Who is covered by workers' compensation? - Pie Insurance

Who is covered by workers’ compensation?

Workers’ compensation insurance is required in every state except Texas. While workers’ comp insurance covers many employees, there are some types of employees who aren’t covered.

In most states, employers are required by law to provide workers’ comp coverage to full-time employees. Because the workers’ compensation system is a no-fault system, it typically doesn’t matter if employee carelessness caused the accident, injury, or illness (but more on that later). Additionally, workers’ comp generally pays employees for an at-work injury that aggravates a pre-existing condition. For example, a worker who aggravates a previous back injury while lifting heavy equipment at work.

Employees who sustain an injury outside the workplace may be covered if the injury happened in the course of employment. For example, a sales rep who gets injured in a car accident on the way to a client meeting. However, compensation for employees who are injured while working remotely from home depends on the specific nature of the injury, the state the workplace is in, and the details of the company’s remote working policy.

Depending on the state of employment, healthcare providers and first responders may be able to file a workers’ comp claim if they contract COVID-19 in the course of their work. Workers in other professions, however, may not be covered.

In any conversation about workers’ comp insurance, it’s important to note that some states only require employers to provide coverage if they employ a certain number of employees. Check the specific laws in your state.

Who is not covered by workers’ compensation?

Some categories of workers—such as self-employed workers, seasonal employees, domestic employees, agricultural employees, and independent contractors—are exempt from workers’ comp coverage in some states. For example, in New York, the following classes of workers are not covered by workers’ compensation:

• Public school teachers employed by New York City and uniformed New York City firefighters, police officers, and sanitation workers
• Domestic workers employed less than 40 hours a week
• Volunteers at nonprofit organizations who receive no compensation for their work
• Ministers, priests, rabbis, sextons, Christian Science readers and members of religious orders
• Workers covered under other workers’ compensation programs, such as maritime, federal, and certain railroad employees
• Even if an employee isn’t covered by your company’s workers’ comp policy, they still may be able to file a civil claim against you. An active workplace safety program can help prevent employee injuries.

Are all workplace injuries considered no-fault?

As mentioned before, workers’ comp benefits are provided regardless of fault. This means that if a waitress at your restaurant chooses not to wear no-slip shoes but then slips and falls during her shift, any costs related to her injury are still compensable under your policy. There are, of course, always exceptions to that rule, and they can vary from state to state.

Workplace injuries exempt from compensation may include:

• Injuries that occur because the worker was drunk or under the influence of illegal drugs
• Injuries that are self-inflicted or due to a physical fight in the workplace
• Injuries a worker sustains while committing a serious crime while on the clock

In general, most full-time employees are covered by workers’ compensation. Check the specific workers’ comp rules in your state.

Thanks for reading! Please note that this content is intended for educational purposes only. As laws change regularly, you should refer to your state legislation and/or an advisor for specific legal counsel. If you’re a small business owner, learn more about workers’ compensation insurance or check your current rate in 3 minutes.