WORKERS' COMPENSATION INSURANCE
Providing your team with wage replacement and medical benefits
NEW YORK WORKERS' COMPENSATION INSURANCE BENEFITS
Workers' compensation insurance is vital for your businesses because it helps them cover the cost of medical expenses and lost wages for work-related injuries and illnesses.
Small businesses need workers' comp because:
In New York state, workers' compensation insurance is a requirement
Workers' compensation helps protect your most valuable asset – your workforce
A major claim can have a devastating financial effect on your business operations
Who needs workers’ compensation insurance in New York?
For almost all businesses in New York State, Workers’ compensation insurance is mandatory.
Workers’ Comp aims to cover your business in case your employee needs medical care or time off due to an injury that occurred in the workplace or a work-related disease – the policy can also cover legal costs if your employee sues you in case of an accident.
In addition, the policy includes benefits in case of death. These benefits are paid to the deceased employee’s beneficiaries for funeral costs.
What does a Workers’ Compensation policy cover?
Workers' compensation insurance covers legitimate workplace accidents. This includes incidents that occur off the employer's premises but only in the service of the job, such as injuries sustained while traveling for work or working remotely (on the clock).
Generally, by definition, any injury, illness, or disease that occurs out of, or in employment that was caused, contributed to, or aggravated by a specific incident should be covered by this policy. This includes any repetitive occupational disease that occurs while an employee performs their job over time, such as a rotator cuff tear from repeatedly reaching overhead or back injuries from heavy lifting.
Workers' Compensation insurance offers five basic benefits:
Medical care for the injured worker
Temporary disability benefits to make up for lost wages while the injured employee is recovering
Permanent disability benefits if an employee can't return to work
Death benefits are paid to a spouse, children, or dependents if the worker dies due to job-related injury or illness
Supplemental job displacement benefits, which pay for skill enhancement or retraining if the injured worker can't return to the job they had before the injury
What kinds of things are NOT covered under a Workers' Compensation policy?
While workers' compensation is no-fault, there are circumstances in which compensation does not cover injuries. Here are some common examples of cases not be covered by a Workers’ Compensation policy:
A worker intentionally inflicts their injuries or illnesses
The injury or illness occurs while the worker is doing something illegal
The employee wasn't on the clock
The worker's behavior was in clear violation of company policy or protocol
The employee was under the influence of drugs or alcohol
The injury occurs after an individual is laid off or terminated
Off the Clock
As a general rule, if an employee deviates from performing their job duties, i.e., does something for a personal benefit and is not furthering the business of the employer. Any injury that occurs during the period of deviation is not within the course of employment and, therefore, not covered. However, when the deviation stops and an employee returns to the normal course of their employment, any injury that would then occur is now covered. Keep in mind; if the deviation from the course of employment is solely for the employee’s benefit, the incident is not covered. If the employer does receive some benefit during the deviation, then the injury may be covered.
Coming and Going Rule
If an employee is injured on their commute to or from work, aka “coming and going,” this is not considered within the course of their employment and would therefore not be covered. There are, however, exceptions to this rule:
The employee's contract includes transportation to and from work;
The employees have no fixed place of work;
The employee is on a special mission for the employer
There are special circumstances the employee was furthering the business of the employer.
When the injury occurs where an employee would reasonably be expected to be during the course of employment while fulfilling the duties of their job, then it will likely be covered. A common example includes the employee parking lot. If an injury occurs while an employee is walking to or from a designated parking lot to the employer’s building, within a reasonable timeframe (before or after work), then they are usually entitled to workers’ compensation coverage because it’s a place they are expected to be while under the conditions created by the employer. Any similar situation created by an employer would likely allow an employee to collect worker compensation benefits under the Coming and Going Rule. Coverage may not apply if you were in the parking lot at a time when not expected to work or not engaging in furthering the business of your employer.
If an employee is leaving or returning to an employer’s premises and is injured while receiving medical treatment for a work-related injury (for example, while attending a physical therapy appointment), would they still be covered under workers’ compensation? Generally, yes, as long as there wasn’t a route deviation between the medical facility and the employer’s premises.
