In addition to understanding the basics of Workers’ Compensation coverage and how to file a Workers’ Comp Claim, it’s also important to know what Workers’ Comp insurance does — and doesn’t — typically cover.
Please note that this isn’t a comprehensive list, and you should always consult with your agent or carrier to clarify provisions in your specific policy.
What Workers’ Comp Usually Does Cover
1. Medical Expenses
Workers’ Comp insurance can help cover treatment costs associated with a work-related injury, including emergency room visits, diagnoses, immediate medical treatment and ongoing doctor’s appointments.
2. Prescription Medications
Medications are an important — and potentially costly — part of rehabilitation following a work-related injury. If medications are deemed necessary by an employee’s medical provider, Workers’ Comp insurance can cover pain relief medications, antibiotics and prescribed medication therapy.
3. Rehabilitation Services and Physical Therapy
We’ve shared about the benefits of developing a return-to-work program as a way to reduce Workers’ Comp costs. Workers’ Comp insurance may aid in facilitating this type of program by covering rehabilitation services like physical therapy, chiropractic sessions and exercise prescribed by a doctor.
4. Travel Expenses Related to the Injury
If you’ve ever received the bill for an ambulance transport, you know it can be surprisingly expensive. Additionally, repeated trips to doctor, physical therapy or chiropractic appointments for a work-related injury can also mean frequent stops at the gas pump. Workers’ Comp insurance can help cover these travel expenses.
5. Lost Wages
In addition to return-to-work programs, Workers’ Comp insurance may reimburse employees for lost wages, helping them cover expenses during or after recovery from a work-related injury.
6. Mental Injuries
Many states are starting to recognize the reality of mental injuries in the workplace. Legislative and regulatory trends show that Workers’ Comp coverage of mental injuries, including treatment options, are changing. Because these trends are very state specific, it’s important to fully understand what exists for the states in which your business operates.
7. Permanent Disability Compensation and Ongoing Costs of Care
In some unfortunate cases, a work-related injury can result in permanent disability. This means an employee never returns to pre-accident condition, no matter how much surgery, physical therapy and/or medication is prescribed. Many states set limits on the monetary coverage awarded, usually a one-time payment. In the event an employee needs ongoing care, Workers’ Comp can cover that treatment and other expenses like live-in or home care.
8. Funeral Expenses
In the tragic event an employee loses their life in a work-related accident, Workers’ Comp insurance will help cover final expenses related to their funeral and burial.
What Workers’ Comp Doesn’t Typically Cover
1. Non-Employee Injuries
Workers Comp’ will not typically cover injuries incurred by independent contractors, freelance workers, volunteers or workers outsourced from other companies. If you fall into any of these categories, consider getting a quote for a “ghost” Workers’ Comp policy.
2. Injuries Related to Commuting
If an employee is in a car or bicycle accident while on their way to work, Workers’ Comp will not cover their injuries because they weren’t performing duties directly related to their job. However, if a worker’s duties require traveling in a company vehicle, accident injuries may be covered.
3. Employee Intoxication and Illegal Activities
If an employee drinks alcohol or uses drugs on the job and gets hurt, Workers’ Comp won’t help cover any related expenses. The same goes for an employee conducting any illegal activities while on duty.
4. Failure to Adhere to Safety Policies
Workers’ Comp will not cover an employee who doesn’t follow safety policies like wearing a hard-hat on construction jobsites or wearing non-slip shoes in a restaurant. Additionally, injuries related to unnecessary roughhousing or horseplay will not be covered by Workers’ Comp insurance.
Keep in mind that this is not a comprehensive list, and your specific policy may or may not have provisions that cover these items. That’s why we recommend connecting with your insurance advisor or carrier to determine the ins-and-outs of your specific policy. And if you don’t have Workers’ Comp insurance yet, click here for a quote today!
