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How to Fight a Workers’ Comp Claim

How to Fight a Workers’ Comp Claim text overlaying image of two people playing tug of war 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.

If you want to learn more about your state’s specific workers compensation laws you can read our state by state guide here.

Dispute The Claim

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.

Is Employer Liability and Workers’ Compensation the Same?

is employer liability and workers' compensation the same? text overlaying image of a businesswoman comparing plans If you’re running a business, you probably know that you need workers’ compensation insurance to protect both your business and your employees in the event that they sustain an injury at work. Not only that, but most businesses have to have workers’ comp insurance in most states. But you might have also heard of employer liability insurance and might be wondering whether these are two separate types of policies, and if you need both.

So, we’re here to clear things up. Workers’ comp insurance and employer liability aren’t technically the same, but they do go hand-in-hand. When you buy workers’ compensation insurance, employee liability insurance is part of your policy. Employer liability is the part of your policy that protects your business from going bankrupt if you face a lawsuit and are liable for an employee’s workplace illness or injury.

Workers’ Compensation Insurance

You are probably more familiar with the term workers’ compensation than employer liability. Since, as we pointed out above, you most likely need this type of insurance to operate your business. And even if it wasn’t mandatory, this type of policy would be incredibly important: workers’ compensation insurance will pay for an employee’s medical expenses as well as a portion of their lost wages if the employee becomes ill or sustains an injury on the job.

For example, your workers’ comp policy would pay for medical care and lost wages if an employee gets an injury while doing heavy lifting, or after slipping and falling on a wet floor. It would also pay out if an employee got sick from long term exposure to dangerous chemicals on the job.

Workers’ comp insurance, like any other type of commercial insurance, comes with its own set of things it covers, as well as conditions and exclusions. Workers’ compensation insurance typically covers:

Medical care resulting from accidents that happen to workers while they are at work
Lost wages (within limits) after an employee is injured or becomes ill because of their job
Ongoing care needed as a result of an employee’s illness or injury
Funeral expenses, paid to the worker’s family if the employee passes away from their injury or illness
Treatment for repetitive stress injuries

Employer Liability

Now that we’ve looked broadly at workers’ compensation insurance and what it covers, we can take a closer look at employer liability insurance, which is included in a workers’ comp policy. This embedded policy is meant to cover your legal fees if an employee alleges that you were negligent in preventing, or even treating, the injury/illness that they are receiving workers’ comp payouts for.

For example, if an employee is injured while using a power drill, and workers’ compensation doesn’t cover all of their medical bills, or they want to seek damages for emotional distress, for example, your employee can seek more compensation in other ways. They can sue you for not properly maintaining the tool.

A claim like this can cost you a lot of money. But your employer liability insurance will cover the cost of any settlements or judgements made against you. And it’s important to note that whether or not you are liable, you are still responsible for covering the cost of defending yourself against any claims brought against you. So that makes it extra important to have proper employer liability coverage. Since it will also cover the cost of your defense.

But getting employer liability insurance is fairly straightforward. As we pointed out above, workers’ compensation usually includes employer liability as part of the policy. So, you’ll be getting a 2-for-1 deal, just make sure you have the right coverage for your business. If you’re unsure what you need. Speak to an EZ agent about how workers’ comp works in your state, and what kind of employer liability coverage your policy should have.

Types of Workplace Injury Cases

Claims for injuries sustained on the job can take many forms. let’s look more specifically at what employer liability covers. The following are examples of situations where you may benefit from having employer’s liability insurance. So, that you would not have to pay the costs of litigation. Or any eventual settlement, judgment, or damages awarded by the court out-of-pocket.

Consequential bodily injury – Imagine an employee has a serious accident that could end his or her life. The stress of the situation also causes a heart attack in a member of his immediate family. The other family member could actually sue your business for monetary damages. Since their condition was a direct result of your employee’s work injury.
Negligence – If your employee sustains an injury at work. They can claim that the accident was because your company did not have adequate safety measures in place to prevent it.
Third party over-action – If an employee is hurt on the job, they have the option of filing a lawsuit against a third party (like a machine manufacturer). The other business may in turn decide to file suit against you. And claim that you did not properly maintain your equipment, and this improper maintenance caused the accident.
Dual capacity – Let’s say your business designs and builds a piece of machinery. Say your employee sustains an injury while using this equipment. Your employee has the right to sue you in the capacity of their employer as well as the manufacturer.
Loss of consortium – This type of lawsuit is typically filed by a worker’s family member if an employee dies or suffers a catastrophic injury (such as neurological damage) that prevents him from working or performing their everyday duties and functions.

