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Am I Eligible for Workers' Compensation Benefits?

November 4, 2019

Injuries resulting from workplace accidents can result in crushing financial burdens for the injury victims and their families. Fortunately, most employees are covered by workers’ compensation benefits. However, determining eligibility for workers’ comp and recovering benefits can sometimes be a frustrating, confusing process.

In this post, the Cincinnati workers’ compensation attorneys at Young, Reverman & Mazzei discuss injuries and illnesses covered by Workers’ Comp as well as who is eligible to receive benefits.

Workers’ Comp Eligibility Requirements

Workers’ compensation is an insurance-based program that provides injured workers with financial benefits to help cover medical bills, rehabilitation services, and lost wages. If you suffered a job-related illness or injury, it’s likely that you’re entitled to workers’ comp benefits.

Eligibility for workers’ compensation varies somewhat by state, but there are generally four main requirements that must be met to obtain benefits:

You Must Be An Employee

When it comes to eligibility for workers’ compensation, only those classified as “employees” are eligible for benefits. Independent contractors such as freelancers and consultants are not typically entitled to workers’ compensation benefits. However, there may be other avenues those workers can pursue in court for compensation, depending on the circumstances of the injury or illness.

You Must Be Covered By Workers’ Compensation Insurance

This is often an easier requirement to meet, as most employers are required to carry workers’ compensation insurance if they have a certain number of employees. Most states require employers with at least one employee to acquire insurance, but some states exempt small businesses with fewer than three employees. Many employers choose to purchase workers’ comp insurance even if they aren’t required to in order to protect themselves from potential lawsuits.

Your Injury or Illness Must be Work-Related

In order to be eligible for workers’ compensation benefits, you must prove that the injury or illness was directly connected to your work. According to the U.S. Occupational Safety and Health Administration, an illness or injury is work-related if an event or exposure in the work environment caused or contributed to it. Although this eligibility rule generally refers to injuries from an accident at the workplace, it also applies to job-related tasks away from the office and to work-related injuries or illnesses that manifested over time.

You Must Meet Your State’s Reporting & Filing Deadlines

There are time limits for reporting an injury and filing a workers’ compensation claim. Each state has its own deadlines. In the tri-state area, basic deadlines are as follows:

  • Ohio: You must report the ailment and file a claim for benefits within two years of the date of the injury. If your claim is for work-related illness, you must file within one year of becoming ill or within six months of a formal diagnosis by a doctor.
  • Kentucky: Workers who are injured at work and require medical attention must report the injury within 24 hours; a First Report of Injury form must be filed within 30 days of the injury. For non-medical emergency injuries, workers have up to two years from the date of the injury or onset of illness.
  • Indiana: Injured workers must notify their employers within 30 days of a work-related injury, but have up to two years from the date the injury occurred to file a claim for benefits.

Injuries and Illnesses Covered by Workers’ Compensation

Workers’ compensation covers a wide range of injuries and illnesses, as long as they occurred in the workplace or during the course of the individual performing their job-related duties. Examples of common injuries and illnesses cited in workers’ compensation claims include:

  • Broken bones, burns and chemical exposure caused by workplace accidents
  • Repetitive-stress injuries, including carpal tunnel syndrome, hearing loss and back problems
  • Occupational diseases, including certain musculoskeletal disorders and some forms of cancer
  • Pre-existing conditions that are exacerbated with regular work-related duties

Mental illnesses such as PTSD, anxiety, and depression may occasionally be covered by workers’ compensation if the condition stems from a traumatic event that happened at work, although these conditions are difficult to prove in court without the help of a qualified workers’ compensation attorney.

Your injury or illness may not be covered by workers’ compensation if it is minor and treatable with basic first aid, or if it occurred on the way to or from work. There may be exceptions if you are driving a company vehicle, traveling on a business trip, running errands for your employer, etc. You may also ineligible for workers’ compensation if your injury was caused by misconduct, such as horseplay or while breaking a workplace safety rule.

Exemptions for Certain Workers

Despite meeting the general eligibility requirements described above, you may end up disqualified from workers’ compensation benefits if you belong to a category of workers exempt under state law. These categories vary by state, but the most common types of exempt workers include:

  • Housekeepers
  • Undocumented workers
  • Child caregivers
  • Agricultural and farm workers
  • Temp agency or staffing agency employee
  • Casual and seasonal workers

What If the Workplace Accident Was My Fault?

Workers’ compensation is generally a no-fault system. This means that there is no requirement to find the company you work for at-fault, and you may still be eligible for benefits even if you did something that contributed to the injury.

This does not apply in certain situations, however, especially if you intentionally caused the injury. If your injury or illness was the result of alcohol or drug use on the job, your injury will also not be covered.

If you have questions about workers’ compensation, it’s a good idea to talk with an experienced workers’ compensation lawyer, who can help determine whether you’re eligible for benefits and guide you through the process to recover benefits.

Consult a Cincinnati Workers’ Compensation Attorney

The dedicated workers’ compensation attorneys at Young, Reverman & Mazzei know how stressful it can be to seek workers’ compensation benefits on your own, especially when you’re coping with an injury or illness that prevents you from working.

Our law firm was founded in 1972 to protect the rights of injured workers in the greater Cincinnati area, including our neighbors in Kentucky and Indiana. We offer free consultations to help you understand your eligibility and options for filing, and we don’t charge for our services unless we successfully obtain benefits on your behalf.

To learn more about determining eligibility and how to apply for workers’ compensation benefits, call Young, Reverman & Mazzei today at 800-721-1678 or contact us online to schedule your free initial consultation.

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