Hassle-Free Health Coverage: Eligibility
It is important to distinguish between the eligibility requirements for health insurance and those for workers' comp insurance. With a health insurance policy, the employer may decide to offer coverage only to a class of employees; such as "all salaried employees" or "employees who have worked one year or more for the firm."
With workers' comp insurance, singling out classes of employees for coverage is not permitted. Eligibility for workers' comp is statutorily determined. Full-time employees, part-time employees and even illegal workers (in California) are covered by workers' comp insurance.
In order to be eligible for workers' comp benefits you must work in an occupation that is covered by workers' comp and have had an accident or sickness that is work-related.
In most states, all workers (except those specifically excluded) come under workers' comp laws. For these states, the law must list the employees excluded. Commonly excluded employee include:
- farm labor,
- domestic servants, and
- casual workers.
Even for these employees, workers' comp coverage is usually available on a voluntary basis at the election of the employer.
Early workers' compensation laws applied only to very hazardous occupations. Over the years, the scope of the laws has expanded to embrace more and more occupational groups. Every state has some exempt classifications, but it is estimated that about 90 percent of the nation's employees now fall under workers' compensation laws.
Some states exempt employers from workers' comp laws if they employ fewer than a stipulated number of employees (usually three). But, even if an employer has fewer than three employees, he may voluntarily decide to comply with the workers' comp law to avoid liability claims down the road.
Today, in most states, an employer subject to compensation laws is obligated to buy workers' comp insurance or demonstrate an ability to provide the required benefits. However, most states permit an employer to set up a formal program of self-insurance -- including specific loss-handling procedures and proper funding of reserves against claims.
Companies large enough to offer self-funded health insurance to employees are usually good bets to self-insure their workers' comp.
The purpose of workers' comp is to provide benefits if you have an accident or sickness that is job-related -- arises out of and in the course of employment. Falling on the dance floor while attempting the Electric Slide and breaking your arm does not make a workers' comp claim; slipping on a wet floor at the job site and breaking your arm does.