The Key Differences

Now that you know the basics of both workers’ compensation and employer liability insurance, it’s time to dive into the key differences between the two. These policies complement one another, but they do cover different things. When workers’ comp stops paying, your employer’s liability policy kicks in. Both policies cover injuries that happen on the job, but in different ways.

Here are some key differences between the two policies:

Workers’ compensation protects employees, and employer liability protects a business from lawsuits filed by third parties.
The state’s wage rate determines workers’ compensation insurance payouts. There is also a maximum amount. But payouts from employer’s liability insurance have no limit.
When compared to workers’ compensation, employer liability coverage is more extensive because it covers a wider variety of claims.

The Cost

As you saw above, you can get both of these coverages in a bundle as workers’ compensation insurance. So, let’s take a look at what that might cost. In general, the amount your business will have to pay for workers’ compensation insurance is typically calculated per every hundred dollars of your company payroll. While it’s impossible to give an exact figure without first taking into account the variables unique to your business. You can typically expect to pay anywhere from $0.60 to $2.27 per $100 of payroll for workers’ compensation.

In general, the amount you will end up paying can be affected by things like:

The state your business operates in – Please see our state-by-state workers’ compensations guides for more specific information on how this coverage works in your state. And how much you can expect to pay.
How many employees you have – The more employees you have, the greater the risk of injury in your workplace. Just by sheer numbers
How much you pay your employees – Again, your insurance company partially determines you rate on every $100 of payroll.
If you have seasonal workers
The type of work your business does – If all of your employees are office workers, your risk (and your cost) will be much lower than if your employees work with dangerous equipment or chemicals.
Claims history – Workplaces with few or no workers’ comp claims will be able to enjoy lower rates. So, make sure your workplace is as safe as possible!

It’s important to note that you might not technically need workers’ comp if you have few (or no) employees. In some states, employers with fewer than five employees do not have to carry workers’ comp. For example, in the state of Alabama, only businesses with five or more employees are mandated to carry workers’ compensation coverage.

With that being said, coverage is mandatory in most states for any company with even one worker. So, check out our state-by-state guides to workers’ comp. Then speak to an EZ agent for help finding out what your business needs and how much you can expect to pay for a policy.

How EZ Can Help

It is important to keep in mind that both your business and your employees will benefit from having workers’ compensation insurance that includes the right amount of employer liability. If you have any further questions about the specifics of workers’ compensation or employer liability, a knowledgeable EZ agent is available to answer them now. We help you find the best plans and our help is free! We can give you free, instant quotes, just enter your zip code into the bar above. Or speak to someone right now, call 877-670-3538.

Workers’ Compensation Myths

Workers’ Compensation Myths text overlaying image of a street sign with myth and fact on it 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.

What Is A Monopolistic Workers’ Compensation State?

What Is A Monopolistic Workers’ Compensation State? text overlaying image of a worker in a warehouse A monopolistic state is any state where workers’ compensation is exclusively provided by the state’s workers’ compensation program. Meaning there is no open market for workers’ compensation insurance and getting coverage from private companies is illegal and not available. Certain companies in monopolistic states are permitted to self-insure. However, the requirements to qualify as a self-insuring employer are very strict and almost unobtainable for smaller businesses. There are currently only 4 states that are monopolistic, North Dakota, Ohio, Washington, and Wyoming. Nevada and West Virginia used to be monopolistic states but they’ve switched to a competitive market system now. Nevada opened its market to private insurers in 1999 and West Virginia followed suit in 2008. Below we’ll discuss how each state operates their workers’ compensation program as well as what their self-insurance guidelines are.

