Are You Eligible for Workers' Compensation Benefits?

Injured on the job? Find out if you qualify for workers' comp.

If you are injured on the job or become ill as a result of your work, you may be entitled to workers' compensation benefits. Workers' compensation is an insurance program (required by state law) which provides payment to employees who suffer work-related injuries or illness. Eligible employees receive compensation for lost work and medical bills, regardless of who was at fault; in exchange, employees forfeit the right to sue their employers for the illness or injury (with a few exceptions; see Nolo's article Workplace Injury: When You Can Sue Outside of Workers' Compensation).

Typically, there are three basic eligibility requirements for workers' compensation benefits:

  • The person or company you were working for must carry workers' compensation insurance or be legally required to do so.
  • You must be an employee of that person or company.
  • Your injury or illness must be work-related.

In addition, there are some special rules for domestic workers, agricultural and farm workers, leased or loaned workers, casual or seasonal workers, and undocumented workers (these are discussed in the "Special Rules for Certain Workers" section below).

Let's take a closer look at all three of the basic eligibility requirements.

Requirement One: Employer Must Be Covered By Workers' Compensation

Not all employers are required to have workers' compensation coverage. State laws vary, but an employer's responsibility to provide coverage usually depends on how many employees it has, what type of business it is, and what type of work the employees are doing. For example, a few states require only employers with at least three employees to be covered, but most states don't set a minimum. (In these states, an employer that has just one employee must provide coverage.) In addition, some states allow charities to opt out of the workers' compensation system; other states do not. Generally speaking, the vast majority of employers are required to carry coverage; if your employer claims not to be covered by your state workers' compensation statute, you may want to double-check with an attorney.

Typically, employers may provide coverage either by purchasing insurance (on the private market or, in some states, from a state fund) or by self-insuring

Many employers purchase workers' compensation insurance even if they aren't required to do so. State laws typically allow these exempt employers to "opt in" to the workers' comp system. This allows the employer to ensure that its employees are compensated for workplace injuries -- and that they can't file a lawsuit against the employer.

The federal government has its own workers' compensation system. If you are a federal employee, you must look to that system rather than your state system for benefits. You can find out more about federal workers' compensation at the website of the Department of Labor's Office of Workers' Compensation Programs.

Requirement Two: You Must Be An Employee

Not all workers are employees when it comes to workers' compensation eligibility. For instance, independent contractors are not employees and are not entitled to workers' compensation benefits. Examples of independent contractors might include freelance writers or computer consultants. Many employers misclassify workers as independent contractors when they are really employees, however. If you have been denied benefits because the employer claims you are an independent contractor, you should consider consulting with an attorney. To locate a workers' compensation attorney in your area, visit Nolo's Lawyer Directory.

Usually, volunteers are not employees, and so they are not entitled to workers' compensation benefits. There are some exceptions to this rule, however. Some states specifically cover volunteer fire fighters, for example. Also, some states give organizations the option of covering their volunteers.

Requirement Three: Injury or Illness Must Be Work-Related

If your injury or illness is work-related, then it is most likely covered by workers' compensation. Generally speaking, 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. For example, 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, your injuries are clearly work-related.

Sometimes, however, this issue is harder to figure out. Let's say you were injured on your lunch break, but while picking up a sandwich for your boss. Or maybe you were injured while commuting to work in the company car, walking to an off-site social event with coworkers, or playing softball at the company picnic. In situations like these -- where the injury didn't happen at work but has some connection to the job -- it isn't always easy to determine whether you are covered. See Nolo's article Workers' Compensation: Is Your Injury or Illness Work-Related? for more information.

Special Rules for Certain Workers

Even if you meet all three of the general eligibility requirements described above, you may not qualify for workers' compensation benefits if you fall into one of the special groups of workers who are exempt from coverage under the workers' compensation laws of some states. The most common exempt categories are covered below. If your employer claims that you fall into one of them and are therefore not entitled to benefits, you may want to speak to an attorney to make sure.

Domestic workers. A domestic worker is someone who works in a home -- such as a housekeeper or a babysitter. Some states don't require employers to cover these types of workers.

Agricultural and farm workers. The majority of states exempt agricultural and farm workers from workers' compensation coverage. Not every person who works on a farm falls into this category, however. For example, a horse trainer is not considered a farm worker when it comes to eligibility for workers' compensation benefits.

Leased or loaned workers. If you were loaned to an employer through an agency (for example, a temp agency), states differ on which company -- the one you did the work for or the agency -- has to provide workers' compensation coverage for you.

Casual or seasonal workers. You are a casual or seasonal worker if you work only at certain times of the year or work only intermittently or sporadically. Some states do not require that casual or seasonal workers be covered by workers' compensation.

Undocumented workers. Some states -- including Arizona, California, Florida, Montana, Nevada, New York, Texas, and Utah -- expressly cover undocumented workers in their workers' compensation statutes. Other states, such as Idaho and Wyoming, expressly exclude undocumented workers. Still other states (such as Colorado) have not yet dealt with the issue, leaving it to the courts to struggle with whether to cover these workers.

For More Information

For more information on workers' comp, see Nolo's article Types of Workers' Comp Benefits, or if you were injured in California, see the book California Workers' Comp, by Attorney Christopher Ball (Nolo).

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