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Who Qualifies for Worker’s Compensation Benefits?

Apr 12, 2016 - Articles by

Not all those who suffer an injury on the job are entitled to workers’ compensation benefits. Generally speaking, a worker must suffer an injury as a result of an accident, or deviation from the normal work routine, in order to obtain workers’ compensation benefits. Workers who suffer an on-the-job back injury are not subject to this requirement of an “accident,” and must only have sustained their back injury as a result of a specific traumatic incident. Back conditions resulting from degeneration due to work performed over time are not covered by workers’ compensation. Additionally, employees who suffer repetitive motion injuries may be covered by workers’ compensation even if there was no “accident.” Finally, employees who suffer an occupational disease — such as asbestosis or mesothelioma — can be covered by workers’ compensation even though no accident occurred. Proving these occupational disease claims, however, is often very difficult.

In addition to the requirements as to the type of injury in order to be covered by workers’ compensation, there are also types of employment that are not covered. An employer is not required to have workers’ compensation unless there are three or more employees in regular employment with the employer. Exceptions to this rule are employers who employ individuals whose activities involve the use or presence of radiation. In this circumstance, employers are required to have workers’ compensation insurance if there is even just a single employee. Agricultural operations are not required to carry workers’ compensation insurance unless ten (10) or more regular non-seasonal workers are employed.

Workers injured outside of the State of North Carolina are still covered for workers’ compensation benefits in North Carolina so long as the contract of employment was made within North Carolina, the employer’s principal place of business is in North Carolina, or if the employee’s principal place of employment is in North Carolina. Conversely, employees from out-of-state employers can be covered under North Carolina’s workers’ compensation system if the employee is working in North Carolina and suffers injury. In this circumstance, the injured worker has the opportunity to choose whether he or she wishes to receive benefits under North Carolina’s system, or the system of their home State. The benefits available to an injured worker in North Carolina are more favorable than most other States.

An employee of a sub-contractor who suffers injury on-the-job may be able to obtain workers’ compensation benefits through a general contractor’s workers’ compensation insurance if the sub-contractor does not carry workers’ compensation coverage.

Special rules apply to truck drivers, and the determination of whether or not a driver is an “employee” is determined on a case-by-case basis by analyzing the degree to which the alleged employer exercises control over the performance of the truck driver’s duties.