While workers’ compensation covers most workplace injuries, there are a few exceptions. The workers’ compensation system is a no-fault system. Meaning, it makes no difference whether the injury was caused by you or your employee’s negligence. In general, all that matters is that your employee’s injury was directly caused by their job. However, there are a few circumstances where workers’ compensation won’t cover an injury. There is also a statute of limitations in every state that says your employees have to report the injury within a certain time frame otherwise they forfeit their right to workers’ comp. Having this information available for your employees can help make sure they don’t file a fraudulent claim or don’t wait too long to file.
If an employee is injured or becomes ill as a result of their job, they may qualify for workers’ compensation benefits. Which include reimbursement for medical bills and some lost income, as long as they are eligible. In exchange for this protection, they give up the right to sue you for damages. With the exception of a few cases where they can sue outside of the workers’ compensation system. Workers’ compensation benefits typically include four main eligibility requirements:
Your Business Must Have Workers’ Compensation Coverage
In general, the vast majority of employers—but not all—have to obtain workers’ compensation insurance. State regulations vary, but an employer’s responsibility to offer coverage is generally determined by the number of employees, the type of business, and the sort of job employees perform. Most jurisdictions require coverage for any employer with at least one employee. Although some states establish a minimum of two to five employees. Other states have distinct standards for agricultural or building companies, while other states enable charity to opt out of the workers’ compensation system. Texas for example makes workers’ compensation coverage optional for practically all privately owned companies.
They Must Be A Paid Employee
When it comes to workers’ compensation eligibility, not all workers are employees. Independent contractors (such as freelancers, consultants, or participants of the “gig” economy) often don’t qualify for workers’ compensation benefits. Although the rules vary by state, courts will generally consider the degree of control the worker has over their work such as if they choose their own hours or had to report to you directly for instructions. Volunteers are typically not eligible for workers’ compensation payments, but there are rare exceptions. Some states, for example, specifically cover volunteer firefighters, while others allow any group to cover its volunteers.
The Illness or Injury Has To Be Work Related
In general, it is work-related if the employee was doing something for the benefit of the company and was wounded or became unwell as a result. For example, if they hurt their back while lifting boxes as part of their warehouse job, acquire carpal tunnel syndrome as a result of typing on the job, or become ill as a result of exposure to dangerous chemicals on the job, their illnesses are clearly from work.
The Claim Has To Meet Reporting and Filing Deadlines
Even if your employee meets all of the other requirements, they may lose their access to workers’ compensation benefits if they fail to meet the deadlines in your state for reporting the accident to you and filing a workers’ compensation claim. The statute of limitations governs how long they have after a working injury to file a claim for workers’ compensation payments. States also have substantially shorter timeframes for your employees informing you of a job accident (usually 30 to 60 days, but sometimes less).
So, while they may have two years to file a claim, they may only have 30 days to notify you. Also, keep in mind that the statutes of limitations for workers’ compensation sometimes vary depending on the nature of the claim. For example, if they didn’t find the sickness until much later, most states grant more time to file a claim for an occupational illness that developed over time.
Deadlines By State
Alabama – Report to employer within 5 days, 2 years to file
Alaska – Report to employer within 30 days, 2 years to file
Arkansas – Report to employer asap, 2 years to file
California – Report to employer within 30 days, 1 year to file
Colorado – Report to employer within 4 days, 2 years to file
Connecticut – Report to employer asap, 1 year after injury, 3 years after first symptom of occupational disease to file
Delaware – Report to employer asap, 2 years after injury, 1 year after diagnosis of occupational disease
Florida – Report to employer within 30 days, 2 years to file
Georgia – Report to employer within 30 days, 1 year to file
Hawaii – Report to employer asap, 5 years after injury 2 years after first symptom of occupational disease
Idaho – Report to employer within 60 days, no limit to file
Illinois – Report to employer within 45 days, 3 years to file
Indiana – Report to employer within 30 days, 2 years to file
Iowa – Report to employer within 90 days, 2 years to file
Kansas – Report to employer within 20 days, 3 years to file
Kentucky – Report to employer asap, 2 years to file
Louisiana – Report to employer within 30 days, 1 year to file
Maine – Report to employer within 60 days, 2 years to file
Maryland – Report to employer within 10 days, 60 days after injury, 2 years after diagnosis, or death to file
Massachusetts – Report to employer asap, 4 years to file
Michigan – Report to employer within 90 days, 2 years to file
Minnesota – Report to employer within 180 days, 3 years after submitting the report to department of labor, no longer than 6 years after injury to file
Mississippi – Report to employer within 30 days, 2 years to file
Missouri – Report to employer within 30 days, 2 years to file, 3 years if the employer did not file a report to the division of workers’ compensation in a timely manner.
