Who Is Covered Under Workers’ Compensation?

This is a common question for people who have been hurt or become ill due to their employment.

Workers’ compensation is a kind of insurance employers purchase for the coverage of these job-related injuries and illnesses. 

What is workers’ compensation?

Workers’ compensation insurance, usually called “workers’ comp,” is a state-mandated program to protect workers harmed on the job. Under this program, an employee who is injured or disabled in connection with work is eligible for payments required by law. This typically happens at a state level, although the federal government offers its own workers’ compensation insurance for federal employees specifically. Otherwise, every individual state has its own workers’ compensation insurance program. You can learn more about Florida’s workers’ compensation benefits laws by finding the appropriate office on the State Workers’ Compensation official page of the U.S. Department of Labor’s website.

Injured employees usually receive workers’ comp, regardless of who was at fault for the injury or illness. Since these workers comp benefits perform as a type of insurance, they prevent the employee from suing their employer under a negligence theory in personal injury for the covered injuries.

What types of situations are and are not covered by workers’ compensation insurance?

Workers’ compensation insurance can cover a wide range of problems. It’s meant to provide coverage of injuries that happen due to employees’ or employers’ carelessness. It might cover someone who gets carpal tunnel syndrome from too many hours spent typing at work, or a construction worker injured after dropping a heavy beam on their foot. Although the range of the illnesses and injuries covered is broad, there are still some limits. States may choose to demand drug and alcohol testing on the injured employee—to determine if they were sober at the time of an accident, for example. The employer can then deny workers’ compensation benefits if these tests show the employee was under the influence at the time of the injury. There are other situations where compensation may be denied—such as if the injuries turn out to be self-inflicted and if the employee was not actually on the job at the time of the injury.

What types of expenses does workers’ compensation insurance cover?

The payments are often modest, but workers’ compensation insurance is meant to cover the following:

• Medical treatment for the injury or illness
• Replacement income for the time the employee isn’t able to work
• Compensation for any permanent injuries
• Benefits to survivors of workers who are killed on the job

However, it’s important to keep in mind that if an employer has workers’ compensation benefits in place, the employee cannot sue the employer in a personal injury court, but rather can sue their employer in a workers’ compensation proceeding. There may also be other considerations. For example, workers’ compensation benefits do not cover pain and suffering. Some people are unsure of what to do, especially if they may be facing a lifetime of pain after an accident. A local attorney can answer questions and help you understand your options if you are struggling with such a decision.

When it comes to wage replacement, workers’ comp typically offers two/thirds of the worker’s average wage, and there is a fixed maximum amount that the benefits will not exceed. That pay cut sounds scary, but one piece of good news is that these benefits are not taxed. So in some cases, if the employee was making a fair wage, they should have a reasonable amount of take-home pay. Eligibility for wage replacement starts immediately after a few days of work are missed because of a specific injury or illness.

Does workers’ compensation insurance cover long-term and permanent injuries?

Yes. Workers’ compensation insurance does cover both long- and short-term injury situations. Additionally, it covers injuries and diseases that slowly develop over a long period of time from repetitive motion—like carpal tunnel syndrome, or spine problems from some sort of repetitious movement or heavy lifting.

Who is covered by workers’ compensation insurance?

Generally, most kinds of employees are eligible to benefit from workers’ compensation insurance. However, employers frequently exclude some workers from coverage. These may include:

• independent contractors
• business owners
• volunteers
• employees of private homes
• farmers and farmhands
• maritime employees
• railroad employees
• casual workers

Federal government employees are covered under the federal workers’ compensation insurance program, so they are not covered by state workers’ comp. In some states, the state government won’t enforce the workers’ compensation program on employers with less than a certain number of employees. Florida sets the following requirements for employer coverage:

• Construction employers who have one or more employees, including any non-exempt business owners, must provide coverage

• Non-Construction employers who have four or more employees, including any non-exempt business owners, must provide coverage

• Agriculture—if there are six regular employees and/or twelve seasonal workers who work more than 30 days during a season but no more than a total of 45 days in a calendar year, the employer must provide coverage

Can I sue my employer for a work injury?

Yes. If you were hurt on the job, it would be in your best interest to consult a trusted attorney to explore your options. 

Some people have concerns that if they sue an employer, they may go months without income, and with medical bills piling up, before their lawsuit can be heard in court. Your lawyer can help you understand your options for handling bills and medical expenses in this situation.

Can my employer fire me for or tell me not to file a workers’ comp claim?

No, in most states this is prohibited by law. In the event that an employer does retaliate against an employee for filing a workers’ compensation claim, the employee should immediately seek legal counsel.

To get started, schedule a free case evaluation with the team at The Law Offices of David M. Benenfeld, P.A. today. We know waiting for compensation is hard, especially when you have medical bills and expenses continuing to pile up.

Explore your legal options now by calling us at 954-677-0155 or request more information online about our legal services.