Workers' Compensation Insurance

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 of Insurance to show proof of coverage 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. Learn more.

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 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.

Typically covered:

• Physical injuries, including hearing loss and carpal tunnel syndrome

• Pre-existing conditions worsened by the work environment

• Workplace slips, trips, or falls

• Injuries caused by a workplace hazard, such as a falling ceiling tile

Not typically covered:

• Injuries suffered while not at work

• Self-inflicted injuries

• Injuries suffered while in violation of company policy

• Injuries from committing a crime

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 team members who are covered by workers’ comp can receive financial protection if they are harmed while performing regular work duties.

View requirements by state.

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. Look up class codes.

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.

When first purchasing a workers’ comp policy, the premium (price) is based on the estimated payroll over the period the policy will cover. To ensure the policyholder is paying the correct premium, a “premium audit” or “payroll audit” is conducted after the policy period has ended. This audit can result in the policyholder needing to pay more or less for the policy—if there’s a difference between the actual and estimated premium. The insurer will reach out to the policyholder to conduct the audit and may ask about the duties of different team members or request payroll documents.