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People Who Are Not Employees

If you aren’t employed by the company, you aren’t going to be able to file a claim. Let us say that you are hurt on the job site, but you don’t work there, you aren’t going to be covered under what they have to offer to their employees. Know that this would go for visitors, family members, and other people who are not paid directly by the company. Their coverage would fall under other insurances the business may have.

People Who Are Subcontracted Employees

It is important to understand that if you are a subcontracted employer you are not covered under that particular employer’s compensation plan. You may be covered under one that is offered through the company that hired you, but the company that you are working for is not responsible for you. Make sure that you know who has your workers compensation insurance policy if you are a subcontracted or a temporary employee.

People Who Are Not Performing Job Duties

If you take a company truck home and you get in an accident when you are off of the clock, your workers compensation policy will not cover it. In order to be covered by workers compensation, you must be working, you can’t be off the clock and just hanging out, they aren’t going to cover it. Understand this so that you are aware of when you should make a claim through this insurance.

People Who Are Under the Influence of Alcohol or Drugs

If you get hurt on the job and you are under the influence of alcohol and drugs, they aren’t going to cover you with a workers compensation policy. The one thing that is specifically excluded on a workers compensation policy, and something that in most cases will almost guarantee that your claim gets rejected, is being affected by drugs or alcohol.

Knowing who is covered under a policy is very important. You want to make sure that you are well aware of the rules that go into a workers compensation policy so that you are familiar with it. You need to know what is covered and what isn’t and who is going to be covered so that you are set in case you need to make a claim and know what you should make a claim for.

Workers Compensation from the Beginning

Employee benefit systems similar to worker’s compensation have been found in ancient Rome, Greece and China where there were pre-determined payment schedules for workers who lost various body parts during the course of their labor. Throughout history, systems like this have existed but they did not exactly mirror the type of worker’s compensation benefits employers now must offer.

Most historians place the origins of modern worker’s compensation in Germany in the mid-1800′s. During the height of the industrial revolution, Germany’s government passed legislation that would protect railroad workers in the event of an on-the-job accident or injury. They were following the example of German worker guilds which provided certain benefits (including a disability payment benefit) to the guild members. As a socialist country, Germany was very concerned about offering social insurance programs and this model of worker’s compensation fit nicely.

In the 1880′s Workers’ Accident Insurance, a compulsory plan to provide for workers outside the railroad system who had had an accident on the job, was introduced. This was the first universal and formalized worker’s compensation plan.

Workers Compensation Progress through the Years

Workers’ Accident Insurance spread through Europe during the late 1800′s, though it was often called Workmen’s Accident Insurance, and by the 1890′s it had replaced England’s court run Employer’s Liability Act.

By the turn of the century, America had its own workers compensation plan in place with Maryland as the first state to adopt it. Unfortunately, the early plans in America placed a great burden on the injured employee. Instead of just showing the injury and receiving a benefit, the employee had to provide proof that he or she had been injured as a result of employer negligence. Then, after obtaining some sort of proof, the employee had to sue the company in order to be awarded benefits. While this protection was better than no protection, proving their case was difficult and many workers went through the time and expense of a court proceeding without ever receiving a benefit. By 1908, President Theodore Roosevelt stepped in and pointed out the one-sidedness of the present system.

Soon after, in 1911 to be exact, the state of Wisconsin adopted a new workers compensation law that allowed for a tradeoff between injured employee and responsible employer. Rather than forcing the employee to find the proof of the employer negligence and sue, the employer would automatically provide medical care and replacement wages to injured employees. But here is where the tradeoff came in; as a result of the benefits, the employee had to agree not to sue the employer for further damages. While we might credit President Roosevelt with this abrupt change of pace, the reality is more likely that the workers who were able to prove negligence under the old law and sue their employers were taking in more money for damages through lawsuits than employers might have to pay when taking care of the wages and medical expenses of every claimant. In addition, even the lawsuits the employers won had a price since they still had to take the time to defend themselves and had to bear the expense of legal counsel.

The one state that held out of the new form of worker’s compensation legislation was Florida. At that time, Florida had a very small population and no manufacturing jobs. But when Florida politicians decided to try and attract new residents and businesses to the state in 1935, they were forced to adopt the new worker’s compensation model.

If you’ve already got E&O, general liability and small business property insurance, aren’t you insured for just about everything? Why would you need to get workers’ comp and employers’ liability, too?

Besides the fact that many states have laws that require companies with W2 employees to carry workers’ compensation coverage, these policies simply provide coverage that other types of business insurance don’t. To protect their own interests, your clients want to be sure that you’re protecting yours.

Liability vs. other types of insurance

First, it’s helpful to understand the difference between a liability policy and other types of insurance coverage:

Liability policies are designed to protect your business from the high cost of covered lawsuits or similar insurance claims, and any settlements that a court orders you to pay as a result.

