Workers Compensation Insurance Policy Information
Workers Compensation Insurance. Workers' compensation insurance is a type of insurance that provides medical, rehabilitation, and financial benefits to employees who are injured on the job or become ill as a result of their job.
It is designed to protect employees from the financial impact of workplace injuries or illnesses, and to ensure that they receive the necessary medical treatment and support to return to work as soon as possible.
The employer pays for the insurance, which is typically required by state law. If an employee is injured on the job, they can file a claim with their employer's workers' compensation insurance provider, who will then provide the necessary benefits.
This type of coverage is "no-fault," meaning that if the injured employee's injury, illness or disease arose out of his or her employment, and it was accidental, then the injured employee will receive benefits regardless of fault.
If however, an employee purposely injures himself (for example, by deliberately jumping off a roof), then the injury would not be covered even if the incident occurred during working hours and at the jobsite.
Employers Liability covers an employer's common law or tort liability for employee injuries that fall outside the scope of the state laws or acts. This liability is separate and distinguished from the liability that workers compensation laws impose.
The workers compensation insurance policy provides the mandatory benefits that the various state laws prescribe and require for accidental work-related injuries that occur in the course of employment, subject to its terms and conditions. It must be emphasized that the injury must arise from and be related to the injured worker's job duties. Coverage also applies to the related costs for disease or death that occur as a result of the accident.
There are times when the employed worker's injury is not compensable under workers compensation or occupational disease laws. In those cases, Employers Liability coverage responds to the injured worker's allegations of negligence on the employer's part, subject to its terms, conditions, limitations, and exclusions. The coverage the basic policy provides may be broadened, restricted, clarified, or made to comply with specific state regulatory requirements by using a variety of available endorsements.
Workers compensation insurance protects your business from employee lawsuits for the injuries they sustain or diseases they contract that arise out of and in the course of their employment - with rates as low as $37/mo. Get a fast quote and your worker comp insurance now.
Below are some answers to commonly asked workers comp insurance questions:
- What Is Workers Compensation Insurance?
- How Much Does Workers Compensation Insurance Cost?
- What Are The Three Main Parts Of A Workers Compensation Insurance Policy?
- What Does Workers Compensation Insurance Cover?
- What Is Experience Rating In Workers Compensation?
- What Is A Workers Compensation Modification Factor?
- What Is An Anniversary Rating Date For Workers Compensation?
- What Are Common Workers Compensation Insurance Coverage Gaps?
- What Does Workers Compensation Insurance Cover & Pay For?
What Is Workers Compensation Insurance?
Workers compensation insurance is a type of insurance that provides financial benefits to employees who are injured or become ill as a result of their job.
This insurance is typically required by law and is designed to cover medical expenses, lost wages, and other costs associated with the injury or illness. The benefits provided by workers compensation insurance are intended to help employees recover and return to work as soon as possible.
Employers are typically responsible for purchasing and maintaining this insurance coverage for their employees.
How Much Does Workers Compensation Insurance Cost?
The average price of a standard $1,000,000 Workers Comp Insurance policy for small businesses ranges from $29 to $297 per month based on location, industry, payroll and experience.
What Are The Parts Of A Workers Compensation Insurance Policy?
The three most basic parts of a workers compensation policy include:
The policy consists of the Information Page, the coverage form, and all endorsements and schedules at policy inception. It is an insurance contract between you and the insurance company. It includes all agreements that relate to the insurance and can be changed only by written endorsements the company issues.
PART ONE - WORKERS COMPENSATION INSURANCE
Workers compensation insurance applies to bodily injury by accident that occurs during the policy term. It also includes bodily injury by disease caused or aggravated by employment conditions. The insurance company pays benefits you are required to pay when they are due.
The policy covers your entire liability as an employer under the workers compensation laws of the state or states involved. This includes a number of statutory provisions included and referred to in the policy, if required by state law.
PART TWO - EMPLOYERS LIABILITY INSURANCE
Employers liability insurance protects you against suits brought against you by employees for injuries due to accidents or diseases that arise from their employment by you. This coverage is subject to specific limits and has a number of exclusions.
