Your workers’ compensation premium is calculated with a formula that has 3 primary components. First the type of business you own, second your claims history, and finally, your total payroll. The formula is Payroll (per $100) x Class Code Rate x Experience Modifier (if applicable) + State Taxes & Fees = Premium. The National Council on Compensation Insurance (NCCI), a trade association for the U.S insurance industry, and state agencies such as the Workers’ Compensation Insurance Rating Bureau (WCIRB) collect and analyze data to make sure that insurance companies in every state use the formula consistently and reliably. Below we’ll look at the specifics of each portion of the formula. As well as the full formula to help you understand how your premium will be calculated. We will also look into a few ways to lower your premiums.
1.Business Type
For this portion of the formula your company is put into a hazard group based on the likelihood that an accident will occur in the workplace. A business with a low risk profile, like a professional services firm, will have a different hazard group than a business with a higher risk potential, like a construction company. For each classification, the average cost per injury and death is first calculated. As you can imagine, workplace injuries from a construction site will likely cost more than injuries that could happen in an office setting. It’s very important that your employees are correctly classified, as it has a direct impact on your workers’ compensation premium. Additionally, if you classify your employees incorrectly you can face penalties and your insurer can even refuse to cover claims if they find the employee was put in a lower classification than they should have been.
2.Claims History
The next portion of the workers’ compensation premium formula is based on the amount of workplace accidents your company has had in the past. This is also called your experience modifier. Your company will compare this amount to the average accidents for businesses in your same classification with the same or similar amount of employees. The average modifier rate is set at 1.0 for the scale, the less injuries the lower your modifier rate is, the more injury claims you have the higher the number. During a specified measurement period (typically 1-3 years), if your business experiences less workplace accidents than the average, your premium will most likely be lower than what a similar business with more accidents paid. Having a lower premium is a huge incentive for businesses to do more to prevent workplace injuries.
3. Payroll
The final portion of the formula for workers’ compensation premiums is the total payroll of your business annually. The higher your payroll, the higher your workers’ compensation premium will be. This also means the more workers you have, the more potential for on the job injuries or illness. To make sure your payroll amount is accurate, every business is required to complete a workers’ compensation payroll audit a few months after their policy is renewed. If you don’t complete this audit you will face a penalty for noncompliance, so it is mandatory. If the audit shows that your payroll was actually higher than what you reported, you will have to pay the additional workers’ compensation premium on the correct information.
On the other hand, if you overestimate the amount of your payroll then you will be issued a refund for the overpayment of your premium once the insurance company adjusts the rates. Every state has a different average of how much they can expect per $100 of payroll. To find out more about your state’s rates check out our state by state workers’ compensation guides.
Ways To Lower Your Workers’ Compensation Rates
Now that you know what affects your premium rates, you’re able to calculate and get a rough estimate of what you could be paying. If you know your premium is likely to be more than you’d like, there are ways to start lowering your premiums to make it more affordable, as well as make your company safer not just financially, but physically as well.
Develop A Drug Policy
Certain industries are actually more prone to drug use and alcoholism in the workplace according to the Substance Abuse and Mental Health Services Administration (SAMHSA). For example, the mining industry has the highest rate of alcohol abuse at work sitting at 17.5% and right behind them is the construction industry at 16.5%. Since these industries are already considered high risk based on the type of work they do, it’s very important for these types of businesses to follow drug-free policies because their policies will already be more expensive. For drug use, Food industry workers sit at 19.1% and construction workers are at 14.4 percent.
You have the right as an employer to conduct drug tests on both current and prospective employees. Although, you’ll want to look into your state laws first as some states only allow drug testing once there’s a job offer on the table. However, making sure that your employees are not working under the influence of drugs or alcohol prevents catastrophic accidents. Promoting a drug free workplace can lower your workers’ compensation premiums as well as increase productivity, lower absences, lower employee turnover, and improve morale.
Aside from drug testing there’s a few other things you can do to help promote a drug-free workplace. For one, you can make it a point to educate your employees about the risks of working while impaired. You can also help workers who struggle with substance abuse by offering resources such as helpline numbers and treatment center information to help them seek treatment for their addiction.
Drug Free Policy State Discounts
Not only will a drug free workplace lower your premiums by preventing accidents, but in 13 states there is a discount for workers’ compensation premiums if you implement a drug-free policy within your business. The following 13 states already have discounts for drug-free work policies:
Alabama – 5% discount
Arkansas – 5% discount
Florida – 5% discount
Georgia – 7.5% if the drug-free workplace program is certified by the state Board of Workers’ Compensation.
Hawaii – 5% for safety and health programs
Idaho – Premium reductions for conducting drug and alcohol testing for current and prospective employees.
Kentucky – 5% discount
Mississippi – 5% discount
Ohio – 5 year phased-in premium reduction that can reach up to 20% discount.
New York – Workplace Safety and Loss Prevention Incentive Programs have a 6% discount.
South Carolina – 5% discount
Tennessee – 5% discount
Virginia – 5% discount
Safety Protocols
Creating a safe work environment can boost employee morale and reduce workers’ compensation costs. Establishing a culture of safety is easier than you might think, and you’re probably already doing some of this work.
Ensure that your employees have access to the tools and information necessary for their safety on the job.
If you have not already done so, schedule regular safety inspections.
Utilize daily safety checks to constantly remind employees to exercise caution while at work.
Plan weekly or monthly deep dive inspections.
Putting an emphasis on safety will not only reduce workplace accidents and injuries and lower your workers’ compensation premiums, but it will also demonstrate your concern for their well-being.
Safety Rewards
Check with your insurance provider to see if they will lower your premiums in light of the fact that your company has become safer over the past year. Typically, these types of safety bonuses are distributed after a period of one year in which fewer claims were filed. It is important to check with your insurer to determine whether or not safety rewards are currently being offered, as they are not guaranteed.