When an injury occurs due to horseplay – something that is not within the course of employment – it is generally not covered. But, if the employer is aware that horseplay activities are taking place and is either participating, ignoring, or condoning them, then the injury may be covered within the course of employment.
Company Sponsored Events
Company-sponsored events can present a gray area when it comes to covering injuries under workers’ compensation. On the on hand, if a company-sponsored event did not require an employee to attend, and there was no benefit for the employee beyond general goodwill, then the injury might not be covered. But if an employee felt obligated to go, that not attending the event would jeopardize their relationship with the employer or affect working relationships, then an injury at such an event may be covered. A common example we see (from a claims perspective) is at a company-sponsored softball game. Whether the injury would be covered under workers’ compensation would need to review on a case-by-case basis and consider factors including the number of employees attending, management attendance, company sponsorship (uniforms), and if there was an expectation for employees to participate.
Work From Home
An employee is typically deemed to be in the course and scope of employment while at home and furthering the interest of their employer. Therefore, if an employee is injured while at home during business hours and the injury is related to employment or only includes a minor deviation (bathroom meal), then the injury is generally compensable.
An employee is considered in the course and scope of employment while traveling on a company-sponsored business. Any injury suffered while traveling to, at, or from an airport, hotel, or external office is generally compensable. Any minor deviation or reasonable activity is generally acceptable. Examples include injuries sustained while in their hotel room, having a meal, or commuting between appointments. Unnecessary or larger deviations such as gentlemen’s clubs, sightseeing, and private recreational activities would not compensate.
If an injury occurs due to a fight between two employees, it will depend on what the fight occurred over. It would not be covered if the argument was over a personal matter not related to work. If the fight arose over a matter related to employment that was a function relative to work, then it may be covered.
Intoxication / Intentional Act
Intentional injuries are not covered. If an employee is under the influence of an illegal substance and intoxicated, and the intoxication is the sole cause of their injury, the injury is generally not covered. However, if other factors have contributed to the injury, and the employee was still present participle at the business, it may be covered even if the employee was intoxicated. For example, if another party is at fault in a vehicle accident, the injury is compensable regardless of any drug/alcohol usage influences.
How do Workers' Compensation Laws Differ from New York to other States?
Workers' compensation laws are regulated on the state level; hence they differ in their requirements and penalties.
Some states, like California, are "no-fault," meaning injured employees don't need to prove that their injury was the fault of someone else to receive benefits. In "fault" states, it's necessary to demonstrate who was to blame for an accident, making the claim resolution process longer and more arduous.
In Illinois, for example, employers are obligated to inform the workers' compensation insurance carrier if an employee is out for three days due to an injury. Other state requirements are different. In Georgia, an employee must be out of work for 7 or more days before the employer must notify the Board of Workers' Compensation.
How much does New York Workers' Compensation Insurance cost?
The average cost of workers' compensation depends on various factors, such as the number of employees, annual payroll, specific occupation, and the rate classification of the business
As a rule of thumb, small businesses that pay an average salary to their employee will pay around $600 per employee per year. However, the numbers could be really different, depends on the factors affecting the price.
How To Get Workers' Compensation Insurance?
Digital Agent will ask you to enter your business details and get covered in less than five minutes.
In most casees you'll receive an instant quote. If your case is complex, it may take a few more days.
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Abigail, our AI, is our most experienced agent. She will walk you through the buying process and help you understand the various laws, class codes, and underwriting involved with workers' compensation insurance.
Can I increase or decrease Workers’ Compensation coverages?
Usually, yes. On the quotation page, right before purchasing a policy, you’ll be able to adjust the coverage that works for you. Naturally, we have maximum and minimum limits to all coverages. If your coverage limits do not affect the premium, as this is regulated in the state of New York, we will select the highest coverage available and disable the option to modify it.
How can I lower my workers’ compensation policy price?
Your policy price (the ‘premium’) is mostly affected by your business category (e.g restaurant, a store, security company, etc), and your expected yearly payroll. A different coverage amount in certain states may affect your rates dramatically as well.