How Do You Know if Your Injury is Covered by Workers Compensation?

To prove that you are entitled to workers’ compensation benefits, a worker must prove:
  1. You were an employee at the time of the injury, and
  2. Your injury was suffered “arising out of” and “in the course of” employment.

Employees are covered under the workers’ compensation act and entitled to its benefits.  Independent contractors are not covered, and, typically, neither are their employees.  Once the worker proves that s/he was providing services for the employer at the time of the injury, the burden of proof shifts to the employer to prove the worker was an independent contractor.  Whether a person is an employee or an independent contractor is a question of fact.  There are a number of factors to consider when determining if a person is an employee or an independent contractor.  It is important to understand that neither the intent of the parties, nor one factor is determinative.  The factors to consider are:
  • The existence of a contract for the performance by a person of a certain piece or kind of work at a fixed price.
  • The independent nature of his business or of his distinct calling.  Basically, does the worker have his own business separate from the work he is performing for the employer.  If there is an independent business that is more likely to show he is an independent contractor.
  • The worker’s ability to employ assistants with the right to supervise their activities.  If the worker is an employer, paying wages and supervising employees that is evidence of an independent contractor.
  • The worker’s obligation to furnish necessary tools, supplies, and materials.  An employer supplying tools, supplies, and materials is evidence the worker is an employee.
  • The worker’s right to control the progress of the work, except as to final result.  If the employer has a right to control the manner in which work is done, that is evidence of an employer/employee relationship.
  • The length of time which the worker is employed.  A longer period suggests employer/employee relationship.
  • The method of payment.  If the worker is paid by the hour or week that is demonstrative of an employer/employee relationship.  If the worker is paid by the job, that is indicative of an independent contractor.
  • Whether the work is part of the regular business of the employer.  If the worker is performing work that is typical of the business of the employer, that shows an employer/employee relationship. 

In order for an injury to be compensable under workers’ compensation it must both “arise out of” and occur “in the course of” employment.  “Arising out of” refers to the cause or source of the injury, meaning the employment activity contributed in some fashion to the injury.  “In the course of” refers to the time, place, and circumstances of the injury.  In other words, the injury happened at work, or because of work.

For instance, a person having a heart attack at work, that may be in the course of employment (because it happened at work), but is not necessarily arising out of employment (since the heart attack may have been caused by factors not related to the employment).  If a worker loses an eye because co-workers are throwing objects in an act of horseplay, the injury meets the “arising out of” requirement, but not the “in the course of” requirement.

Typically, workers who are injured either coming to or going from work are not covered under workers’ compensation, unless the worker meets an exception to the going and coming rule.  If a worker is required to drive in the course of their employment that it typically covered.  Additionally, if a worker is injured while running a work errand, even if it is on their way to or from work that is compensable. 

Idiopathic injuries are not compensable.  The relates to the “arising out of” requirement.  Idiopathic injuries are those that were just as likely to happen elsewhere due to reasons entirely personal to the worker, but coincidentally occurred at work.  For example, a worker injures his/her back while twisting on a toilet at work is an idiopathic injury.