Workers’ compensation benefits provide a way for California employees to cover some financial costs when unable to work due to an injury or illness. California remains a “no-fault” workers’ compensation state, so eligible workers can file claims without the burden of proving someone was negligent. However, not every worker may fall under the category of an eligible employee or covered injury.
Rules and eligibility for workers’ compensation claims
Independent contractors are not eligible for workers’ compensation benefits. Independent contractors are not employees, and they fall under the category of “self-employed.” Worker’s comp rules do not apply to contractors, but liability laws do. If the contractor suffered an injury because of someone’s negligence, filing a civil suit might be an option.
Employees do not receive blanket approval for workers’ compensation claims under all circumstances. Each claim undergoes a review and might receive a denial. An employee that suffers an injury while under the influence of drugs or alcohol, for example, might not be eligible for benefits.
Other issues that impact eligibility
An employee who intentionally injures themselves for any reason won’t be eligible for a claim. Someone’s attempt at self-harm won’t receive a workers’ compensation payout as a reward for such dubious behavior.
Belligerent employees that start fights and end up hurt would likely lose out on any claims. An innocent worker who did not start the fight but suffered injuries in an altercation might have a workers’ comp claim, along with a lawsuit against negligent parties. Persons that suffer emotional injuries and no physical harm, however, would probably face a claim denial.
Denials may prove unfair, though. An employee might suffer an accidental injury, but the denial derives from the false claim the worker hurt him/herself intentionally.
An attorney could assist a client with filing a workers’ comp claim. The attorney may work on the client’s appeal if a denial occurs.