What Does Workers Compensation Insurance Cover?

Work Injury Claim Form - Banner Image for What Does Workers Compensation Insurance Cover Blog

Workers compensation insurance has a dual role. It protects your business as well as all of its employees. Workers compensation insurance in California covers the following benefits for employees who suffer a work-related injury or illness1:

  • Medical care: This includes reasonable and necessary medical treatment, such as doctor visits, hospital services, surgery, medication, lab tests, and physical therapy2.
  • Temporary disability benefits: These are payments for lost wages while the employee is recovering from the injury or illness. The amount is usually two-thirds of the employee’s average weekly wage, subject to minimum and maximum limits.
  • Permanent disability benefits: These are payments for any lasting impairment or loss of function caused by the injury or illness. The amount depends on the employee’s level of disability, age, occupation, and wages.
  • Supplemental job displacement benefits: These are vouchers to help the employee pay for retraining or skill enhancement if the injury or illness prevents the employee from returning to the same job or employer.
  • Death benefits: These are payments to the employee’s spouse, children, or other dependents if the injury or illness results in death. The amount depends on the number of dependents and the employee’s wages.

Workers compensation insurance in California does not cover the following:

  • Pain and suffering: Workers compensation benefits are based on the no-fault principle, which means that the employee does not need to prove that the employer was negligent or responsible for the injury or illness. Therefore, the employee cannot sue the employer for damages such as pain and suffering, emotional distress, or loss of enjoyment of life.
  • Punitive damages: These are damages that are intended to punish the employer for intentional or malicious conduct. Workers compensation benefits are the exclusive remedy for work-related injuries or illnesses, which means that the employee cannot seek any other compensation from the employer, unless the employer committed a serious and willful misconduct3.

States require businesses to purchase the insurance, so business owners in the pool and spa industry need to know what, specifically, it covers.

Workers Comp Protects Your Business

If an employee is injured at work, your business has no obligation to pay a worker who is absent and accepting weekly compensation payments. The employee who accepts workers comp payments relinquishes the right to sue your company and cannot claim damages for pain and suffering.

Workers Comp Protects Your Employees

The basic benefit is disability pay, up to a state-specified cap. This can sustain your sidelined staffer with weekly, tax-free income, generally about 2/3 of the average worker’s normal pay. Workers comp also covers:

  • Medical diagnostics and treatments for injuries or sicknesses an employee sustains on the job site, business-related events, or work-related travel.
  • Provisional benefits during the time a claim is disputed.
  • Hospital stays.
  • Survivors’ benefits if a person dies in a work-related incident.
  • Repetitive movement injuries.
  • Retraining and rehabilitation where appropriate.
  • Lump-sum payments in appropriate permanent disability cases.

What If the Worker Is at Fault?

Workers compensation insurance covers accidents caused by carelessness, regardless of who’s at fault. That said, states can have employees tested for drugs or alcohol use and can refuse to pay benefits if the accident happened while an employee was impaired.

There is no coverage for self-inflicted injuries, for employees hurt after starting a fight, or accidents that happened while a staff member flouted a company policy or a law.

Do All Small Businesses Need This Coverage?

Even if you own a small business and your state exempts employers with only a few employees, workers compensation insurance has value. Independent contractors are sometimes considered staff, especially if paid hourly, in the eyes of the state Workers’ Compensation Board or the courts.

Independent pool service owners get CPA discounts on workers comp insurance coverage, plus a variety of other insurance plans.

Joining CPA is easy. We look forward to receiving your application and helping you determine your insurance needs



Others as supplied and linked.