Protecting employees: Workers’ compensation vs. health insurance

Insureon Staff.
Where health insurance coverage ends and workers' comp coverage begins can be confusing for employers and employees alike. Learn about how the two insurance policies differ from one another.
Hands placed one on top of the other.

As a small business owner, you may already understand the basic differences between workers’ compensation insurance and health insurance. Workers’ comp covers workplace injuries and illnesses. Health insurance (including temporary and long-term disability coverage) is a benefit that many employers offer their workers for preventative care and medical expenses.

The difference between the two can sometimes be confusing, especially when a small business owner is trying to determine whether they should:

  • Offer health insurance (and particularly disability benefits) to employees
  • Purchase workers’ compensation insurance and health insurance as an independent contractor

Before purchasing insurance, there are a number of factors and legal obligations that each business owner should consider, such as the location of the company and their business type.

What’s the difference between workers’ comp and disability insurance?

Although workers’ compensation insurance and disability insurance both provide financial help to sick and injured workers who are unable to work, there a few key differences that separate the two policies.

Workers’ compensation insurance

Workers’ comp is a type of business insurance that pays for the medical treatment of injured workers when they experience a job-related injury or illness. Most states require businesses that have employees to provide workers’ compensation benefits.

Disability insurance

In general, health insurance benefits individuals by helping them pay for medical care that is unrelated to their work. Disability insurance is a type of health insurance that will help pay an individual’s lost income if they become disabled and are unable to work.

The federal government does not require Americans to carry health insurance, although Washington DC and the states of California, Massachusetts, New Jersey, Rhode Island, and Vermont do require individuals to have health insurance or pay a tax penalty.

While short- and long-term disability insurance policies are also voluntary, a few states, such as California, have state disability programs that offer mandatory coverage to all eligible employees.

The primary differences between the two coverages are:

  • Workers’ compensation insurance applies only to a work-related injury, while health insurance and disability insurance only apply to non-work injuries. Most health insurance providers exclude coverage for injuries and illnesses that are covered by workers’ comp
  • Workers’ compensation insurance is often a mandatory coverage for employers, while disability insurance is not. Even if you work in a state with a statuary disability program, you don’t have to pay for it on behalf of your employees (unless you want to, of course). Employees make tax-deductible contributions to fund these programs, unless their employer offers to cover the cost as a benefit

Though nearly every state requires employers to carry workers’ comp coverage for their employees, the specifics of the regulations vary from state to state. For example, some state laws require coverage even if you have only one employee. Others may require it once you hire four employees.

Does the Affordable Care Act require employers to offer health insurance to employees?

It depends on the size of your business. