Eligibility for Workers’ Compensation Benefits

Each state has its set of employment laws for workers’ compensation besides the federal government statutes. Workers’ compensation is a mandatory insurance policy for U.S employers and it’s meant to benefit victims of workplace injuries or illnesses. The policy is a disability program providing cash and healthcare benefits, or both to workers.

Employers in all states (excluding Texas) must maintain a worker’s compensation policy which is handled by individual states. The applicable benefits can vary by state and that’s why you should consult an employment attorney in California USA if you’re a victim of workplace injuries or illnesses.

Eligibility for Workers’ Compensation

All workers are eligible for workers’ compensation in the U.S except crewmembers and railroad workers (interstate). However, eligibility depends on the status of employment; t employees are covered by employers while independent contractors buy their policies.

The federal law allows the two ineligible groups of workers (crewmembers and interstate railroad employees) to sue their respective employers for work-related injuries instead of receiving workers’ compensation.

Employees vs. Independent Contractors

Employees work for a person or company and they’re expected to be loyal to one employer. The features of an employee include:

  • Employees take orders from their employers;
  • They must perform the core business of the employer;
  • Employees use employer’s tools
  • Employer-employee relationships are typically long-term;
  • The employer deducts tax from employees’ wages.

On the other hand, the features of independent contractors include:

  • They use their tools;
  • Taxation isn’t deducted from their pay by the employer;
  • The working relationship is usually short-term;
  • They don’t perform the employer’s regular business;
  • Independent contractors manage their time.

The main distinction between an employee and an independent contractor is who decides how the job is to be performed. Employees follow the employer’s instructions to accomplish the assigned tasks or jobs while independent contractors don’t take instructions from employers–they are their bosses. For instance, you can’t tell a plumber how to do their jobs, you only tell them what you want to achieve like fixing a leaking pipe.

Employer’s Fault in Workers’ Compensation Claims

You’re entitled to a worker’s compensation regardless of who was at fault for your injuries–provided you suffered work-related injuries. In other words, you have a right to recover damages whether you, the employer, or another employee is liable for your injuries.

Can You Sue the Employer for Workplace Injuries?

The workers’ compensation program is the typical remedy for injured employees therefore, you can’t sue an employer who has an active worker’s compensation plan. However, some exemptions can influence legal action against the employer, including:

  • When an employer frustrates an injured employee with the sole aim of denying them their dues;
  • When an employer denies or tries to avoid liability for a legitimate claim;
  • If your employer failed to pay insurance premiums, invalidating the insurance policy.

If your employer is complicating a straightforward claim, you should contact an employment attorney in California USA to discuss your situation.

External Work-related Injuries

An injury need not occur at the work premise to qualify for compensation. As long as the injuries are work-related–you were injured while at your employer’s business, you can recover workers’ compensation benefits. You can sustain external work-related injuries in various ways, such as:

  • When making deliveries;
  • When attending or going to a business meeting; or
  • While participating in a work-related external education program
  • While attending your company’s recreational event.

Injuries Not Covered By Workers’ Compensation

The injuries sustained by an employee while commuting to and from work are not covered under the provisions of workers’ compensation. Also, not all external work-related injuries qualify for workers’ compensation. The basic guideline is that an employee was within the scope of their employment duties when the accident occurred to qualify for workers’ compensation. Otherwise, an injured employee will lose the right to this benefit if they were injured while doing personal activities or while on personal errands.

For instance, you’ll not be compensated if you’re injured while on personal shopping in a company’s car. If you’re also injured while sightseeing during an education trip, you’ll not be compensated.

Injury Claims against Employers that Don’t Have Workers’ Compensation Insurance

Workers’ compensation insurance is mandatory for all employers in the U.S except in Texas. Alternatively, an employer should be self-insured if they don’t have a worker’s compensation insurance policy. The available legal options for injured employees whose employers lack worker’s compensation insurance or self-insurance include:

  • Filing legal action against the employer; or
  • Bringing a workers’ compensation claim with the special fund for addressing workers’ compensation claims.

Awards for Work-related Injuries under the Workers’ Compensation Law

Although workers’ compensation laws can vary by state, the recoverable awards are common across the board, including:

  • Weekly compensation;
  • Disability benefits;
  • Award for medical treatment;
  • Compensation for therapies and medical rehabilitation.

The recoverable damages in a workplace injury claim depend on the severity of injuries and the applicable law in your state.

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