Review Employee Classifications
This recommendation may be so simple as to be overlooked. While it is true that each type of business will have a different overall rate, the costs associated with each classification of employee will also vary. For instance, a sheet metal worker will have different standards than a bookkeeper who rarely visits the production floor. Ensure that each employee is correctly classified in their current position according to your policy. This simple tip will save you a substantial amount of money.
Workers’ Compensation Insurance With EZ
The majority of states require businesses to carry workers’ compensation insurance. Which will not only protect your business but also your employees. Keeping your employees safe does not have to be an expensive endeavor for your company. There are numerous ways to promote safety routines and programs. All of which will help you reduce your workers’ compensation expenses. If the best practices for claims management are implemented and followed in a timely manner, your employees will be able to return to work as soon as they receive medical clearance to do so. Not only will production return to normal, but workers’ compensation costs will decrease as well.
Come to EZ for free, instant quotes from one of our licensed agents to help you look for the best workers’ compensation policy. If you already have workers’ compensation benefits but are looking for a better deal, we can assist you. Your EZ agent will be familiar with the local regulations and able to provide guidance as you shop around for the best policy at the most affordable price. Enter your zip code in the box above. Or call us at 877-670-3538 to speak with one of our licensed agents.
Workers’ compensation insurance is designed to protect you and your employees financially in the event of a workplace accident or unjust. Workers’ compensation insurance isn’t just a good idea, depending on your state it may be a legal requirement. When it comes to workers’ comp claims, the majority of them are approved because workers’ compensation is considered “no-fault”. Meaning that employees do not need to prove that their employer was at fault for their injury.
As long as the employee files their claim on time, has witnesses to their accident, and seeks medical treatment for their injury, the employee will receive benefits. There may come a time, however, when one of your employees files a claim that you find questionable. In this case, you do have options, including the option to contest the claim. Below we’ll look at how you can fight a questionable claim. As well as the impact workers’ compensation claims can have on a business.
Reasons To Dispute A Workers’ Comp Claim
You can’t fight a workers’ comp claim for no reason, you and your insurance company must have a legal basis for disputing any claims. Here are some of the reasons you could have for disputing a claim:
Your employee missed the deadline to file a claim
The wrong paperwork was used to file a claim
The injury didn’t happen at your company
Your employee quit before filing a claim
The injury happened while the employee was at work but was not working
The injury was intentional
Always File The Claim
Even if you suspect the workers’ compensation claim is false. You have to file it when the employee comes to you with it. You can be penalized if you fail to report a work-related injury with a full report of all related details as soon as possible. The insurance claim adjuster’s job is to determine whether or not the claim is valid or not. You are paying premiums to your insurance company so that they can handle these matters. If your report is thorough and you work closely with your adjuster, there is a good chance the adjuster will catch the fraudulent claim and deny it anyway. So, delaying or not filing a report because you think it’s invalid could backfire on you, best to just let the adjuster do their job.
Work With The Claims Adjuster
Once you’ve filed the workers’ compensation claim with your insurance company, an adjuster will be assigned to the case. They will contact you and the employee personally, as well as review all documents associated with the case including medical records. The adjuster ultimately decides if the claim will be denied, but at this point you will have more information about the claim than the adjuster. If you have reason to believe the employee lied, or was injured outside of work, now is the time to gather all information that supports why you think it’s invalid. Document, date, and save everything that indicates why you think the claim is fraudulent. Most importantly, inform your adjuster immediately that you believe the claim to be questionable. Indicating in your initial report that you believe there are reasons to deny the claim serves 2 purposes.
First, it lets the adjuster know they may need to file an extension early, since workers’ compensation claims have to be completed in a certain time frame, and disputing a claim will take more time to investigate. Secondly, marking your claim as questionable from the beginning will actually make your adjuster pay closer attention. They will spend more time looking through the paperwork, medical records, and searching for warning signs that otherwise may have been missed. Finding one of these red flags doesn’t necessarily mean anything, as accidents and coincidences do happen. But if an adjuster notices that more than one exists, they will look into it further to make sure if the claim is or isn’t fraudulent.
Warning Signs
A new hire who immediately filed a claim after being hired
An employee who has immediately hired an attorney after the injury
Claims from an employee who may have been “disgruntled”
Employees with poor attendance, poor work records, or financial issues
Injuries with no witnesses, or that happened in an area the employee isn’t assigned to normally work
Injuries that occur late on a Friday or right when they return to work on Monday
Learn Your State’s Procedure
While workers’ comp is mandatory in almost every state, each state has its own laws and procedures for dealing with claims. Including disputing them. You can call your insurance provider and ask about what you need to know about local procedures. So you don’t accidentally make a misstep and cause trouble for yourself or your company.
You have the option to dispute even if the adjuster doesn’t deny the claim after the investigation. In some states, such as Texas, you have to submit a form or attend a hearing to dispute the claim in front of a judge. In other states, such as New York, or Tennessee, you may have to appear before a judicial panel or speak with a state-assigned workers’ compensation arbitrator. However, regardless of the state your company is in, you will most likely have to defend your position orally, in writing, or both. You will also need to provide all of the evidence you gathered when you first filed the claim and informed the adjuster of your concerns. Remember the “document, date, and save all information” part? This is where that step comes in handy.
How Workers’ Comp Claims Affect Businesses
Workers’ compensation claims tend to have a greater impact on smaller businesses. This is because larger companies have deeper pockets and larger payrolls, allowing them to absorb the financial cost with not much issue. Regardless of how big or small your business is though, workers’ comp claims can cause your business issues. Below we’ve detailed how claims can affect you. So, you understand why it’s important to fight fraudulent claims to protect yourself. As well as explain why doing everything you can to avoid workplace accidents is even more important.
