deadlines. However, most follow a time frame that starts on the date the workplace injury took place. For example, if you sustained an injury last Monday, then the count begins on that day.

Let’s use South Dakota’s reporting requirement of three business days as an example. In this case, you must report the injury on or before Thursday of the same week. Failure to do so may result in your not being eligible for potential benefits.

In other states, such as California, workers have up to 30 days to report their injury to their employer. As with SD, though, failure to report a work injury within the deadline can lead to the loss of benefits.

Speaking of California, the state also has laws on part-time workers’ compensation eligibility. All Golden State employers with at least one full- or part-time worker must have workers’ comp.

An Initial Medical Visit that Satisfies State Laws

Whichever state you work in, know that you can go to the nearest ER during a medical emergency. After this, your state, employer, or employers’ insurer already has a say on the next doctor you can see.

That’s because, in some places, the state itself governs who can treat injured or ill workers. For example, in Illinois and New York, workers are often free to choose their treating doctor.

Then, there are states like North Dakota and Ohio, where employers get to make that choice. In these states, employers have the right to select a provider panel. The panel consists of doctors whom workers should see when they get a work injury or illness.

For those reasons, it’s imperative to have your HR department go over the rules with you. If possible, do this right after your initial ER treatment. Otherwise, you may lose your benefits if you see an unapproved doctor.

A Claim Filed Within the State’s Statute of Limitations

A statute of limitations is a legal deadline for filing claims. Its length depends on the nature of the legal matter. For workers’ comp claims, most states have one- to two-year deadlines.

However, a couple of states, namely Kansas and Nevada, have shorter deadlines. In Kansas, workers only have up to 200 days from the incident to file a claim. In Nevada, that drops to 90 days from the date of the injury or the first time you noticed the onset of the illness.

Those deadlines are some of the top reasons employees hire worker compensation lawyers. After all, these legal pros take over much of the process, which can take weeks or even months. They can fill out forms, gather medical records, and investigate on your behalf.

If you were to do all of that on your own, it might take you longer to recover from your injury or illness. So, instead of dealing with it alone, it might be in your best interest to hire a worker’s comp attorney.

Satisfy Workers’ Compensation Eligibility Requirements to Get the Benefits You Deserve

There you have it, your ultimate guide to workers’ compensation eligibility factors. Just remember that the main requirement is that your injury or illness has something to do with your job. So, if you got injured or sick while doing an activity or a task for your employer, then you’d likely get coverage.

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