The Things about Workers Compensation Insurance You Should’ve Known Before

Every job brings certain risks of injuries – children playing around can accidentally hit the mailman with the ball, the librarians can fall off the ladder while looking for a specific book, and not to mention the number of accidents on construction area that happen every day. That’s why you should get familiar with workers compensation insurance.


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The number of injuries that happen during working hours increases day by day. Some of them are not a big deal, but sometimes they can cause serious problems that can affect your condition permanently.

Accordingly, it’s essential to check if your employer provides you with a workers’ compensation insurance – that way, the costs of medical treatment and loss of wages will be reimbursed in case you have an accident while at work.

Let's see a broader picture of workers comp coverage, as well as the employees' rights after the injury.

What is Workers’ Compensation Coverage?

Workers compensation insurance is designed to provide medical treatments and wage benefits to employees who got injured or ill while working. It pays death benefits to families of employees who died at work.

This type of coverage is required by law in most states (except Texas and New Jersey), and it is considered social insurance since it relies on the contract between management and labor. Hence, business owners are protected from lawsuits from their workers who suffered an injury.

Besides, it doesn’t refer to the injuries on the workplace only – for instance, if you have a car accident when coming back from a client, it is covered with workers comp policy since it’s observed as an injury while performing duties.

Who Purchases Workers’ Comp Insurance?

Employers purchase workers comp insurance policy. Still, not all employers are obligated to have one.

For instance, sole proprietors and freelancers don’t have to buy the policy, but it’s recommended to purchase one – that way, the workers compensation allows them to receive a partial income while they’re unable to work.

However, if the obligated employers don't have workers comp insurance, they can face serious problems – from paying expensive fines out of their pockets to going to prison.

What Does Workers Comp Cover?

As long as your injury is job-related, it will be covered with workers comp insurance. For example:

Lunch Breaks

If you get injured while picking up a lunch for your boss, or if you get hurt while eating in employee cafeteria or lunchroom, you could claim the workers comp. Still, if you do something inappropriate during lunch breaks, and if you, for example, start a fight, don’t expect the insurance to compensate for your medical treatment.

Company Events

In case of injury during special events organized by your company (picnics, sports events, parties), the insurance policy will reimburse the medical cost. However, the companies that don't expect their employees to participate in off-duty activities may not include this type of injury into the policy.


Workers comp will kick in only if:

  • You had an accident in a company vehicle
  • You were required to use your car for business purposes
  • You were performing particular tasks for your employer
  • You were traveling on a business trip

In most cases, workers compensation insurance will cover for the diseases caused by long-term job exposure, such as pain, loss of strength and coordination, reduced range of motion and flexibility, emotional illness, and similar issues.

Still, sometimes can’t be easily proven if the disease is job-related. Some states have different rules regarding this case, especially if it's about the emotional and psychical illness.

What Doesn’t Workers Comp Cover?

As you might assume, not all the injuries on work are covered with this policy. For example, if you get hurt while performing some forbidden activity, in most cases, the policy won't cover for it – again, it all depends on the state's law.

However, the following four situations are mostly unacceptable, and you can’t rely on insurance if you:

Try to Hurt Yourself or Your Coworkers

In case you’re trying to hurt yourself intentionally, or if you start a fight with your colleagues, the policy won’t cover any loss.

Commit a Crime

If you get hurt while doing any law-breaking activity, you won’t be recompensated for medical costs and treatments. The example would be trying to steal some sensitive cables, and you expose yourself to electric shock.

Get Drunk or Drugged

Employees who get intoxicated during working hours and get injured due to lack of conscious won’t be eligible for medical cost reimbursement.

Fool Around

If the workers’ foolish behavior causes some inconveniences, and someone ends up hurt, the workers comp insurance doesn't help.

Again, the treatment of the situations mentioned above won't be the same in all states and companies. For example, if the court considers fooling around as a regular part of the working environment and sees that such behavior is allowed by the employer, the insurance may reimburse the cost.

Workers' comp policy should also provide disability payments in case you are unable to work. Typically, it should give you two-thirds of your regular income.

Some states also pay for rehabilitation and retraining, depending on the type and seriousness of the injury.

How Does Workers Comp Work?

Now that you know the benefits of worker's compensation policy let's see how it works on a real example.

Let’s say that you broke a leg in a car accident when running an errand for your boss. To prove that your injury prevents you from working for some time, your employer will ask you to see the doctor designated by the company.

The doctor’s report will impact the benefits you receive – for instance, the doctors designated by employer or insurance company may minimize the seriousness of your injury or illness, so that you receive less money than you should.

However, you must be wondering if you could see your own doctor; again, it depends on the states. Some states allow you to go to your doctor after you’ve got injured, and others ask you to request for that while signing the policy.

You can also check if you can change the treating doctor in your policy if you are not satisfied with the one that did the examination.

Are All the Employees Covered with Workmans Comp?

Not all the employees are covered with this policy. Since all the states mostly have different laws, they exclude some types of employees – this workers comp exemption varies, but most states don’t provide the coverage for farm workers, volunteers, domestic employees, and seasonal workers.

Speaking of the question Who is exempt from workers compensation insurance, California has some rules regarding the business owner's spouse and family members:

In the first case, if you are a married sole proprietor, by the state of California, your spouse is automatically considered a co-owner of your small business – hence, he/she will be excluded from workers compensation insurance policy.

On the other hand, if you run a corporation or LLC (Limited Liability Company), your spouse won’t be excluded because you’re married, but the exclusions will be applied if:

  • Your spouse is a titled officer in the corporation
  • Your spouse owns shares
  • Your spouse is a member of LLC (if you run LLC)
  • Your spouse is one of the partners (if you formed a partnership)

Only if your spouse becomes a "regular" employee in your company, and if you put him/her on payroll, there's no reason for them to be excluded from the policy.

When it comes to family members, the rule is almost the same. If you hire your child, spouse, or parent to work at your company, you’ll need to include them in workers comp policy. Still, if your family members are partners or co-owners, they will be excluded.

What is Workers Compensation Insurance Cost?

Workers compensation insurance cost depends on many factors, which mostly include industry and location.

For instance, high-risk industries, such as construction, usually pay more money for the policy than, let’s say, accounting companies.

Also, the cost depends on the state. For example, for workers compensation insurance California pays from $0.40 to $14.63 per $100 covered payroll, which is the most expensive rate in the USA, while Texas has the lowest price, which is $0.31 per $100 of payment.

H&M Insurance – Find the Best Custom-Tailored Workers Comp Policies

H&M Insurance is a leading agency in providing financial protection against liability for work-related injuries. We offer innovative and cost-effective solutions, making sure that your business and your employees are entirely covered against unforeseen events.

We collaborate with the most prominent insurance agencies, such as Nationwide, The Hartford, FirstComp, and others, which allows us to create unique policies that meet everyone's needs.

Contact us today at (619) 296-0005 and learn more about the best workers comp San Diego has to offer.