5 Requirements For Workers Compensation Eligibility

Every employee is entitled to workers’ compensation if they get injured or ill on the job. It allows them to receive medical and wage benefits mandated by the state. This employment benefit also gives them the right to demand compliance from their employers.

If employers fail to provide workers’ compensation coverage, they can suffer from severe and costly consequences, including paying for claims out-of-pocket, possible imprisonment of up to seven years, and revocation of their permit to conduct business. If you were injured on the job in North Carolina, it is crucial to contact a legal attorney for advice on how to file a workers’ comp claim in North Carolina.

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How to be eligible for workers’ compensation benefits

To qualify for workers’ compensation benefits, an individual must meet five requirements. Check them out below.

1, You must be classified as an official employee of the company

Individuals filing for workers’ compensation claims must be classified as legitimate employees of the company. One way to know this is to note the terms and conditions of the employment contract between you and the company. The agreement must expressly state the commencement date of the employment, job title, and the employee’s role and responsibilities.

On the other hand, you may not be eligible for a claim if you are an independent contractor, freelancer, or part of the ‘gig’ economy. However, some official employees are tagged as independent contractors by their own companies to keep the latter from paying payroll taxes on their workers. It’s crucial to have a signed employee-employer contract to avoid having conflicts about your legitimacy as an employee.

2. The employer must have workers’ compensation insurance

In most cases, employers must have workers’ compensation coverage depending on the type of business, number of employees, and type of work executed.

Obtaining workers’ compensation insurance differs from state to state. In North Carolina, the state’s workers’ compensation act mandates all businesses with three or more employees, including corporations, sole proprietorships, limited liability companies, and partnerships, to subscribe to a workers’ compensation insurance.

3. You must have a work-related injury

Work-related injuries are any injury or illness acquired because of work. This includes physical injuries, psychological disorders, and death. Examples include slips and falls, exposure to harmful substances, electrocution, overexertion, entanglement, and violence.

Note that you are entitled to a compensation claim if the accident is not the cause of your misconduct. However, specific measures need to be taken to prove that you are not guilty of the accident.

4. You must attend scheduled medical appointments, tests, and treatments

An employee who is said to have sustained a work-related injury must undergo a medical examination to determine if they indeed got injured at work. The independent physician will ascertain if the injuries are as severe as the victim claims and not caused by another accident.

Suppose the injured party does not wish to attend an independent medical examination. In that case, they may be compelled to do so in certain circumstances, such as when the insurance policy demands the insured party to submit to an examination.

5. You must meet reporting and filing deadlines

You must report your work-related injury as soon as possible to be eligible to claim your compensation. In North Carolina, a worker must report a compensation claim within 30 days since the accident.

Your employer should file the proper documents with its workers’ compensation insurer or the North Carolina Department of Labor within five days of receiving your report. Note that your employer or insurance policy must inform you whether your claim has been accepted or denied within 14 days.

In all cases, you must be proactive in taking receipts and documenting the details of the accident to be accurate and get the compensation you deserve.

Talk to an attorney now

Aside from acquiring negative health consequences, getting a work-related injury necessitates paying exorbitant fees that can destroy your savings. Additionally, it hinders your ability to work and earn a living when you sustain a severe injury. On top of that, it also causes various mental issues, such as anxiety and depression. In summary, it affects your ability to live a quality life.

Fighting for a compensation claim is already tricky, but you can face more problems if your rights are compromised. Hence, it is crucial to consult a legal attorney to determine compensation eligibility, understand state laws, and keep your rights from being abused.

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