Other types of commercial policies, such as small business property or workman’s comp insurance, reimburse your business for all or part of actual costs on covered claims, such as the replacement of a damaged piece of hardware or medical bills.

So depending on what situation you may end up dealing with – a lawsuit, injury or physical damage to property – you’ll need different kinds of insurance to be fully covered. Different types of insurance policies address situations involving different people, too: Some respond to claims from clients and others outside your business, while others are designed for claims from your own employees or subcontractors.

How each policy responds

Let’s talk about how the various types of insurance policies would respond in the event of an on-the-job injury. Suppose one of your employees is working at a client’s site and suffers a serious back injury while moving a heavy piece of equipment:

Not covered under general liability. Your general liability insurance policy covers claims of bodily injury or other physical injury or property damage. It is designed to protect your business against the high cost of lawsuits stemming from incidents that occur on your premises or at other covered locations where you normally conduct business. If it were a client that were to sue you over an injury caused by you or one of your employees, your general liability policy would respond. But a lawsuit from one of your own employees, claiming that your business is responsible for his on-the-job back injury, wouldn’t be covered.

Not covered under property insurance. Your small business property insurance policy covers only property damages, not bodily injury. So if your employee drops that heavy piece of equipment after suffering the injury, this policy would pay for any damages caused to the equipment or the building — but it wouldn’t help pay your employee’s medical bills.

Not covered under professional liability. Your professional liability or E&O insurance policy protects you only against lawsuits in which a client alleges that your business’s negligent acts, errors or omissions caused them a financial loss. Again, no coverage for bodily injury to an employee.

Covered! Your workers’ comp policy covers your employee’s medical and disability expenses in the event of an illness or injury, such as this case. So, if your employee is going to miss work for a few weeks while he recovers, it will pay him a portion of the income he’ll lose. It will also pay any bills for doctor’s visits, medication, diagnostic tests, therapy or hospital stays directly related to the on-the-job injury. So, if your employee is hurt on the job and you have workman’s comp coverage, you won’t have to pay those costs out of pocket.

Your employer’s liability policy, typically included as part of a workers’ comp policy, protects your company should an employee claim that his or her injury or illness was caused by your company’s negligence or failure to provide a safe workplace. So if the employee in this case sues you, this policy pays legal fees and any settlement the court may order you to pay, up to stated policy limits.

But I’m just a one-person operation!

What if you don’t even have employees? Can your client still insist that you carry workers’ comp? In short, yes.

In many states, unless your client can show that you, its subcontractor, carry your own workers’ compensation insurance, you will be automatically covered under the hiring company’s policy, at the hiring company’s expense. And of course, your client doesn’t want that. So even if your state doesn’t require it for one-person companies, you may have to buy coverage just to meet your client’s requirements.

- Classify employees correctly. Your workers’ comp policy shows classifications, job descriptions and estimated payroll. Review it for accuracy, and contact your agent or carrier with questions or to make clarifications or changes.

- Consider a deductible. Typically, workers’ comp covers from first dollar, but most states allow deductibles, which earn you premium credits. Consider your claims history and the amount of the credit when making your decision.

- Drop your own coverage. Many states let owners or corporate officers take themselves out of the workers’ comp policy. That could lower costs, but would also mean you wouldn’t be covered for an on-the-job injury. Make this decision based on the type of business you’re in and the work you do. If you work primarily in an office or low-risk situation, this could be a good idea. But if you spend most of your day on construction sites or other potentially hazardous locations, your own coverage could be worth the cost.

- Ask about merit rating credits. In many states, smaller businesses that typically pay $5,000 in premiums or less may be entitled to a credit of 5 to 15 percent if they have not had any lost-time claims during a period designated by the carrier. Talk to your agent or insurer about what’s available and how you qualify.

- Start safety and drug-free workplace programs. These programs may qualify for premium credits. Most workers’ comp insurance companies assist their policy holders in establishing and maintaining such programs. Also, keep in mind that in addition to saving you on workers’ comp premiums, these programs can be beneficial in a variety of ways, such as creating a more attractive environment to top workers and as a marketing tool with safety-conscious customers.

- Keep accurate payroll records. Insurance carriers deduct “excludable compensation” (such as the difference between base and overtime pay, tips and some other forms of compensation) from your payroll to determine your premium, so keep detailed records. You need to report more than just the total wages you paid.

- Shop around. There was a time when all carriers charged the same rates, but those days are gone. Shop around for the best rates and support services.

