workers compensation insurance

Workers’ Compensation

Workers’ Compensation Insurance

Workers’ Compensation is a type of policy that provides coverage for workers in case of accidents, occupational diseases, or deaths that occur while working. According to the state labor law, businesses with at least one employee are obligated to purchase workers’ compensation insurance regardless of whether they are a part‐time or full‐ time employee. When a business owner is found to have no workers’ compensation insurance, they are fined $1,000 per employee and business operations will be suspended.

What is included?

  1. Medical Benefit: Hospital expenses, treatment expenses, etc…
  2. Income Benefit: Compensation due to the inability to work.
  3. Death Benefit: Funeral expenses and compensation for bereaved family.
  4. Rehabilitation Benefit: Expenses for rehabilitation, treatment, equipment such as wheelchairs, and travel expenses.

Limits of Workers’ Compensation

Temporary disability benefits can range from a minimum of $169 to a maximum of $1,128 per week.

Permanent disability benefits range from a minimum of $169 to a maximum of $1,128 per week.

In cases resulting in death, funeral fees of $10,000 plus $250,000 for one dependent, $290,000 for two dependents, or $320,000 for three dependents.

How much is Workers’ Compensation?

Generally, insurance is calculated based on job classifications and manual rates.
Rates are predetermined according to the type of work an employee performs and the industry of work. High‐risk occupations, such as construction workers and roofers, are charged at higher rates whereas low‐risk occupations, such as office workers, have a lower rate. The basic insurance premium is calculated by multiplying the manual rate of the job class per $100 of payroll. At the time of purchase, the premium will be based on the expected payroll for the next year. *In the case of Corporation, LLC, or Partnership, the Payroll paid to persons with less than 15% interest shall be included in the premium calculation from January 1, 2017.

How to handle a claim

When you, the business owner, receive a report from an employee that they were injured while working, you must provide a Workers’ Compensation Claim Report Form within 24 hours. CA state law requires that the employer report the injury to the insurance carrier within 5 days.
The following Claim Forms will be included with the insurance policy:

    1. Employer’s Report of Occupational Injury or Illness, 5020 Form
    2. Employee’s Claim for Workers’ Compensation Benefits, DWC Form 1
      There is a form that employers and employees fill out together.

What is an Audit?

At the beginning of a policy term, the premium will be based off of the estimated payroll amount for the upcoming year. At the end of the year, the carrier will perform an audit to confirm the actual payroll amount. If the actual payroll amount is higher than the estimated amount from the beginning of the year, the policy holder is responsible for paying the difference in premium and in cases where the actual payroll is found to be less than the estimated payroll, a refund will be issued to the policy holder.

What is the Experience Modification Rate?

  1. This represents an accident claim amount of % compared to the average of the same business in the same industry, for example, 80% of the Experience Modification Rate will be discounted as much as 20%, and 150% will be paid an additional 50% of the premium.
  2. As of 1 January 2017, insurance premiums for the past three years are applicable to businesses with a premium of $10,100 or more.
  3. The period during which the claim amount is applied is based on the amount of the claim for an accident that has occurred for three years, before 4 years 9 month~ 1 year 9 months of Policy’s Anniversary Daye.

    (Ex) If the evaluation date of the insurance contract renewal date is January 1, 2017, the accident amount applied to the experience change is applied from April 1, 2012 to April 1, 2015 to April 1, 2015.

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