Workers compensation insurance, also known as workers comp, is designed to compensate employees for injuries or illnesses sustained as a direct result of their employment. In practice, determining whether or not you are eligible can be complicated. There are special rules that apply to certain types of employers and workers, and you must be able to prove that your illness or injury was work-related. Here are the three major factors involved.
1. Employer Coverage
In Washington State, the vast majority of employers are required to participate in workers compensation, either through the Department of Labor & Industries (L&I) or via self-insurance. However, there are a few exceptions. In particular, businesses that employ partners, managers, and the like, as well as certain freelancers, may be exempt if they have no regular employees. Some companies that fall into this category voluntarily choose to participate, and L&I limits the total number of exclusions that a company can claim. Talk to your company or an L&I representative if you are unsure of your employer’s workers compensation status.
2. Qualified Employee Status
Although the majority of employees are covered by workers comp, some are not. Examples include, but are not limited to: a single domestic worker (though households with two or more must cover everyone), someone doing personal errands or chores outside of the home, musicians hired sporadically for a non-entertainment business, newspaper carriers, and hairdressers leasing space. A good rule of thumb is that if your employment is irregular and inconsistent, you might be excluded, but if you regularly work for the same employer, you are most likely included. Speak with your employer or an attorney for more specific information.
3. Work-Related Injury or Illness
To qualify for workers comp, you must show proof that your illness or injury was work-related. In general, this means filing documentation that details a workplace accident or long-term exposure to disease-causing conditions, along with a physician’s report that states that the accident or exposure most likely caused the injury or illness. However, it is not always cut and dried.
Preexisting conditions are, of course, not covered—unless you can show that the workplace exacerbated the condition. For example, if you had knee trouble five years ago, and the same knee was dislocated at work last week, it will probably be easy to prove that your workplace exacerbated your condition. However, if you sprained your ankle at home two weeks ago, you would be hard pressed to receive workers comp coverage for ankle pain at work today.
In some cases, the conditions under which you were injured or became ill matter. If you were injured on your regular commute, you are likely not eligible for workers comp. If you were on a required business trip, however, you most likely are eligible. If you were ignoring a workplace safety rule, you are probably covered, unless your injury is determined to be self-inflicted.
Qualifying for workers comp might be extremely simple or highly complex, depending on your employer’s status, your status, and the precise circumstances of your illness or injury. It is always best to hire a competent workers comp attorney to walk you through the specifics of your individual case and help you decide how best to proceed. Your attorney will fight for your rights, ensuring that you are treated fairly and allowing you to focus on your recovery.
Bryan Stubbs, Attorney at Law, assists clients throughout the Tacoma, WA area. To protect your rights, speak to us as soon as possible after an injury. For over 50 years, our office has been helping injured workers on workers compensation claims and third party claims. We will fight for your rights and secure the best outcome for your injury claim! BBB A+ Rating.
Contact Bryan Stubbs today at 253-383-5891 to schedule a free initial consultation. If you or a loved one have been seriously injured in an accident at work, call us today.