Premium Hikes
Your workers’ compensation insurance premiums are determined by your industry, number of employees, payroll, and claims history over the last 3 years. A single claim will not necessarily result in a higher premium. But depending on the nature of the claim and the resulting medical bills and disability benefits even one claim could make a mark on your record. The more often you have workers’ compensation claims the more likely it is that your premiums will increase.
Additionally, your insurer also takes your experience modification rate (EMR) into consideration. Your EMR is how insurance companies compare your claims history to other companies in the same industry. The average EMR is 1.0, the more claims you have the higher above average you are. And then the higher your premiums will be because your company will be considered a higher risk to insure. Regular safety training and following industry-specific safety guidelines can help reduce your premiums.
Administrative Costs
Processing a workers’ compensation claim can take a lot of time. Especially if you’ve signaled that you believe it’s fraudulent. The insurance company will want to examine all relevant evidence, including the employee’s medical records. Effectively giving you or your claims specialist more work to do. Your company may also need to spend a lot of time and money to fix or check any equipment that was involved. As well as repair it if needed. Especially if the machinery involved is found to be defective after the accident. There may also be more paperwork and more hours involved in reporting the incident to state and federal regulators. Particularly if an OSHA violation is suspected. New equipment or training that stems from a regulator’s requirement can take a chunk out of your bottom line.
Legal Action Expenses
If you believe it is false, and you decide to take it to court you could also end up paying. While your attorney will advise you on whether or not you should go to court in the first place. Keep in mind if you lose the case, you will have significantly higher legal fees than you would have if you settled the claim. So, if you are planning on disputing your claim make sure your legal team agrees with the decision. And that you have absolute proof that the claim was fraudulent.
Reputation Damage
Impact on your company’s brand is difficult to predict. Your reputation can be affected by the severity of the accident. Whether it is covered by local news outlets, and whether it spreads on social media. A serious accident, repeated incidents, or OSHA fines could make it difficult to be able to hire new employees or get new customers.
Working With EZ
Workers’ compensation isn’t just about protecting your employees, it’s also about protecting your business. Nobody wants to deny a legitimate claim. But if you encounter one of those rare cases it’s fraudulent, you should know you have rights as well. And remember, EZ.Insure is here to help if you have any questions about workers’ compensation insurance. Or any other commercial insurance for that matter. We will connect you with a highly trained licensed agent. Who will listen to all of your concerns and make sure you get the best policy. To get started, enter your zip code in the box below or call 977-670-3538 to speak with an agent today.
Virtually every employer has to carry workers’ compensation insurance. However, some state laws provide exemptions for particular types of employees and business structures. Only a few worker categories are occasionally exempt. This exemption also applies to certain business owners. However, even when workers’ compensation coverage is not required, it is almost always in the best interest of the employer to provide coverage. If an employee sustains an injury on the job the employer may be held responsible for medical expenses, ongoing therapy, and lost wages.
Additionally, if you as the business owner are injured on the job, a workers; compensation policy can help pay for your medical expenses and compensate you for a portion of your lost wages. Your personal health insurance provider may deny your claim if your injury or illness is work-related, leaving you again responsible for these costs. Below we’ll look at the exemption laws in each state, if you’d like more information on the other workers’ compensation laws in your state, check out our state workers’ compensation guides here.
Any business with 4 employees or less does not have to carry workers’ compensation in Alabama, whether they are full or part time doesn’t matter. Alabama employers do not need to carry workers’ compensation for farm laborers, domestic laborers, or casual laborers including temporary or part-time employees hired for only an hour or a day.
Alaska businesses with one or more employees have to have workers’ compensation coverage unless the Alaska Workers’ Compensation Board has approved the business for self-insurance.
Owners and business executives are exempt if they are:
Sole owners
Partners
LLC owners with at least 10% ownership interest in the company
Executive officer or municipal, religious, or legally registered nonprofit organizations.
Executive officers for for-profit corporations with at least 10% ownership.
As for employees who are exempt from coverage:
Part-time babysitters
Non-commercial house cleaning personnel
People who are hired to help a farm with harvest
Amateur event sports officials
Entertainers under contract
Commercial fishers
Taxi drivers under specific contractual arrangements
Anyone who has benefits through the Alaska temporary assistance program.
Professional hockey players and coaches, as long as they are covered under a health insurance plan.
Some real estate agents
Anyone defined as a transportation network company driver.
There are only 4 exemptions from Arizona’s workers’ compensation. Independent contractors and casual laborers do not need to be covered. As well as any employee who voluntarily chooses to not have workers’ compensation coverage. The only owners who do not have to have coverage are sole owners who have no employees. Beyond that, any business owner with one or more employees needs workers’ compensation coverage.
All employers have to carry workers’ compensation insurance for themselves and their employees. The only exceptions to this are sole owners who opt out of coverage for themselves, or employers who have approval to self-insure.
Connecticut is another state that requires all businesses to carry workers’ compensation insurance with very few exceptions. The only employees that don’t need coverage are domestic workers who work less than 26 hours a week. Sole owners, corporate officers, and partners are allowed to opt out of coverage for themselves but they must have coverage for their employees.
Farm laborers and household workers in a private home who earn less than $750 every 3 months do not need workers’ compensation insurance. Other than that every other business owner and employee needs to be covered.
Any employer with one or more full-time, part-time, permanent, or temporary employees has to provide workers’ compensation coverage. Exemptions include:
If you have a single employee, even a part-time worker, you have to purchase workers’ compensation insurance. Only sole owners, partners, corporate officers, and real estate agents are excluded.
All Kansas companies must have workers’ compensation insurance with only a few exceptions. Some agricultural workers do not need to be covered. Sole owners, partners, corporate officers, and independent contractors with no employees do not need workers’ compensation insurance.