North Dakota Workers’ Compensation

The North Dakota Workforce Safety and Insurance (WSI) provides and administers North Dakota’s workers’ compensation insurance. Employers must complete an application and submit it to the Employer Services Division of WSI in order to get a policy. Applications can be found on the WSI website. North Dakota requires that almost all businesses have workers’ compensation insurance before they even hire their first employee. They also need to include any out of state workers who work for them even though they don’t live in North Dakota. There are certain types of employers that don’t have to have workers compensation coverage including:

Real estate brokers or agents who have paperwork classifying them as independent contractors
Farm and ranch workers
Household domestic workers (such as maids)
Employees of a place of worship
Independent contractors
Federal and railroad employees

In North Dakota, business owners can expect an average cost of $1.28 per 100 of covered payroll. For example a company with a total annual payroll of $100,000 will pay about $1,280 a year , $106 per month, for workers’ compensation insurance. This is only a rough estimate though, as factors such as your location, rates for staffing types (such as laborers vs. officer workers), and your claims history can significantly affect your rates. Additionally, the WSI provides a return-to-work program to assist injured workers in returning to work as soon as possible. The program includes medical case management, vocational case management, and reemployment assistance for injured workers.

Self-Insure Workers’ Compensation in North Dakota

While some states, whether they’re monopolistic or not, allow self-insuring, North Dakota does not allow it. All workers’ compensation insurance must come from the state fund.

Ohio Workers’ Compensation

The Ohio Bureau of Workers’ Compensation (BWC) is the state’s workers’ compensation insurance provider. Employers can apply for coverage by submitting an electronic application on the BWC’s website or by mailing a hard copy to the BWC. In Ohio businesses with one or more employees are required to carry workers’ compensation insurance. Though there are a few exceptions on workers and owners who don’t need to be under the policy themselves:

Charity volunteers
Cooks and gardeners who make less than $160 per quarter
Most volunteers
Sole owners
Partnerships
LLC companies acting as sole owners
LLC acting as partners
Family farm corporate admins
An individual who is incorporated as a corporation
Ordained or associate ministers of religious organizations

Ohio business owners typically pay an average of $0.67 per $100 of covered payroll. For example, a business with a total annual payroll of $100,000 will pay about $670 a year, which is about $55 a month for workers’ compensation insurance. Keep in mind this is just a rough estimate. There are other factors that can affect your premiums, such as where your business is located, varying staffing type rates, and your recent claim history.

Self-Insure Workers’ Compensation In Ohio

Your business is allowed to self-insure but there are a lot of requirements to get approved and it costs to keep the permission. Self-insurance is a privilege granted by the BWC to select employers. Instead of paying premiums to the Ohio State Insurance Fund, self-insuring employers cover any wages and medical costs for work-related injuries and illness out of pocket. This means your company assumes all liability and administers the workers’ compensation program themselves. To qualify you must:

Have a minimum of 500 workers in the state of Ohio
Been in business in Ohio for a minimum of 2 years
Have an active policy with the state insurance fund at the time you apply for self-insurance
Have 5 years of certified financial statements proving you can afford to self-insure
Already have a plan in place to administer the workers’ compensation claims.

And that’s just to apply, if you’re approved your business isn’t necessarily avoiding having to pay the BWC by not having a premium with them. Self-insured businesses must pay the BWC and other programs. In addition to medical expenses and wage compensation, you must pay self-insurance dues. The BWC mandates semiannual assessments based on claim payouts. These payments support BWC and Industrial Commission of Ohio administration costs. SIEF, safety and hygiene services, and the self-insured surplus fund. The BWC will base your assessments on a percentage of your prior state-funded policy’s indemnity payments for the first five years of self-insurance. For three years, new self-insurance employers must pay the SIEGF 6% of their most recent annual payroll premium.

Washington Workers’ Compensation

Most Washington state employers are required by law to carry workers’ compensation insurance. Which is available through the Washington State Department of Labor and Industries. While state workers’ compensation insurance is required for the majority of businesses, there are a few exceptions:

Independent contractors
Sole proprietors
LLCs
One domestic worker in a private home that works less than 40 hours a week
Gardeners or maintenance workers in private homes
Children under 18 who do farm work for their parent’s farm
Employees who already receive coverage under the Federal Employees’ Compensation Act
Volunteers for charities or religious organizations
Salon workers and make-up artists who rent or lease their own space.

