About Pie Insurance, the Company
Our insurance is backed by the Sirius Group, so our protection has A rated financial strength. This means that when you need to file a claim, we’ll be there for you in the way that matters most.
We’ll begin by selling workers’ compensation insurance only. Our long-term goal is to improve as much of the insurance experience for small businesses as we can.
How does Workers’ Comp Work?
Each state administers its own workers’ comp program through a commission or board, meaning each state operates differently. Typically these state agencies ensure businesses comply with workers’ comp laws, collect relevant accident information, and make final decisions on cases.
In most states, employers must maintain records of any accidents, report accidents to state agencies, and inform their insurer of any accident within a specified timeframe.
Businesses that are protected by workers’ comp can easily request a Certificate to show proof of insurance, if needed. For some businesses this is particularly important because they may be required to provide proof of insurance before any work can begin. This is common in the construction industry, for example.
When a business buys a policy, the premium (price) is estimated. To ensure the correct premium is ultimately charged, insurers will perform an audit after the most recent policy period has ended. Insurers look back at the prior period to verify that the upfront pricing was accurate. If there are any material differences in the business risk or makeup of the workforce, the insurer can collect more premium or provide a credit (iii.org).
While many factors go into calculating your premium, the formula is typically similar to this:
Payroll (per $100) X Classification Rate X Experience Modification Rate (if one exists) = Premium
For business owners, workers’ comp protects your company from being sued by employees. It reduces the risk of a crippling financial loss in the case of a serious accident involving your team members. Workers’ comp is also legally required in almost every state and situation. For some, not having workers’ comp can result in large fines or time in prison.
Any of your team members who are covered by workers’ comp can receive financial protection if they are harmed while performing regular work duties.
When you first buy workers’ comp, your premium (price) is based on your estimated payroll over the period your policy will cover. To ensure you’re paying the correct premium, a “premium audit” or “payroll audit” is conducted after the policy period has ended. This audit can result in your needing to pay more or less for your policy if there’s a difference between the actual and estimated premium. Your insurer will reach out to you to conduct your audit and may ask about the duties of different team members or request payroll documents.
The NCCI is an insurance rating and data collection service for workers’ comp. It is a non-profit organization that recommends rates to insurers. To do this, NCCI collects and analyzes a wide range of workers’ comp information. They produce guidance manuals for most (but not all) states to define classification codes and experience modification ratings.
The states that are not part of the NCCI are CA, DE, IN, MA, MI, MN, NC, ND, NJ, NY, OH, PA, WA, WI, and WY.
Applying for Workers’ Compensation
Insurers use a standardized system of class codes to categorize the type of work someone does. For example, the class code 8017 is a retail store employee.
A “governing” class code is the class code associated with the type of work that makes up the highest percentage of your total payroll. To provide a quote, Pie considers a number of factors including your governing class code.
To provide you with a quote, insurers consider a number of factors including your governing class code and any other class codes relevant to your employees. It is important to understand your company’s class codes because many workers’ compensations policies have inaccurate class codes, which can cost employer’s hundreds or thousands of dollars per year.
If you already have workers’ comp, the easiest way to find it is by looking for the “declarations page” sent to you by your insurer.
If you do not have a declarations page to reference or you have never had workers’ comp before, you can seek assistance from any workers’ comp insurer.
Your “governing” ZIP code is the ZIP where the majority of your team members work and are paid.
If your business has locations in more than one state, and these additional locations are the primary offices for other team members, you may need to get a separate estimate for the total payroll in each individual state. You will need to discuss with your insurer if you need separate policies for each state or if you can get a combined policy.
If certain team members work remotely, you should add their payroll to the office they report to the most.
An Experience Modification Rate is a risk rating factor that is unique to your business. It is used by insurers to compare the claims and payroll history of your business to similar businesses. Your Experience Modification Rate is used to adjust your insurance pricing based on actual and expected losses during the period of your coverage. Identifying the correct Experience Modification Rate for your business is very important to get accurate pricing.
Note that businesses with very low premiums may not be assigned an Experience Modification Rate in their state. Additionally, businesses that have been in operation for less than one year do not have an Experience Modification Rate.
The easiest way is to find it in your latest workers’ comp declarations page. Alternatively, you can contact your state’s Advisory Organization or Rating Bureau. To find the appropriate contact information, you can check out your state’s website.
Be aware that it is common for small companies, and businesses that have just started, to not have an EMOD. If your business does not have an EMOD, you will typically be assigned a default rating of 1.0, which means your expected workers’ comp losses will be treated as the average (neither higher nor lower than expected).
You should provide an estimate of the total cost of team members’ wages over the next 12 months. Include full-time and part-time workers that you pay directly, including owners and officers.
Exclude 1099 contractors and consultants. Typically, your total annual payroll amount should also include: overtime, bonuses, commissions, vacations, sick leave and holidays.
If you are unsure, you can look up guidance for your state or ask an insurer.
Claims and Coverage
Workers’ comp covers the damages experienced by a team member who is injured on the job. Both medical care and economic loss, such as lost wages, are often covered.
There are no co-pays that your team members will need to pay when it comes to workers’ compensation insurance.
It is common for states to have treatment and test guidelines, which outline the max payment that will be covered for a given injury.
Many states have a limit on the number of weeks for which benefits can be paid for a temporary disability. As opposed to a permanent disability, team members eventually recover from temporary disabilities.
If a team member dies in a work-related accident, their family may be entitled to death benefits.
- Physical injuries, including hearing loss and carpel tunnel syndrome
- Preexisting conditions worsened by the work environment
- Workplace slips, trips, or falls
- Injuries caused by a workplace hazard, such as a falling ceiling tile
- Injuries suffered while not at work
- Self-inflicted injuries
- Injuries suffered while in violation of company policy
- Injuries from committing a crime
If a team member is injured traveling to and from work, can they receive workers’ compensation benefits?
Generally, no. However, this can be a legally complicated question and there may be exceptions if the employer provides the means of transportation (like a company car), pays for transportation, or if travel is required while working. You will likely need to seek legal advice for your specific case (workplacefairness.org).
The Insurance Information Institute (iii.org) suggests you can reduce your risk by:
- Educating team members about the claims process in advance so that they know what to expect and can get the correct treatment as fast as possible.
- Making team members feel part of the team through communication while they are out of the office to reduce anxiety, encouraging a swift return to work.
- Implementing workplace safety and accident prevention programs