When you are hurt on the job, you could be entitled to workers’ compensation benefits. Employers in California must provide coverage for their employees either through the state fund or private insurance. Benefits could cover reasonable and necessary medical treatment.

However, there are certain eligibility requirements for workers’ compensation benefits. Reach out to the trusted team of workers’ comp attorneys at Glauber Berenson Vego to learn more about workers’ compensation claim eligibility in Downey.

Requirements for Workers’ Compensation Eligibility

The main requirements for workers’ compensation eligibility in Downey and throughout the state are the employer having workers’ compensation insurance, the injured worker being classified as an employee at the business, the illness or injury being work-related, and the worker filing their claim within the applicable state deadlines.

While these eligibility requirements may seem basic, there are multiple additional factors to consider. For example, it is not always immediately clear whether someone is an employee. Many workers are incorrectly classified as independent contractors, and their title alone is not sufficient to disqualify them from obtaining workers’ comp benefits. The state considers other factors, such as how much control the employee has over setting their own schedule and job duties to determine their status.

Similarly, whether or not an illness is work-related can present a point of contention for employers and insurance adjusters. In some cases, it is immediately apparent. If the employee was performing a task related to their job and sustained injuries in a sudden accident, it is considered a work-related event. This might include exposure to chemicals, electrocution, amputations, or burns. Some cases are not as clear-cut. For example, repetitive stress injuries that occur over time, such as carpal tunnel, often face employer or insurer pushback as to whether the employee’s condition stemmed from their job tasks or things they do in their personal time. The same thing can be said for injuries involving pre-existing conditions.

Rules for Specific Types of Workers

Not all employees are covered by workers’ compensation insurance. As mentioned above, independent contractors or gig workers typically are not covered by their company’s policy. As a result, if they suffer a work-related injury, they must cover the cost out of their own pocket. However, it is not uncommon practice for companies to misclassify employees as independent contractors. Sometimes, this is done innocently, but other times, it is to limit benefits like workers’ compensation.

Additional types of workers who are exempt by law from workers’ compensation benefits include:

  • Seasonal workers
  • Agricultural workers
  • Undocumented workers
  • Contract or temp employees
  • Domestic workers like housekeepers or caregivers

When you are denied workers’ compensation benefits but believe the determination was in error, reach out to our team. Our legal professionals will explain Downey’s exemptions and requirements for workers’ comp coverage. If the denial was an error, we could help appeal the determination.

Call a Downey Attorney To Learn More About Workers’ Compensation Claim Eligibility

Employees injured on the job have a legal right to workers’ compensation benefits for their lost wages and medical treatment related to a work injury. When you have questions about workers’ compensation claim eligibility in Downey, do not hesitate to reach out to our team. We are dedicated to providing injured workers with the help they need to successfully recover medical care, lost wages, and more.

Workers’ Compensation Claim Eligibility in Downey

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