Employers who regularly employ one or more employees for 35 or more hours per week for 13 or more weeks in the 52 weeks prior must provide coverage. Exemptions include:
Agricultural workers (fewer than three employees working less than 35 hours per week)
Domestic workers (fewer than three employees working less than 35 hours per week).
All employers must provide coverage. Exemptions include:
Sole proprietors, partners, and officers of corporations
Domestic or household employees whose typical responsibilities include house cleaning and yard work
Casual employment
Only those working for assistance or sustenance
Officials of amateur athletic competition, such as a timer, referee, umpire, or judge.
Real estate, securities, and insurance salespeople paid solely on commission with no minimum earnings guarantee
Direct sellers
Those who deliver single or multiple newspapers and have acknowledged in writing that they have no insurance coverage.
Freelance correspondents who submit articles or photographs for publication are compensated for each submission but have not confirmed coverage in writing.
Barbers and cosmetologists who have contracts with cosmetology salons.
Petroleum land specialists
Licensed jockeys participating in a horse race, from the time the jockey reports to the scale room until the jockey is weighed out after the race.
Licensed trainers, assistant trainers, exercise persons, and pony persons on the premises of a licensed horse race meet.
Non-Montana residents whose primary duties are not performed outside the state. The employer must adhere to the coverage requirements in the location where the employee resides or works.
Officers or managers of a private, non-profit irrigation ditch company, water user cooperative, corporation, or organization.
A minister who is ordained, commissioned, or licensed by a church or religious order.
Individuals who provide companionship services or respite care to incapacitated individuals. The individual providing services or care must be directly employed by a family or legal guardian.
Excluding air search and rescue volunteers, volunteer reserve auxiliary law enforcement, and volunteer firefighters, volunteer workers are defined as:
Professional athletes who compete in contact sports for a team or club
Personnel of freight brokers and forwarders
A musician whose performance is governed by a written contract
Employers with at least one employee have to provide coverage. Exemptions include:
Employment associated with entities engaged in interstate commerce that are not subject to Nevada’s legislative authority
Employment covered by private disability and death benefit plans comprising compensation payments of equal to or greater amounts than those provided in NRS 616 and in effect for at least one year prior to July 1, 1947.
Temporary employees insured in another state who are brought into Nevada if extraterritorial coverage provisions are in effect with the other state.
Casual employment in the construction industry (employment lasting less than 20 days with a total labor cost of less than $500), if the employment is not in the course of the employer’s trade, business, profession, or occupation.
Employers with at least three employees have to provide coverage. Exemptions include Sole proprietors. However, sole proprietors are counted as employees when determining whether a business employs three or more individuals.
All employers must provide coverage. Exemptions include:
Volunteers who provide their services to nonprofit organizations without compensation
Ministers, priests, and rabbis duly ordained, commissioned, or licensed; sextons; Christian Science readers; and sects of religious orders
Customers of supervised amateur athletic activities operated on a nonprofit basis, provided that such s are not otherwise engaged or employed by any person, firm, or corporation participating in such athletic activity Educators in a nonprofit religious, charitable, or educational institution
Individuals employed in a nonmanual capacity by or for a religious, charitable, or educational organization.
Persons receiving charitable aid from a religious or charitable institution who perform work in exchange for such aid, but who are not under an express contract of hire, are considered unpaid volunteers.
People who are covered for specific types of employment under another workers’ compensation system, such as those employed in certain maritime occupations, interstate railroad employees, federal government employees, and others who are covered by federal workers’ compensation laws.
The spouse and minor children of a farmer-employer, provided they are not under an express contract of employment.
Certain foreign government and Native American Nation employees
Provisions of the New York State General Municipal Law that protect New York City police officers, firefighters, and sanitation workers
People, including minors, performing yard work or casual chores in and around a single-family, owner-occupied residence or a noncommercial organization’s property.
Certain real estate salespeople who sign a contract with a broker stating that they are independent contractors are considered independent contractors.
Certain media sales representatives who sign a contract stating they are independent contractors are considered independent contractors.
Certain insurance agents or brokers who sign a contract stating they are independent contractors are considered independent contractors.
Sole proprietors, partners, and certain corporate officers with no additional personnel providing essential business services.
Employers with at least one employee have to provide coverage. Exemptions include:
Sole proprietors, partners, and officers of corporations
Some railroad personnel
Casual employees
Domestic servants employed directly by the household
When less than ten full-time, non-seasonal farm laborers are regularly employed by the same employer, they are considered farm laborers.
employees of the federal government in North Carolina
Those who sell agricultural products for their producers on commission or for other compensation, provided the product is prepared for sale by the producer.
All employers must provide coverage. Exemptions include:
Independent contractors
Some agricultural employees
Certain providers of services administered by the Oklahoma Department of Human Services who are licensed and compensated on a commission-only basis
Any employee of an employer with five or fewer employees who are all related to the employer by blood or marriage. Any employee of a tax-exempt youth sports league.
Sole proprietors, partners, and officers of corporations
Any individual who performs volunteer work and receives no remuneration other than meals, drug or alcohol rehabilitation therapy, transportation, lodging, or reimbursement for incidental expenses is considered a volunteer.
Unlike most other states, South Dakota employers do not legally have to carry workers’ compensation insurance. To avoid civil lawsuits, however, the state encourages employers to have workers’ compensation coverage.
Employers with at least three employees are required to provide coverage. Exemptions include sole owners. However, sole owners are counted as employees when determining whether a business employs three or more individuals.
Employers with at least three employees have to provide coverage. Employers with fewer than three employees who pay wages of at least $500 per calendar quarter must also carry workers’ compensation insurance. Exemptions include some farm laborers.
Employers with three or more workers must provide coverage. Employers with fewer than three workers who pay at least $500 in wages per calendar quarter have to carry workers’ compensation insurance. Exemptions include some farm workers.
