All U.S. employers, with very limited exceptions, are required to purchase Workers’ Compensation insurance. This state-regulated insurance provides state mandated medical and lost wage benefits to employees injured during the course and scope of their employment. Exceptions to purchasing this mandatory insurance include very small companies that do not meet the number of employees requirement, or in some cases, very large companies that prefer to self-insure this risk. An employer’s failure to comply with a state’s requirements will trigger economic penalties and possible criminal prosecution. A variety of Workers’ Compensation insurance programs are available from the employer’s risk finance perspective.
Exclusive Remedy & Employers’ Liability
Although each state’s regulations differ, they all share a common purpose. They provide an “exclusive remedy” in the form of a “no-fault” program for compensating employees in the form of medical benefits and lost wages in connection with injuries that arise in the course and scope of their employment. While Workers’ Compensation insurance responds to the “no-fault” consequences of workplace injury, Employers’ Liability insurance, which is typically joined with Workers’ Compensation policies, provides coverage for common law claims against the employer by the employee, their family or third-parties, if the claimant or plaintiff can meet the legal standard in their jurisdiction for establishing that the injury was caused by the employer’s negligence, gross negligence, recklessness or willful conduct.
The Broad Landscape of Special Funds and State Programs
Many states provide special funds to pay workers’ compensation benefits to injured workers employed by companies that failed to purchase insurance. Assigned risk pools or insurers of last resort are also available for employers that commercial insurers consider too risky.
There are currently four monopolistic states: Ohio, North Dakota, Washington and Wyoming. Puerto Rico and the U.S. Virgin Islands also operate under a monopolistic structure. These states legislated requirements that Workers’ Compensation insurance be provided exclusively by the state’s compulsory program. Commercial insurers may not offer Workers’ Compensation insurance in those four states, yet at least two of the states do allow limited opportunity for self-insurance for well-capitalized employers.
Competitive State Funds
In contrast to monopolistic state programs, Competitive State Funds are state-owned and operated insurance facilities that compete in the open market with commercial insurers to underwrite Workers’ Compensation insurance solely within their respective state.
Arizona, California, Colorado, Hawaii, Idaho, Kentucky, Louisiana, Maine, Maryland, Minnesota, Missouri, Montana, New Mexico, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Utah, and West Virginia operate Competitive State Fund programs.
Second or Subsequent Injury Funds
In most states it’s illegal for an employer to refuse to hire a prospective employee or terminate an employee if they have previously filed a workers’ compensation claim. To reduce the possibility of this form of discrimination, some states established a Second Injury or Subsequent Injury Fund. The purpose of these funds is to limit an employer’s (and their Workers’ Compensation insurer’s) exposure by reimbursing or covering the Workers’ Compensation benefits paid because of an aggravation or recurrence of a previously existing injury. Reimbursement eligibility requires that the injury must result from a qualifying permanent partial pre-existing disability, illness or congenital medical condition that may hinder person from obtaining employment.
Insurance Premium Calculation – The Loss Experience Mod Factor
This is a complex and often misunderstood concept that has a major effect upon a company’s Workers’ Compensation insurance premiums. On a general level, it is essentially a comparative analysis of your company’s Workers’ Compensation loss history for the prior three years against companies within the same or similar industries.