PART THREE - OTHER STATES INSURANCE
Coverage applies to only the states where you have operations. You can have coverage in additional states by listing them in item 3.C. on the Information Page. Doing so provides coverage if an injury occurs in another state but there are limitations. There is no coverage if you operate in a state on the policy effective date that the insurance company does not know about. In addition, you must notify the insurance company if you begin operations in any state.
PART FOUR - YOUR DUTIES IF AN EMPLOYEE IS INJURED
You must immediately inform the insurance company of any injury that the policy may cover. This is the most important requirement. The others require that you cooperate with the insurance company and are similar to provisions in other liability insurance coverage forms and policies.
PART FIVE - PREMIUM
This section explains how the policy premium is determined, based on the manuals, rules, classifications, rates, and rating plans in effect on the policy inception date. It explains how to arrive at and use classifications and explains remuneration or payroll, as well as how premium is calculated and premium audit's role in determining the final premium. It also explains the records you must keep to determine the correct and final premium.
PART SIX - CONDITIONS
This section addresses several key policy conditions. The most important include the role of inspections and their limitations and cancellation terms as they affect both you and the insurance company.
The NCCI Workers Compensation and Employers Liability Insurance Policy may have to be modified for a specific risk. Numerous endorsements are available that broaden, limit, or exclude coverage.
What Does Workers Compensation Insurance Cover?
Do you own, operate, or manage a business which includes at least one employee? Are you familiar with the laws of the states where you operate regarding workers compensation insurance coverage?
The Workers Compensation and Employers Liability Insurance Policy covers your statutory liability as an employer under state workers compensation laws. It pays for medical treatment because of injuries and indemnity payments for employees disabled by work-related accidents. It also provides tort liability coverage for legal actions brought against you for bodily injuries to your employees that fall outside state workers compensation laws.
The coverages provide the benefits that the law requires for injuries employees sustain that arise out of and in the course of their employment, including resulting disease or death, subject to certain policy terms and conditions.
In addition, if the employee injury is not compensable under applicable state workers compensation laws or occupational disease acts, Employers Liability Insurance responds to the employee's allegation of negligence by you, again subject to certain policy terms, conditions, and exclusions.
Workers comp insurance covers bodily injury by accident or bodily injury by disease, including death that results from either. This is subject to the following:
- An Accident - When bodily injury is due to an accident, the bodily injury must occur during the policy period.
- Disease - When bodily injury is due to disease determining the exact policy that must respond becomes more difficult. Because many disease-related bodily injuries are due to cumulative exposure, many different policies could be expected to respond. Because of the need to establish a single policy to respond, the policy explains that the policy in effect when the employee was last exposed to the conditions that either caused or aggravated the bodily injury by disease must respond.
- Workers compensation insurance applies to bodily injury by accident that occurs during the policy term. It also includes bodily injury by disease, including resulting death, caused or aggravated by employment conditions. The worker's last day of last exposure to the conditions that cause or aggravate the bodily injury by disease must occur during the policy term.
- The insurance company pays benefits the named insured is required to pay when they are due.
- The insurance company has the right and duty to defend any legal action filed against the named insured but only for benefits this coverage insures. It also has the right to investigate and settle claims and lawsuits and pay other described reasonable expenses and costs related to those legal actions.
- The insurance company also pays the following:
- Reasonable expenses the named insured incurs at its request, except for lost earnings
- Premiums for appeal bonds and bonds to release attachments for amounts up to the amount this insurance pays
- The named insured's share of litigation costs
- Legally required interest on judgments until it offers the amount due
- All expenses it incurs
- If other insurance or self-insurance applies to the same loss, the insurance company pays only its share. Unless there are specific limits, all shares are equal until the loss is paid. If payments use up any insurance or self-insurance, the remaining insurance pays in equal shares until the loss is paid.
- The named insured is responsible for payments that exceed the benefits the workers compensation law requires, as well as certain other payments. Examples are those required due to willful misconduct, illegal employment, not complying with health or safety laws, and employment-related practices that violate the law.
- The insurance company obtains the named insured's rights to recover from others who may be liable for an injury as a result of the payments it makes. The named insured must do everything possible to preserve those rights.
- The insurance company is subject to all statutory provisions of the workers compensation law. Any conflicts between policy terms and such provisions are changed to conform to those laws. However, nothing in the policy relieves the named insured of its duties and obligations under the policy.
