What Does Workers' Comp Insurance Cover?

Workers' comp insurance provides benefits to employees for workplace injuries without requiring them to prove their employer did anything wrong. The coverage pays for doctor visits and treatment, replaces part of an employee's paycheck during recovery and supports their return to work. While it protects businesses from injury-related lawsuits and gets injured workers the help they need quickly, specific rules determine what's covered, such as what counts as work-related and who qualifies for coverage.

Use this guide to know:

• TLDR What Does Workers’ Comp Insurance Covers Answers
• How workers' comp insurance works
• What workers’ comp insurance covers
• What business risks it doesn’t cover
• What worker’s comp is used for
• What to think about moving forward
• What you should do next

Workers' comp policies cover injuries that happen during the policy period, regardless of when claims are filed. An injury from January can be reported in March and still be covered, though most states require reporting within 30 to 90 days.

Your state's workers' compensation schedule acts as a benefits calculator that determines what injured employees receive. When an employee files a claim, the schedule looks at two factors: how serious the injury is and the employee's average weekly wage. These factors determine benefit amounts for medical treatment, wage replacement and other costs.

Here's an example: A construction worker earning $1,000 per week suffers a back injury that keeps them from working for three months. The benefits would be calculated this way:

• The state assigns a disability rating based on how severe the injury is and how it affects their ability to work
• Most states replace 60-70% of their average weekly wage, so they'd receive $600-$700 per week during recovery
• The schedule determines how long benefits continue based on whether the disability is temporary or permanent

Benefit amounts are set by state law, not negotiated case-by-case. Your insurer processes the claims and pays benefits according to your state's schedule under Part A (workers' compensation coverage). The exception is Part B (employers' liability coverage), where you choose limits that cap lawsuit-related payouts.

Workers' comp policies are divided into parts that cover different aspects of workplace injuries and your legal responsibilities. Part A provides benefits to injured employees, Part B protects your business from lawsuits, and Part C extends coverage when employees work in multiple states. Understanding these three parts helps you verify your policy matches your business risks and identify any gaps in coverage.

Part A covers medical care, lost wages, rehabilitation, and death benefits for employees injured or made ill by their job.

Part B, also called employers' liability, protects your business when employees or third parties sue you for workplace injuries that fall outside Part A coverage.

Part C extends your workers' comp coverage to states not listed on your base policy. This matters if you have remote employees, send workers to job sites in other states, or expand operations beyond your original location.

Workers' comp doesn't cover every employee injury or illness. Policies often exclude injuries that aren't truly work-related, situations involving employee misconduct, or cases where the injury's connection to work is unclear. We've outlined the scenarios your workers' comp insurance might not cover so you can recognize when a claim might be denied:

• Non-work-related injuries: Injuries that happen outside work hours, off company property, or during personal activities, even if the employee was on the clock
• Intoxication-related injuries: Injuries occurring when an employee is under the influence of drugs or alcohol, especially if intoxication contributed to the injury
• Employee misconduct: Intentional self-harm, fabricated or exaggerated claims, injuries during criminal activity, or injuries from fighting and horseplay unrelated to work duties
• Location and timing gray areas: Commuting to and from work usually doesn't qualify unless you're traveling between job sites or using a company vehicle. Injuries during breaks depend on whether you were on premises and whether the activity benefited your employer. Remote work injuries depend on whether the injury happened during work hours, in a designated workspace, and while performing job duties.
• Medical complexity cases: Pre-existing conditions that work may have aggravated and gradual-onset injuries like repetitive stress or occupational illnesses both require proving work was the primary cause.
• Independent contractor misclassification: If someone classified as a contractor is later deemed an employee, coverage becomes complicated

Workers' comp serves three main business purposes: meeting legal requirements, protecting your finances from unpredictable injury costs, and creating a structured process for handling workplace injuries. Use these purposes to help you determine whether workers' comp applies to your situation and why it might be necessary for your operations.

Workers' comp handles work-related employee injuries and keeps you legally compliant, but it excludes situations like non-work incidents and employee misconduct and doesn't cover broader business risks like customer injuries or professional errors. Think of it as your baseline employee injury protection that handles legal compliance and core injury costs, with gaps you'll address through documentation, claims management or additional coverage.

These quick answers address the most common questions about workers' comp insurance coverage and requirements:

Understanding how workers' comp works and what it covers helps you evaluate whether you need it and what to look for in a policy. Use these resources to check whether workers' comp is required for your situation and understand your state's specific requirements:

• Do I Need Workers’ Comp Insurance?
• Workers’ Comp Insurance Requirements