Determining your eligibility for workers’ compensation benefits is critical in securing financial support and medical care following a work-related injury or illness. 

Explore the key factors affecting eligibility, including employee status, the nature of the injury or illness, and reporting and filing deadlines.

Employee status: Employees vs. independent contractors

One primary factor affecting worker compensation eligibility is whether an individual is classified as an employee or an independent contractor.

Workers’ compensation benefits are generally available only to employees, with some exceptions.

Bear in mind:

a. Employee status depends on factors such as the level of control the employer has over the worker’s tasks, the worker’s economic dependency, and the nature of the working relationship

In South Carolina, the distinction between employees and independent contractors primarily depends on factors such as the level of control the employer exercises over the worker’s tasks, the worker’s economic dependency on the employer, and the nature of the working relationship.

A worker is generally considered an employee if the employer has significant control over their work, provides the necessary tools and equipment, and pays a regular salary.

On the other hand, independent contractors typically have more control over their work, use their own tools and equipment, and receive payment on a project-by-project basis.

b. Some states may extend workers’ compensation coverage to specific categories of independent contractors

While independent contractors are generally not eligible for workers’ compensation benefits, some states may extend coverage to specific categories of independent contractors under certain conditions.

These exceptions vary by state and can include certain occupations or industries, or they may be based on the nature of the work performed.

Familiarize yourself with the workers’ compensation regulations in South Carolina. When in doubt, consult an attorney if you may qualify for coverage as an independent contractor.

c. Misclassification of workers can lead to disputes over eligibility for benefits

Misclassifying workers as independent contractors rather than employees can lead to disputes over workers’ compensation benefits eligibility.

Employers may sometimes misclassify workers to avoid paying workers’ compensation premiums or providing benefits.

If you believe you’ve been misclassified and are consequently being denied workers’ compensation benefits, seek legal advice to help you navigate the dispute process and protect your rights.

Work-related injuries and illnesses

To qualify for workers’ compensation benefits, an injury or illness must be work-related, meaning it occurred in the course and scope of employment. This can include injuries sustained on the job and illnesses resulting from workplace conditions or exposures.

Bear in mind:

a. Injuries that occur during work breaks, commutes, or personal activities may not be covered

Not all injuries are considered work-related and eligible for coverage. Injuries that occur during work breaks, commutes, or personal activities outside of work hours generally do not qualify for benefits.

However, there may be exceptions, such as if an injury occurs on company property during a break or is sustained while performing a work-related task during your commute.

b. Occupational diseases, such as those caused by exposure to hazardous substances, may qualify for benefits

Workers’ compensation benefits are not limited to just physical injuries. Occupational diseases, illnesses caused by exposure to hazardous substances or harmful conditions in the workplace, may also qualify for benefits.

Examples of occupational diseases include:

• Lung diseases caused by exposure to asbestos
• Hearing loss due to excessive noise, or
• Skin conditions resulting from contact with harmful chemicals.

If you suspect your illness is a result of your work environment, contact our Columbia workers’ compensation attorney.

c. Pre-existing conditions may be covered if they are aggravated or worsened by work-related factors

In some cases, workers’ compensation benefits may cover pre-existing conditions if work-related factors aggravate or worsen them.

For example, if you have a pre-existing back injury that is further aggravated by your job duties, you may be eligible for benefits to cover the additional harm caused by your work.

Provide documentation and medical evidence to support your claim, as pre-existing conditions can be challenging to prove in workers’ compensation cases. Our attorney will help you build a strong case and ensure you receive the appropriate benefits.

Reporting and filing deadlines

Timely reporting and filing of workers’ compensation claims are essential for maintaining eligibility. Each state sets its own deadlines for notifying employers of injuries or illnesses and submitting claims to the appropriate workers’ compensation agency.

Bear in mind:

a. Reporting deadlines can range from a few days to several weeks following the incident or diagnosis

In South Carolina, you are typically required to report your work-related injury or occupational disease to your employer within 90 days of the incident or diagnosis.

However, it’s always best to report your injury immediately. This can help ensure a smoother claims process and minimize potential disputes.

b. The statute of limitations for filing a claim varies by state and can range from one to three years

Be aware of the statute of limitations for filing a workers’ compensation claim. This is the time frame within which you must formally file your claim to be eligible for benefits.

In South Carolina, the statute of limitations for workers’ compensation claims is generally two years from the date of the injury or the date you reasonably should have discovered the occupational disease.

This time frame can vary by state, so it’s important to consult with an attorney to ensure you know your jurisdiction’s specific deadlines.

c. Failure to meet reporting and filing deadlines may result in the denial of benefits

Comply with both reporting and filing deadlines in workers’ compensation cases, as failure to meet these deadlines can result in the denial of your benefits.

If you miss a deadline due to circumstances beyond your control, you may be able to request an extension or appeal the denial. However, it’s best to avoid this situation by staying informed about the applicable deadlines and working closely with your attorney to ensure your claim is filed accurately and on time.