Workers’ Compensation Made EZ
Most states require businesses to carry workers’ compensation insurance, which will not only protect your business but also your employees. Keeping your employees safe does not have to be an expensive endeavor for your company. There are numerous ways to promote safety routines and programs, all of which will help you reduce your workers’ compensation costs. If you use the best practices for claims management and follow them in a timely manner, your employees will be able to return to work as soon as they receive medical clearance to do so. Not only will production return to normal, but workers’ compensation costs will get cheaper as well.
Come to EZ for free, instant quotes from one of our agents if you are looking for the best workers’ compensation policy. And if you already have workers’ compensation benefits but are looking for a better deal, we can assist you. Your EZ agent will be familiar with the local laws and able to guide you as you shop around for the best policy at the most affordable price. Enter your zip code in the box above or call us at 877-670-3538 to speak with one of our agents.
You buy workers’ compensation insurance to cover employees in the event of a work-related illness or injury. But not every business owner knows the risks to their business if they opt out of coverage. Or the risk of not having enough coverage to meet your company’s specific needs. Most states have a law that requires workers’ compensation insurance after you have a certain number of employees so not having coverage could be illegal. Leaving your business vulnerable to large claims and possible lawsuits that could leave it bankrupt is the last thing you want to do. Below we’ve made a list of the most common myths about workers’ compensation. And what the facts are so you don’t get misled and make a decision based on some bad advice.
Myth 1: Small Low Risk Businesses Don’t Need Workers’ Compensation
In most states, workers’ compensation insurance is required by law, and many require it as soon as you hire your first employee. It’s important to understand your state’s requirements to avoid compliance issues. Businesses that choose not to carry workers’ compensation insurance despite being required to may be subject to severe penalties and fines. Additionally, injuries can occur even in low-risk industries, so you should be covered no matter how safe your job is. Not to mention, the costs associated with work-related injuries, including medical expenses and lost wages, can build up quickly especially if you don’t have proper coverage. Having a proper workers’ compensation insurance policy in place will protect your business from all angles.
Myth 2: I Only Have A Couple Employees, I Can Pay Out Of Pocket For An Accident
Most states do allow you to self-fund workers’ compensation claims, however it’s not easy to do it. A self-insured workers’ compensation plan is one where you, the employer, assume the financial risk for providing workers’ compensation benefits to your employees. Instead of paying a set monthly premium to an insurance company or state-sponsored workers’ compensation fund, self-insured businesses pay the cost of each claim out-of-pocket as they happen. Since a self insured company assumes this financial risk, it must have the financial resources to meet the obligation.
So for smaller businesses this might not be a viable option. There are even some states who won’t even allow companies to self-insure. And even if your state does allow it you have to apply for the permission to self-insure. Which includes state-specific requirements for example you could have to prove you have a networth of at least $500,000 among other things. Essentially you have to prove you can foot the bill for any and all workers’ compensation costs for every employee that you have.
Myth 3: I Don’t Have Employees, I Use Subcontractors So I Don’t Need Coverage
When you bid on a job your possible client may request proof of workers’ compensation insurance for yourself and any subcontractors who will be working with you. For instance, if you are an electrician and bid on a wiring job for a school, the school will need to know that you and your team all have coverage before they’ll even consider your bid. If you don’t have coverage and you or a crew member are injured on the job, your health insurance can deny coverage because it’s a work related injury. Many health insurance policies will not cover these types of injuries.
At most you can buy yourself a workers’ compensation policy and require any subcontractors you hire to have their own valid policy. Before your team begins working make sure that they have a valid certificate of insurance. If they don’t, and they get injured, you may be held responsible for any injuries which is a huge financial risk.
Myth 4: Seasonal Businesses Don’t Need Coverage
You need the insurance while your business is operating. The majority of insurance companies will write you a seasonal business policy, so long as you clearly define your open and closed period. For example if you have a pool cleaning/maintenance business and only operate between April and October, your insurance company will activate your service in April and pause it in October. That way you are covered while you’re open and don’t have to pay premiums when you’re closed.
Myth 5: I Only Employ My Family Members, I Don’t Need To Cover Them.
In most cases, a family member who works for you is still considered an employee. Like any other employees that are required to be covered. Damages for on-the-job injuries can cost hundreds of thousands of dollars, without a proper policy you risk footing all of that and then some. You leave your business open to punitive damages, as well as lawsuits along with all those medical bills. Just because they’re family does not guarantee they won’t sue you.
Myth 6: My Employees Work From Home They Don’t Need Coverage
You may believe that workers’ compensation does not apply to home-based employees because you cannot control their working conditions. However, that is wrong. You are still obligated to provide a safe workplace for employees. Even if they work from home or a remote location just as you would for an employee who works on site. All employees are entitled to workers’ compensation benefits. Although home-based employees might have a harder time proving that their injuries are work related.
Myth 7: If My Employee Doesn’t File A Claim The Day Of The Injury They Can’t File It Later
There are numerous reasons why an employee may delay filing for workers’ compensation. For example, if your employee slips and falls while moving boxes. The employee might get up and feel a little sore but otherwise fine. But over the next week or so their back becomes increasingly stiff and painful. They go to the doctor and the doctor informs them that they actually have an injury, and it was most likely due to their fall and continuing to move boxes has only made the injury worse. Even though your employee did not immediately report the fall, they are still eligible to file for workers’ compensation. Every state has a statute of limitations for how long your employee has to file a claim. So just because they didn’t file that day doesn’t mean they can’t still claim.
Myth 8: Worker’s Compensation Stops Employees From Suing
This is only half true. Yes, if the employee receives workers’ compensation they cannot sue you for the injury itself. However, there are certain circumstances where they can still file a suit against you. For example if the injury was caused by faulty machinery that didn’t have proper maintenance or safety precautions. The employee could sue you for negligence for not properly maintaining the equipment. Or if you manufacture the piece of equipment that injured your employee they can sue you for product liability.