What Is Experience Rating In Workers Compensation?
Experience rating in workers comp is a calculation that either increases or decreases your premium based on your company's claims (loss history).
Experience rate factors are actually credits or debits that reflect the specific risk's loss experience. They are applied to the premium developed by using manual rates. The National Council on Compensation Insurance, Inc. (NCCI) or another rating organization that has jurisdiction calculates these factors. Experience rating is mandatory for all risks that meet certain eligibility requirements. For example, a risk must be in business under the same ownership for at least two years. Minimum premium eligibility thresholds also apply and vary by state.
Each risk pays its "fair share" of the average annual rate for the class or classes involved based on its own loss experience. The experience may be better or worse than average and the factor determined and applied reflects it. One of the most important consequences of experience rating is that it encourages the named insured to implement loss control, safety, and hazard reduction initiatives that control or reduce losses.
The experience rating factor is calculated using the latest three years of loss experience prior to the current policy period. It excludes the most recent full year. It is recalculated annually by adding the experience for the latest eligible year and dropping the oldest year. The problem with this approach is that it applies historical loss experience to the current policy period in order to predict future losses and results in a time lag in being applied. Effective loss control or safety initiatives implemented today will not impact the premium until at least two years following implementation.
What Is A Workers Compensation Modification Factor?
Once the actual weighted primary and excess losses are calculated and compared to the expected losses, the individual risk modification factor is calculated. The actual losses for a specific risk are divided by the expected losses. If the actual losses are lower than the expected experience, it is a credit modification factor (lower than 1.00). If they are higher, it is a debit modification factor (higher than 1.00).
Individual risk rate modification factors are good for one year and usually apply on the risk's normal anniversary rating date. This is the date when the workers compensation insurance coverage was first purchased. The rate modification factor is calculated and re-figured annually to add updated loss experience and to apply it for the next policy term.
The modification factor applies to the insured business and to each business or entity under the named insured's common ownership.
What Is An Anniversary Rating Date For Workers Compensation?
The anniversary rating date is the date used to compile individual risk statistics and to calculate the experience rating modification factor. As stated in the experience rating section, it is valid for a one-year period and is based on the anniversary rating date.
When a policy anniversary date changes due to a cancellation and rewrite in order to have a common expiration date with other policies, one factor applies for one part of the policy term and a different one for the other if the anniversary rating date is not changed. This complicates the rating factor calculation as well as the audit process.
The anniversary rating date is an important element in applying the experience rating modification factor and other statistics for a risk's workers compensation insurance. It is established based on the effective date of the first policy issued. It includes both the month and the day of the month. It does not change from one year to another, even if the policy is written for a short-term, is cancelled and rewritten, or is modified in some other way to change the policy dates.
In other words, a simple rewrite of a policy or issuing a short-term policy does not change the anniversary rating date. In order for it to change, the risk must file a change request on the appropriate form with either NCCI or the rating organization that has jurisdiction.
What Are Common Workers Compensation Insurance Coverage Gaps?
No Other States Coverage For Incidental Exposures
A business might quickly expand its operations to other states. If the insured neglects to notify its insurer of the expansion and an employee is injured in a state not listed in the workers comp policy, the employer might have no workers compensation coverage for the injury.
In that case, the employer will have to pay the workers compensation benefits out of pocket.
If the employee sues the employer as a result of the injury in the new state, the employer will also have no coverage for the suit under Part Two, employers liability.
Not Listing States Of New Permanent Operations
To avoid a gap in coverage, an insured that begins operations in one of the states listed for other states insurance must immediately notify the insurer.
If the workers comp insurer is not informed within 30 days of policy inception, there is no coverage for that new state.
Improperly Insuring Leased Workers When Using a Professional Employer Organization (PEO)
When a PEO is utilized, it is important to establish who is responsible for insuring leased workers and to ensure that insurance placements are made in accordance with jurisdictional and contractual requirements.
If this is not properly handled, the party that thought it did not need to buy workers compensation insurance can be held liable for non-compliance... and bear the costs of insuring the leased workers.
No Stop Gap Endorsement for Monopolistic Fund States
To avoid a coverage gap, any firm with business operations in any of the monopolistic funds or territories should obtain stop gap insurance using an appropriate endorsement to its commercial general liability or workers compensation policy.
The monopolistic find states are:
- North Dakota
Standard workers comp insurance policies in most states provide employers with both workers compensation and employers liability coverage, monopolistic state funds provide only workers compensation coverage.
This coverage gap can be addressed by adding "stop gap" (employers liability) coverage in the monopolistic states mentioned above.
No Voluntary Workers Compensation Endorsement
Employers with workers who are not subject to state workers compensation laws should consider buying voluntary workers compensation coverage.
Why? Because employers without workers compensation coverage may end up paying substantially larger claims as the result of a negligence suit by an injured worker than the amounts they would pay in providing statutory workers compensation benefits.
Workers compensation benefits are usually the "exclusive remedy" of employees covered under the workers compensation law. Virtually all state workers compensation laws exclude some types of employment. These may include domestic, agricultural, and casual workers and volunteers.
The employees who are not eligible for workers compensation benefits can sue the employer for damages in the event of an on-the-job injury resulting from employer negligence. If an injured employee can prove some negligence on the part of the employer, he or she may recover amounts that are much greater than state workers compensation benefits.
For this reason, many employers that have exempt employees elect to purchase voluntary workers compensation coverage.
What Does Workers Compensation Insurance Insurance Cover & Pay For?
Here are some examples of Workers Compensation Insurance claims and how the insurance can help pay for them:
- Slip and Fall Accidents: A worker slips on a wet floor in the workplace and suffers a back injury. Workers Comp Insurance can cover the worker's medical expenses, lost wages, and rehabilitation costs.
- Repetitive Strain Injuries: A worker develops carpal tunnel syndrome from typing on a computer all day. Workers Comp Insurance can cover the worker's medical expenses, lost wages, and rehabilitation costs.
- Machinery Accidents: A worker loses a finger in a machine accident while operating heavy machinery. Workers Comp Insurance can cover the worker's medical expenses, lost wages, and compensation for the permanent loss of the finger.
- Occupational Diseases: A worker develops lung cancer due to exposure to toxic chemicals in the workplace. Workers Comp Insurance can cover the worker's medical expenses, lost wages, and compensation for the long-term effects of the disease.
- Mental Health Issues: A worker develops depression and anxiety from the stress of working in a high-pressure environment. Workers Comp Insurance can cover the worker's medical expenses, lost wages, and therapy costs.
In each of these cases, Workers Comp Insurance can help pay for the costs associated with the worker's injury or illness, including medical expenses, lost wages, and compensation for permanent disabilities. The insurance can also provide legal representation in the event of a lawsuit filed by the injured worker.
'Real Life' Court Cases Involving Workers Comp:
Midwestern Indemnity Company v. David Rich and Paul Savage
Midwestern Indemnity Company (Midwestern) had issued a commercial general liability policy, which included workers compensation coverage, to Paul Savage. While working as an employee of Savage, David Rich was seriously and permanently injured. He received workers compensation benefits but then filed an action for damages, alleging that his employer knew, or should have known, that the job assigned to him would place him in a hazardous situation that probably would result in serious injuries. Savage referred the action to Midwestern, which denied liability and refused to defend. (A consent judgment of $1.3 million was entered in favor of Rich against Savage.) Midwestern then filed this action for declaratory judgment.
The policy excluded coverage of claims for bodily injury "expected or intended from the standpoint of the insured," and "bodily injury to an employee arising out of or in the course of (a) employment by the insured, or (b) performing duties relating to the conduct of the insured's business."
The trial court granted Midwestern's motion for summary judgment and Rich appealed.
The higher court pointed out that Rich was injured while working for Savage and was performing duties assigned to him by the insured. The policy issued to the insured excluded injuries such as those Rich sustained.
The judgment entered in the trial court holding that the policy did not cover the injuries sustained by the employee was affirmed.