Montana – Report to employer within 30 days, 1 year to file
Nebraska – Report to employer asap, 2 years to file
Nevada – Report to employer within 7 days, 90 days after injury, 1 year after death to file
New Hampshire – Report to employer within 2 years, 3 years to file
New Jersey – Report to employer within 90 days, 2 years to file
New Mexico – Report to employer within 15 days, 1 year to file
New York – Report to employer within 30 days, 2 years to file
North Carolina – Report to employer within 30 days, 2 years to file
North Dakota – Report to employer within 7 years, 1 year after injury or 2 years after death
Ohio – Report to employer asap, 1 year after injury or 2 years after occupational disease
Oklahoma – Report to employer within 30 days, 2 years to file
Oregon – Report to employer within 90 days, 2 years after injury or 1 year after diagnosis to file
Pennsylvania – Report to employer within 120 days, 3 weeks after injury or 300 weeks after exposure to work hazard that led to disease to file
Rhode Island – Report to employer within 30 days, 2 years to file
South Carolina – Report to employer within 3 days, 2 years to file
South Dakota – Report to employer within 3 days, 2 years to file
Tennessee – Report to employer within 15 days, 1 year to file
Texas – Report to employer within 30 days, 1 year to file
Utah – Report to employer within 180 days, 6 years to file
Vermont – Report to employer asap, 3 years to file
Virginia – Report to employer within 30 days, 2 years to file
Washington – Report to employer asap, 1 year after injury or 2 years after disease diagnosis to file
West Virginia – Report to employer asap, 6 months after injury or 3 years after diagnosis or last exposure to hazard that led to disease to file
Wisconsin – Report to employer within 30 days, 2 years after injury, 6 years after traumatic injury, 12 years after disease diagnosis to file
Wyoming – Report to employer within 72 hours, 1 year after injury or diagnosis or 3 years after last exposure to hazard that led to disease whichever is later.
Accidents Workers’ Compensation Won’t Cover
As we said earlier, if the injury or illness happens while your employee is working then their injury is almost always covered. However, what about the types of accidents not covered? It’s important to let your employees know what wouldn’t be covered so that they don’t try to file a false claim. It also helps to let them know how certain behaviors at work can hurt them, not only physically, but financially as well.
Commuting
The “coming and going rule” usually applies if the injury happens while commuting to and from work. Travel to and from their fixed work site is not regarded within the scope of their employment under this rule. For example, if they are in an accident on their way to work in the morning, workers’ comp will not cover their injury.
However, if they use a corporate car, don’t have a set work location, or were doing a work errand, workers’ comp will most likely cover their injuries. A traveling salesperson, for example, may qualify workers’ compensation benefits if he or she is in an accident while driving from home to the first client meeting of the day. Similarly, an executive assistant who gets in an accident on the way to work while picking up their boss’ dry cleaning would most certainly qualify.
Recreational Activities
If your company provides opportunities for team building and recreation to your employees. Injuries sustained at a social event, such as a business picnic, Christmas party, or happy hour, may or may not be covered by workers’ compensation. Certain factors, such as the following, increase the likelihood that the injury may be covered:
Employees being required to attend the event
Your company benefited from the employee being there, such as the event having a work-related presentation
The event happened on the business’ property during working hours
However, if an event is clearly voluntary and solely for the employee’s benefit, it’s very unlikely workers’ comp will cover the injury. Workers’ compensation decides claim eligibility on a case-by-case basis. Employees shouldn’t assume that because their injury occurred at a workplace social function, it is not covered by workers’ compensation.
Substance Abuse
Most, if not all, state workers’ compensation statutes expressly prohibit injuries caused by the worker’s own intoxication. For example, if someone falls from a ladder after drinking, workers’ comp will most likely deny their claim. They may still qualify for payments if they have evidence that the accident was inevitable or not their fault. For example, if they were working on a factory line and another worker struck them from behind with a lift truck while they were under the influence, they may qualify for compensation even though they were under the influence.
Horseplay
Because horseplay and practical jokes are beyond the scope of employment, workers’ comp doesn’t typically cover injuries resulting from them. There are, however, exceptions to this rule. If you, as the employer, for example, permitted prolonged horseplay, their injuries may be covered. Similarly, if they were an innocent bystander, they will almost certainly still qualify for benefits.
Similarly, workers’ compensation does not cover most injuries caused by workplace fights or altercations. If the conflict is over a work injury they may still qualify for benefits. For example, if they get into a fight with a coworker over their favorite sports team, it’s unlikely that workers’ comp will cover them. However, if a coworker hits another after they complain about his or her poor job performance, they may be eligible for compensation.
Working With EZ
Educating your employees and yourself about workers’ compensation regulations and limits is an important step toward protecting everyone. The next step is to find the best workers’ compensation policy. We take pride in our customer service and do everything we can to make purchasing simple and stress-free. We provide our consumers our undivided focus by providing personalized service and quick outcomes.
When you complete our form, you will receive free quotations from your dedicated agent, who will understand your requirements. We want to make sure you make the best decision possible and get the finest coverage at the best price. Check out your quotes today because our services are entirely free! If you have any further inquiries, please put your zip code in the box below or call us at 855-694-0047. You will be speaking with a local insurance agent who will be able to answer all of your questions and assist you in determining the appropriate workers’ compensation policy for your company.
Kyle Mehlman is Marketing Coordinator specializing in SEO, copywriting and content creation. In 2021, Kyle graduated from the University of North Carolina, with a degree in Journalism and Media.