Myth 9: If The Accident Is The Employee’s Fault They Can’t File A Claim
This is another common misconception about workers’ compensation insurance, but it’s mostly untrue. The misunderstanding likely comes from you confusing workers’ compensation claims with a personal injury lawsuit. It is true that in order to file a personal injury lawsuit, the employee’s injuries had to have been the company’s fault. But that isn’t the case with workers’ compensation. Workers’ compensation is mostly no-fault. Meaning if your employee has a work related injury or illness, they are eligible to file a claim. Regardless of who was at fault. It makes no difference if you believe they should have been paying more attention or could have avoided the accident. The only exceptions to the workers’ compensation no fault rule is if your employee was under the influence of drugs and alcohol at the time of their injury. Or if they intentionally hurt themselves to attempt workers’ compensation fraud.
Myth 10: I Don’t Need An Insurance Agent To Get The Best Policy
This is a difficult myth; a do-it-yourself approach could lead to costly errors. Despite the fact that there are several online tools and carriers that can help you buy a policy. But they can’t help with everything the way an agent can. For example, if you fill your application out and select the wrong classification code for your employees. You will end up owing a massive fine at the end of the year audit. Or your insurance provider could deny you coverage due to the misclassification or other error. We highly recommend consulting with a licensed agent who specializes in workers’ compensation insurance. They will recommend the appropriate coverage and guide you through the process step by step.
Here at EZ, we connect you with your own personal insurance specialist who can quickly compare plans available in your area all while staying within your budget. And they do it all for free! That’s right none of our services cost you anything. Our only goal is to make sure you get the best workers’ compensation coverage, and any other business insurance coverage for that matter. To get started, enter your zip code in the box below or call 977-670-3538 to speak with an agent today.
Every business that has employees should have workers’ comp insurance. In fact, this type of coverage is required in most states. But even if it weren’t required to have it. You would still have a responsibility to protect your business and its employees from the legal and financial risks associated with workplace injuries.
These policies typically cover most workplace injuries and illnesses caused by workplace conditions. But workers’ compensation cases aren’t always black and white. They definitely cover things like repetitive stress injuries, traumatic brain injuries, broken limbs sustained after a fall, etc. But what are the limits? What or who is does workers’ compensation not cover?
Workers’ compensation insurance is among the simpler types of commercial insurance policies to understand. Simply put, if one of your employees sustains an injury on the job, the policy will be cover them. Employees benefit from compensation for medical expenses and lost wages, and businesses save money by avoiding lawsuits.
But in reality, though, things are not always so straightforward. Some workplace injuries may raise doubts in the minds of employers. What if, for instance, a worker sustains an injury on the job, but the incident was entirely their own doing?
In this case, you should know that workers’ compensation is no-fault. Which means that employees who are injured due to their own carelessness are still entitled to benefits. However, this still has its limits. For example, an employee’s claim will be denied if the incident that led to the injury occurred while the worker was under the influence of alcohol or drugs.
In addition, workers’ comp generally covers repetitive stress injuries like carpal tunnel syndrome and asbestosis. But when it comes to repetitive stress injuries like chronic back pain or diseases like heart disease or high blood pressure, things become a little murkier. An employee claiming that one of these conditions is from work must provide overwhelming evidence.
So, let’s clear things up a little and look a little more closely at what isn’t covered by workers’ compensation.
Examples of Injuries Workers’ Compensation Won’t Cover
Workers’ compensation insurance covers most injuries on the job or when an employee is off-site but still working. Injuries employee injuries in the workplace must be evaluated on a case-by-case basis. There are exceptions to coverage, including:
Driving to or from work – If an employee is hurt while commuting to or from work, the injury is not considered to have occurred in the course of their employment. As a result, the employee is not eligible for compensation unless they were driving specifically for their job.
Injury while intoxicated – If an employee sustains an injury while under the influence of an illegal substance or while intoxicated, and if the employee’s intoxication is the only cause of the injury, the injury will typically not be covered by workers’ comp.
Horseplay – Playing around at work, in general, does not contribute to the success of the company, which is why an injury that results from such an activity is not covered by insurance. But there is an exception to that rule. If an employee gets an injury during the incident but wasn’t directly part of the horseplay, the rule will not apply to the employee.
Intentional actions – In the event that a worker intentionally brings about their own injuries or illnesses while on the job, workers’ compensation will not cover them.
Illegal activities – Workers’ compensation won’t cover injuries of workers as a result of illegal activities on the jobsite.
Policy violations – Employees who sustain injuries while acting in a manner that is contrary to the company’s policies, procedures, or protocols are not covered by workers’ compensation.
Ex-employees – Unless the injury occurred before the employee was terminated from their position. Former employees who have been fired or laid off from their jobs will no longer be covered by workers’ compensation insurance.
Are All Employees Covered?
Workers’ compensation coverage requirements vary by state, as well as by the number of employees and their classification codes. For example, manual laborers are classified differently than office workers for workers’ comp purposes. Some states, for instance, mandate workers’ comp insurance only for businesses with a specific number of employees. In general, though, all full-time employees must be covered by workers’ compensation insurance, but the specific regulations may vary from state to state. Workers’ compensation laws for freelancers, temp workers, and interns are not standardized across the country.
In some states, workers’ compensation insurance is optional for:
Farmhands
Insurance agents
Family members under a certain age
Casual workers
Business owners and partners
Real estate agents
Most state laws also list specific types of employment excluded from workers’ compensation coverage. Typical examples of excluded workers include:
Part-time domestic workers, such as maids and nannies
Part-time gardeners or maintenance workers employed in the home to perform specific work.
intermittent workers performing very little work in the course of a year.
