Workers Compensation Insurance

A workers compensation policy responds to accidental injury that occurs during work with mandatory benefits. However, besides taking place at work, an injury must also be related to the injured person’s duties. Further, the policy also covers costs associated with disease or death that may be the ultimate result of the accident. If the employee’s injury does not qualify for compensation under the Workers Compensation Acts (or Occupational Disease Acts, if separate) the policy will respond to an employee who sues his or her employer, alleging negligence.

The type of business that can be insured with a workers comp policy may be an individual, partnership, joint venture, corporation, association, fiduciary, or other entity. A typical policy lists the work locations that are covered. The policy is designed to handle work-related accidents as well as diseases. The amounts that must be paid are defined by the state or jurisdiction where a covered incident occurs. The policy usually lists the other types of costs and expenses that are eligible for payment under the policy.

In other respects, a workers compensation policy is similar to other kinds of insurance. The policy benefits include being provided a legal defense against certain types of lawsuits. The policy explains that, when other sources of loss payment are available, the policy will begin any payment once the other source has paid its obligation. However, the policy will not pay for any amounts that exceed stated benefit amounts. The insurance coverage may be expanded, restricted, or made to comply with specific state requirements through the use of endorsements.

Generally, the insurer that provides coverage acquires the covered company’s legal right to pursue payment from a party that may have been responsible for a workplace injury.

Coverage provided to workers who are injured on the job is invaluable and is, primarily, via workers’ compensation protection. Such protection is framed by the Workers Compensation Act which addresses payment for medical treatment and disabilities. It also replaces, largely, the need for injured workers to have to sue their employers for compensation.

However, the nation’s workers’ compensation system has a lot of concerns including the following:

• Viability of workers compensation
• Federalization
• Affordable Care Act
• Holes in workers compensation
• Blurred lines between workers compensation and group health
• Options to workers’ compensation
• Evolving claims model
• Pending court challenges regarding coverage
• Bureaucracy

Workers compensation has traditionally been called the Grand Bargain precisely due to workers sacrificing a right to sue employers in place of the ability to depend on fair compensation when injured on the job. However, as is evident from the long list of issues, a number of important players are dissatisfied with the system. Insurers believe that it is plagued by arbitrarily high treatment costs and fraud. Legislators believe that it is inefficient and acts as a disincentive from business growth. Businesses see it as a burden that hampers profitability and substantially increases payroll expense.

Problems with proper worker protection are likely to increase as employers increasingly ignore the need to buy workers compensation coverage, even though it means breaking laws, facing fines and even criminal penalties. Yet, instances of absent or insufficient coverage persists due to increased use of misclassified employees, manipulation of submitted payroll information, abuse of worker contractual agreements and other problems. The increased presence of sharing economy workers also complicates matters.

If you have employees, it is imperative to seek out an insurance professional to assist you with fulfilling your protection obligations.