According to data from the U.S. Census, employees in the United States are rapidly aging and many people over the age of 55 are still working. These numbers have increased by more than 50% over the last six years. With this in mind, there’s a way for employers and employees to prepare by actually changing the work environment, as well as taking caution with more safety initiatives. This is where employers and workers unions have a rare situation where they can genuinely work together for the betterment of both parties. Furthermore, as commodity and labor prices in the marketplace will fluctuate, worker’s compensation policy trends will also have to change as well. Group health insurance plans will increase, forcing workers compensation insurance to also change as the larger corporations force the insurance industry to also adapt.

Together with the problem of worker maturation, this presents a new field of pitfalls, which then cause finance problems essential in insurance policy formation. In addition to their employers, aging workers need to learn new methods to use modern assisted technology. If incidents do occur then, they’re more successfully dealt with in the workers compensation statements. While older personnel are more experienced and have less workplace injuries, they are from a financial standpoint, more expensive than newly hired younger staff. This provides an incentive and opportunity for employers to find younger workers to replace them. However, with the changes in broad demographic trends, the gap between the aging labor force and their replacements continues to grow. The growth of age-related health issues will also produce changes in work compensation.

In accordance with the US Bureau of Labor Statistics, in 2004, the states paid out over $56 million to assist workers; annually that amount continues to increase. In almost all of theses cases the injuries were physical incidents while the worker was attending to his official work duties at the assigned work place. Nearly half of the insurance budget set aside by the states is used for health care bills alone, and throughout 2007, workers compensation payouts rose to nearly $70 million. The statistics also stress the number one issue in worker’s compensation claims were again, physical related injuries.

The most beneficial way for the system to improve is to actually favor the older workers. However, as trends Indicate, the system needs some serious revision. For some employers, what might have been adequate in the past will certainly not suffice in the future. If workers compensation laws favor assisted technology, costs will go up for employers. This may reflect in the national economy as more regulations are applied in the different states. Assisted technology may have higher costs for the employers, but they will benefit society as a whole by reducing our government payouts in the form of injury compensation.

Typically, the immediate employer is responsible for paying all benefits. Which means if your contractor has a subcontractor employed by him, then that subcontractor needs to cover any employee he’s too. Every degree of subcontractor has to do the same thing, which means if your 5th level subcontractor, inside a large construction project, comes with an employee by having an injury; he needs to cover for it. However, in many cases it may be more complex than that. There has been many cases that went to the courts about who is responsible to cover any benefit. In most cases, the end result has always been exactly the same, and the immediate subcontractor needs to be the one. However, several cases have ended up differently. For instance, if the main contractor has significant say over what the employee does, then it may be they become accountable for the workers’ compensation as well.

But what happens when the subcontractor has no insurance? In these instances, then the next stage becomes responsible, all the way up to the main contractor. What this means is even when an employee fails for a specific company, that company may end up spending for his claims if he works best for among his subcontractors. This could cause major financial troubles for companies when they suddenly find out that some of their subcontractors aren’t covered. One way these businesses can protect themselves is by requiring an evidence of insurance, often a certificate they have, issued by the insurer. This way, the main contractor knows that anyone they hire is going to be covered, plus they won’t wake up with having to pay considerable amounts of money following a workplace accident.

Workers’ compensation is an important part from the work force, particularly in industries where accidents tend to be more common. Fortunately, subcontractors routinely have no issue getting their claims through, so when there is an issue, courts have usually sided with the worker, forcing the company to pay for. Even when no subcontractors, or even the primary one, will pay the needed money, then States typically have a fund set aside for such cases, although each contractor may suffer fines and costs. When employed in an industry where several levels of subcontractors exist, as with construction for example, it’s important to make certain all the paperwork is in order.

The majority of this kind of coverage protects workers who are doing contract jobs offsite or who get injured around the actual property of the business. Really the only rule that applies is that the employee must really be carrying out a project for the business when the accident occurs. They have to really be clocked in and this applies to car accidents too. If they’re driving to or from a job and are still on the clock then it is going to be covered.

For instance, say you working as a roofer for a company. You are using a nail gun and accidentally run a nail through your hand. Now on top of that fact that it’ll hurt a lot, the medical bills will start to accumulate quickly. There will probably be considered a fee for the ambulance ride, surgery and rehabilitation. Without workmen’s compensation insurance there might be a long wait before you get these paid for. On top of the wait you’ll probably still wind up spending for everything out of pocket. Workman’s comp is a great policy to have.

Workers comp insurance protects a business from a lot of bills that may occur from an accident. It covers bills, damages and several other activities that could occur from any sort of accident. Most often the medical bills are covered; however, often even the lost wages and death benefits are covered under this plan.

Something that should be paid close attention too is always that worker’s compensation insurance coverage is not health care insurance. It’ll only cover incidents that happen at the office or perhaps a work related job site. Medical insurance covers any kind of medical incident on or off the job, workers compensation insurance does not. On top of this you pay some for health care insurance as an employee. Employers cover the cost for worker’s comp. In many places today this kind of coverage is needed for businesses.