Taxi drivers
Some agricultural workers
Workers’ compensation insurance is typically required by states, but the federal government does not provide its employees with this protection. Instead, they are protected by federal workers’ comp.
These exemptions are not universal, and you should be aware of the workers’ compensation laws in your state. Check out our state-by-state workers’ comp guides for more specific information on laws in your state.
Is There a Workers’ Compensation Claim Deadline?
The majority of the time, the rules governing workers’ compensation work in the employee’s favor. On the other hand, though, employees cannot decide to make a claim for an injury that occurred years ago.
Although there may be some exceptions to these rules. In general, a claim for workers’ compensation benefits has to be made within a certain amount of time in order to be considered. Employees usually have between one and three years from the date of the accident to notify their employer and file a complaint with the state from the time the accident occurred. This time period varies from state to state. Check out our guides to workers’ compensation in each state to get an accurate estimate of the amount of time your employees have to file claims, as well as how long the claims process generally takes.
Does Where an Employee Gets Injured Matter?
The vast majority of injuries that occur while working are covered by insurance, with a few exceptions. But is it necessary for an employee to actually be present at their place of business? In the vast majority of cases, it doesn’t make a difference where the employee is located, as long as they are working; in fact, they could even be traveling between different locations.
Take, for instance, a scenario in which your employee sustains an injury while traveling to or from work. Because they were not carrying out any work-related responsibilities, they would not be eligible for workers’ compensation benefits. Suppose on the other hand, that a contractor must travel from one location to another in order to check on worksites or deliver supplies. Because the contractor was carrying out their duties at the time of the injury, they would be eligible for coverage in the event that they were in a car accident.
Workers’ Comp Laws for Federal Employees, Railroad Employees, and Longshoremen
Workers’ compensation benefits for federal employees, railroad workers, and longshoremen (dock workers) are administered by separate systems from those administered by individual states.
Postal workers and other federal employees have access to benefits under the Federal Employees’ Compensation Act (FECA). Injury and illness on the job are covered by this law.
The Federal Employers’ Liability Act, also known as the Railroad Workers Act, provides protections for railroad workers. In the event of an industrial accident on the railroad, this law allows employees without workers’ compensation to sue their employer. they may get compensation for expenses such as medical care, lost wages, and pain and suffering.
The Longshore and Harbor Workers’ Compensation Act governs workers’ compensation for longshoremen who sustain injuries or occupational diseases while working on U.S. navigable waters or piers.
There are workers’ compensation lawyers who focus on these types of situations. If you are a federal employee, railroad worker, or longshoreman and you get an injury on the job, you should hire a lawyer who focuses on workers’ compensation law.
EZ Can Help
Every business owner should think of workers’ compensation insurance as essential to their operations. It safeguards not only the employees on whom you rely on and who are important to you, but also the hard work that you have put into building your business. But, as with any other insurance policy, there are limits to its coverage. And both employers and employees should be aware of the things that the policy does and doesn’t cover.
EZ is here to assist you with any questions you may have regarding workers’ comp coverage for your business. We will set you up with your own dedicated agent. Who will provide you with instant free quotes, answers to all your questions, and help choosing and signing up for policies, all free of charge. You already have a lot on your plate, so let us handle your insurance needs. To start, simply enter your zip code in the bar located below. Or you can call 877-670-3538 to speak with an agent right now.
It’s hard to say which type of business insurance is most important for your business. They all cover specific things and keep your business protected in different ways. But there is one type of commercial insurance that you are most likely required by law to have if you have employees: workers’ compensation.
This type of policy covers you and your employee if they are hurt while working, or sick because of workplace conditions. Workers’ comp in nearly every state covers medical expenses, disability, rehabilitation, and death benefits. And while there is some uniformity in regard to the benefits available to injured workers across the country. There is considerable variation in the amounts and methods each state distributes. If you want to find out more about how workers’ comp works in your state, check out our state-by-state guide. Then talk to an EZ agent about what you need.
First, though, read on to find out more about how workers’ comp covers these four benefits (medical expenses, disability, rehabilitation, and death). So, you know exactly what to expect from your policy.
Medical Expenses
At its core, workers’ compensation covers medical expenses incurred by employees who get sick or hurt on the job. It will cover most medical expenses for most legitimate claims. Including bills that come from visits to the doctor, inpatient care, skilled nursing care, medication, diagnostic imaging, physiotherapy. And the cost of long-term supports like walkers and wheelchairs.
In some states, though, there’s no coverage for “alternative” therapies like biofeedback and massage. And it’s possible that one state may cover a treatment while another won’t. Additionally, in some states there are limits on certain treatments. For instance, the law might allow no more than twenty-four visits to a chiropractor or physical therapist.
In most cases, workers’ comp does not have spending caps, deductibles, or copayments. And workers will be eligible for benefits until they have made a full recovery from their injury.
Managed Care
A managed care organization (MCO) is a healthcare provider or group of healthcare providers that has a contract with an insurer or self-insured employer to provide managed healthcare services to enrolled workers. In many states, benefits through a managed care plan can be provided by employers or workers’ compensation insurers to get injured workers the care they need. In fact, insurers in some states legally have to offer this option to businesses.
Managed care plans are governed by a wide range of statutes. Typically, a plan will include some combination of the following:
Provider Networks – A network of medical professionals who have agreed to provide discounted services to members of an insurance pool or employee group. In some states, injured workers will have to receive care from in-network providers.
Utilization Management – This type of management is intended to ensure that the type of medical care that is provided to workers is necessary, appropriate, and efficient with regard to costs. Before carrying out particular medical procedures, providers might be have to get prior approval from the insurance company.
Pharmacy Benefits Manager – An administrator of a program that purchases prescription drugs whose job it is to limit spending. A pharmacy benefit manager (PBM) is responsible for establishing formularies, negotiating discounts with drug manufacturers, forming contractual relationships with pharmacies, and paying claims for prescription drugs.