In Washington, business owners can expect to pay $1.57 per $100 of covered payroll on average. Thus, a business with a total annual payroll of $100,000 will pay approximately $1,570 per year for workers’ compensation insurance, or approximately $130 per month. This is only a rough estimate, as factors such as your location, the different rates for staffing types (laborers versus office workers), and your claims history can significantly affect your rates.

Self-Insure Workers’ Compensation In Washington

If your business has at least $25 million in assets and an accident prevention program, you may be able to self-insure. Every other employer must purchase workers’ compensation insurance from the state fund.

Wyoming Workers’ Compensation

Wyoming’s state workers’ compensation fund is administered by the Wyoming Department of Workforce Services. However, if you have a lot of workers’ compensation insurance claims in the past and are considered high risk, you may not be eligible for the Wyoming public workers’ compensation program. Since you have to maintain coverage, you can contact the state’s assigned risk pool for “last resort” coverage in this situation. Almost every business in Wyoming has to cover workers’ compensation insurance for all of its employees. Although there are some exceptions:

Casual workers
The majority of professional athletes
Domestic workers in private households
Private duty nurses who work for an individual
Employees of the federal government
Volunteers for some organizations
Independent contractors and self-employed
Partners
Limited liability company (LLC) members
Corporate executives

Workers’ compensation insurance is estimated to cost business owners in Wyoming $1.70 per $100 of covered payroll. For example, a business with an annual payroll of $100,000 will pay approximately $1,700 per year, or $141 per month, for coverage. However, these rates can vary based on numerous factors.

Self-Insure Workers’ Compensation In Wyoming

Unlike most other states, Wyoming’s workers’ compensation laws prohibit employers from self-insuring their claims. All employers in the state are required to purchase workers’ compensation insurance through the state or the risk pool depending on eligibility.

Additional Coverage In Monopolistic States

In monopolistic states, if you purchase workers’ compensation insurance through a state fund, your policy will not include employer’s liability coverage. Therefore, an employee is able to file a lawsuit against you for work-related injuries or illnesses. Employers’ liability in monopolistic states is typically covered under a general liability policy endorsement. Employers’ liability insurance obtained via endorsement is often referred to as stop-gap coverage. Moreover, due to the restrictive nature of monopolistic state markets, workers from these states cannot be covered by multi state workers’ compensation policies. If a business operates in multiple states, and one of those states is monopolistic, it must acquire separate workers’ compensation policies to ensure that all of its employees are covered.

EZ Can Help

Even though you don’t need help comparing policies as you can only buy through the state fund in monopolistic states EZ can still help. Your business will most likely need general liability (stop-gap) insurance as well as several other types of commercial insurance. With those, we can help you compare prices, plans, and companies available in your area to make sure you get the best coverage possible. We make the process of purchasing business insurance as simple and stress-free as possible. In addition, we give each customer our undivided attention.

Your dedicated agent will provide you with instant, no-obligation quotes as soon as you submit our form. Who will provide personalized service and make an effort to comprehend your needs. We want to ensure that you receive the best coverage at the most affordable cost. Our services are entirely complimentary, so check out your quotes right away. If you have further questions, please contact us at 877-670-3538. You will speak with a local insurance agent who can answer any questions you may have.

What Isn’t Covered by Workers’ Compensation?

What isn't covered by workers' compensation text overlaying image of a worker looking in the distance 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 Coverage Limits

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.

The 4 Parts of Workers’ Compensation

the 4 parts of workers compensation text overlaying a photo of a construction worker 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.

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Myth 1: Small Low Risk Businesses Don’t Need Workers’ Compensation

Myth 2: I Only Have A Couple Employees, I Can Pay Out Of Pocket For An Accident

Myth 3: I Don’t Have Employees, I Use Subcontractors So I Don’t Need Coverage

Myth 4: Seasonal Businesses Don’t Need Coverage

Myth 5: I Only Employ My Family Members, I Don’t Need To Cover Them.

Myth 6: My Employees Work From Home They Don’t Need Coverage

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Myth 7: If My Employee Doesn’t File A Claim The Day Of The Injury They Can’t File It Later

Myth 8: Worker’s Compensation Stops Employees From Suing

Myth 9: If The Accident Is The Employee’s Fault They Can’t File A Claim

Myth 10: I Don’t Need An Insurance Agent To Get The Best Policy

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