(Midwestern Indemnity Company v. David Rich and Paul Savage, Appellant-No. 02CA1584-Court of Appeals of Ohio, Second District, Darke County-October 18, 2002-778 North Eastern Reporter 2d 141)
Tony Moncus, Deceased, Appellant v. Billingsley Logging and American Interstate Insurance Company
Tony Moncus (Moncus) worked cutting logs for Billingsley Logging (Billingsley). The owner, Mitchell Billingsley (Mitchell), had the entire logging crew meet at a centrally located service station one morning so he could lead them to a new location they could not find on their own. This was standard practice when starting work on a new tract and occurred a few times each year.
Moncus had to drive his own vehicle that day and not ride with the others on a company truck because he had to leave early to run a personal errand. Moncus was killed in a head-on motor vehicle accident before arriving at the logging site. His vehicle contained no tools or equipment belonging to Billingsley. Since he was paid based on the number of tons of wood that he cut, Moncus was paid nothing on the day of his death because he had not yet cut any wood.
A claim was filed for workers' compensation benefits on behalf of Moncus. The administrative law judge (ALJ) held that Moncus did not sustain a compensable fatal injury due to his not performing an employment-related service at the time of the accident. The ALJ found that the preponderance of evidence disproved the death resulting from an injury compensable under the Workers Compensation Act. The Arkansas Workers' Compensation Commission (Commission) affirmed and adopted the ALJ's decision.
This was based on the "coming and going" rule that ordinarily precludes recovery for an injury sustained while the claimant is going to or returning from work. The rationale behind the rule is that the claimant is not within the scope of his employment while traveling to and from his job and is subject to the recognized hazards of travel to and from work in a vehicle. The rule is subject to exceptions in cases where the employee is injured when in close proximity to the employer's premises, where the employer furnishes the transportation, where the employee is a traveling salesperson, where the employee is injured on a special mission or errand or when the employee is paid from the moment he leaves home until he returns home.
The appellant acknowledged the "coming and going" rule but argued that the day in question was not a normal workday because the employees were ordered to meet Mitchell and follow him to the tract. It was asserted that Moncus was performing employment-related services when he was killed driving to the job site because of Mitchell's orders and that Billingsley would have benefited because the day's business could be conducted successfully.
The rationale of the ALJ, adopted by the Commission, was that Moncus was not performing an employment-related service at the time of the accident. Employees of Billingsley were ordinarily required to provide their own transportation to and from the logging tracts of land. Meeting at a central location to drive to a new tract occurred regularly, although infrequently.
It was determined that such meetings and driving to a new tract as a group did not advance Billingsley's purpose or interest on those days any more than any other day when employees traveled to the logging tract on their own. While meeting in this manner was not customary, it was done at least a few times each year when commencing work at a new site.
In either case, Moncus was required to travel to the actual job site where his work would begin and this case did not fall into one of the recognized exceptions to the "coming and going" rule. For these reasons, the claim was not compensable. The court of appeals affirmed the decision of the ALJ.
(Tony Moncus, Deceased, Appellant v. Billingsley Logging and American Interstate Insurance Company, Appellees. No CA 05-264. 93 Ark. App 402, 219 S.W. 3d 680.)
Additional Resources For Workers Compensation Insurance
Learn about workers compensation insurance - a policy provides medical, wage and other benefits to employees who are injured or become ill on the job. Workers comp coverage is mandated by each state.
- Employers Liability
- Workers Compensation Class Codes
- Workers Compensation Insurance
- Workers Compensation Insurance Laws
- Specialty Workers Comp
Businesses need workers compensation insurance to protect both the business and its employees. This insurance covers the medical expenses and lost wages of an employee who is injured on the job. Without workers comp insurance, the business would have to pay for these expenses out of pocket, which could be financially devastating for a small business.
In addition to covering the costs of an injury, workers compensation insurance also protects businesses from potential lawsuits. If an employee is injured on the job and chooses to sue the business for their injuries, the workers comp insurance will cover the legal costs and any potential settlements or judgments. This protection is crucial for businesses, as a single lawsuit could cripple their finances.
Furthermore, workers comp insurance is often required by law in most states. In many cases, businesses are required to have this insurance in order to operate legally. Failing to have workers comp insurance can result in fines and legal penalties, which can further damage a business's financial stability.
In short, workers compensation insurance is necessary for businesses to protect themselves and their employees from financial ruin in the event of a workplace injury. It is a crucial aspect of running a successful and responsible business.