Medical Care Management – This type of management provides supervising care to make sure that injured workers get the appropriate treatment they need. So, that they can get back to work as quickly as possible.
Disability
Disability benefits compensate an employee for a portion of the wages they lose while they are unable to work as a result of an injury on the job. For instance, if a construction worker breaks their leg in an accident. It is highly unlikely that they will be able to return to work until they have fully recovered. Because of the amount of time this will take, they will require financial assistance during this time when they cannot work.
“Disability” as it relates to workers’ comp has four distinct categories:
Temporary Total Disability (TTD) – To receive TTD benefits, your employee must have been injured so severe that they will not be able to return to work at all for a long time. For example, if a worker sustains an injury to their back and is subsequently unable to perform any duties for six weeks, but will then return to their regular responsibilities.
Temporary Partial Disability (TPD) – Your employee has a relatively minor injury that has only temporarily rendered them partially disabled. For instance, a worker breaks their arm while they are on the job and must work reduced hours. They’re able to still work just not to their full capacity.
Permanent Total Disability (PTD) – If your employee has an injury that will not heal and will be unable to generate income in the future by performing the kind of work they were doing at the time of the injury.
Permanent Partial Disability (PPD) – The injury your worker suffers might affect them permanently, like an injury that causes hearing loss, but they might still be able to work. The injury, though, might prevent them from earning as much income as they did before their injury.
Disability Payments
The severity of a worker’s disability will determine how much money they will receive from workers’ compensation benefits. In general, your employee’s average weekly pay prior to the injury is the basis for the calculation of benefits. This amount, though, might be subject to minimum and maximum limits, depending on your state. There will be a waiting period before benefits are provided, which is typically one week. If the disability lasts less than that period of time, your employee will not be eligible for benefits.
Typically, disability benefits are as follows:
Temporary Total Disability – With TTD, benefits will be paid while your employee is recovering. Typically, these benefits are calculated as a certain percentage of the worker’s average weekly wage. For example, if a worker whose normal weekly wage is $1,000 is unable to work due to a broken leg for a period of two months. They will get a total of $667 weekly over the course of the eight weeks.
Temporary Partial Disability – With TPD benefits, your worker will typically receive their normal pay in addition to a percentage of the difference between their normal pay and their reduced pay. This is the case when the worker receives compensation for work that they are able to perform. For instance, a worker who sustains an injury to their leg is unable to perform their regular job duties because those duties require them to stand. They typically make $1,000 a week. During the two months that it takes for their leg to heal, they are responsible for performing administrative work. This job only pays $500 each week. So, there is a difference of $500 per week between their regular pay and their current pay. They will earn $500 per week plus $333 (66.66% of $500). For a total of $833 per week while they are unable to perform their normal duties.
Permanent Total Disability – A worker who is totally and permanently disabled will typically receive compensation equal to 66.66% (or some other specified percentage) of their previous average weekly wage for the rest of their life. When an employee reaches the official retirement age in some states, the benefits they have been receiving will end.
Permanent Partial Disability – A permanent partial disability may be classified as either “scheduled” or “non-scheduled” in some states. Injuries on the schedule typically involve a specific limb, organ, or part of the body. A worker who suffers a permanent injury to a body part in the schedule can receive disability payments for a specific period of time. If an employee loses a finger on the job, for instance. They may be eligible for 45 weeks of disability pay at 66.66% of their regular wage.
Disability benefits for employees with a permanent partial injury not on a schedule are determined in accordance with applicable state law. Benefits may be calculated in accordance with the worker’s degree of impairment, loss of earning capacity, wages lost. Or some other factor, depending on the state.
Rehabilitation
The part of workers’ compensation that covers rehabilitation helps if something catastrophic happens to an employee that prevents them from working and requires long-term treatment for recovery. For example, if an employee has a history of mental breakdowns, such as after prolonged exposure to toxic stress. They may not be able to work for a time. But rehabilitation and therapy during this time may help them recover. Although they may no longer be able to return to your place of work.
Rehabilitation can also include a service called Transferable Skills Analysis, which can help the employee in these situations. The goal of this program is to assist participants in securing gainful employment that puts their acquired skills to use. Their benefits cover the cost of a case manager who will assist them in their job search.
Death
If an employee dies on the job, his or her dependents will receive workers’ comp death benefits. This protection is in place to help families deal with the monetary fallout of a loved one’s death. This type of coverage will help the deceased’s loved ones pay for funeral expenses. And help replace the income they would have otherwise received.
It’s important to be aware of the laws and regulations in your state before purchasing workers’ compensation insurance. It’s also vital that you stay well-informed on your insurance policies. So, that you can communicate effectively with your staff in the event of an accident.
Working With EZ
EZ.Insure knows that in order to succeed, businesses must have all the information possible. That’s why we’re here to answer all of your questions about the commercial insurance policies you need! But don’t worry, we know that your time and money are valuable. So, you won’t pay anything for our services. And you won’t have to worry about being inundated with calls from your agent as they answer your questions, help you compare plans, and sign you up when you’re ready. To start, either enter your zip code into the box below or call 877-670-3538 to speak with an agent. Thanks to EZ.Insure, getting insurance is a breeze.
Even if you suspect the workers’ compensation claim is false. You have to file it when the employee comes to you with it. You can be penalized if you fail to report a work-related injury with a full report of all related details as soon as possible. The insurance claim adjuster’s job is to determine whether or not the claim is valid or not. You are paying premiums to your insurance company so that they can handle these matters. If your report is thorough and you work closely with your adjuster, there is a good chance the adjuster will catch the fraudulent claim and deny it anyway. So, delaying or not filing a report because you think it’s invalid could backfire on you, best to just let the adjuster do their job. 
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