Nowadays companies are required to carry some type of insurance coverage in many places. Besides the proven fact that it is the law it’s a positive thing to possess. Accidents can and do happen all the time. They are especially likely in a workplace in which you use tools and therefore are often on project sites you might be unfamiliar with. In these instances it’s a great preventive measure to take order to possess your company as well as your employees covered. This can make sure that no one loses any money out of pocket for expensive medical bills that may result from an accident on the job. So cover your organization and purchase worker’s compensation insurance.

A brand new rule was recently published which requires every employer which has taken workers comp insurance to produce and post a workers comp notice in its place of business. Employers will also be required to post an Anti-Fraud Reward Program notice. Under one of the current rules, carriers are required to provide employers with a compensation notice, which is colloquially known as the “broken arm poster.” This incorporates the Anti-Fraud Reward Program poster. The reason the brand new rule was proposed ended up being to update the current rule, as well as to adopt the new and revised workers compensation notice posters. Keep in mind that this also includes the Spanish version of the poster.

The Bureau of Monitoring announced in September that it plans to add a more thorough explanation of bill review as well as an evaluation aspect of the claims audits. This can take place on January 1st, 2011. The explanation of bill review is expected to supply the health care recipient having a reason or reasons for the decisions some insurance company has made regarding reimbursement. The requirements for that upcoming Florida explanation of bill review are available in the administrative code, under Rule 69L-7. The requirements have not been changed since July in 2004.

Overall, the alterations to workers compensation in Florida which have recently occurred in addition to those don’t be surprised in the coming year will play a minor yet natural part in how workers connect to employers as well as their insurance companies. Both employers and workers are advised to keep their eyes open for just about any new changes to workers compensation (which may be done around the Florida workers compensation website), because the nature of the various intricacies of workers comp changes and can play a significant part in an employee’s (and the employer’s) life.

The development of your workers compensation premium has essentially two elements which determine your cost. The first element is determined by your classification which is the same for those restaurants. Advisory rates are produced by the National Council on Compensation Insurance for many states. Insurance providers either adopt these rates or apply for a deviation from these rates which may be either a credit or perhaps a debit.

The second element that determines your fees are your experience modification rating (EMR). The use of the experience modification factor adds another dimension for your insurance cost by adding what’s basically a risk financing component.

Your EMR is promulgated by using an intricate formula and is produced by comparing your actual states the expected claims of the restaurant of comparable size. It is through the use of this formula that you ultimately purchase a portion if not completely of your own losses. The EMR is calculated using the three prior year’s payroll and incurred losses. Some if not all from the claim you’ve in 2006 is going to be paid for in policy years 2007, 2008, and 2009.

For instance, an insurance policy effective 11/1/2007 would use payroll and incurred losses for that policy years 11/1/2003-04, 11/1/2004-05 and 11/1/2005-06 to develop the EMR. Many states now utilize the knowledge rating adjustment (ERA) which reduces all medical only claims by 70% before they are used within the calculation of the EMR.

A medical only claim of $4,000 will only use $1,200 in the calculation from the EMR. Conversely a $4,000 declare that was $3,400 medical and $600 in lost wages will use the entire $4,000 to calculate your EMR.

So how exactly does that affect your premiums?

Let’s take a restaurant in Illinois averaging $2,000,000 annually in payroll for the prior 3 years and no claims in years 2003-04 and 2004-05 only one $4,000 claim in 2005-06.

The experience modification factor for that 2007-08 policy if the $4,000 claim is $3,400 medical and $600 lost pay would be approximately .85. Looks great. You have a credit mod however, if the claim was medical only the modification factor would be .82 or 3% lower. This $4,000 claim will be used to calculate your EMR in a long time 2008 and 2009 along with the 2007 policy year.

There are several other factors within the formula for example expected losses, payroll and also the stabilizing value that effect your final modification. Unless there is a significant alternation in those factors the mod within our example would remain 3% higher for policy years 2007, 2008 and 2009.

Let’s translate that 3% into premium dollars. Depending on how much schedule credit (schedule credits are discretionary credits underwriters can use to workers compensation rating) is being put on a policy, using advisory rates in Illinois and a $2,000,000 payroll you’re talking about the absolute minimum premium difference of $1,800 at zero schedule credit to some savings of $1,100 per year in a 40 % schedule credit. These amounts would increase with increases in the advisory rates in subsequent years.

It’s not only vital that you implement coming back to work program and remain in touch with injured employees but it is essential to utilize an insurance company who has managed care arrangements with local doctors, clinics and hospitals in your town. This can allow you to make use of pre negotiated pricing for the employees care.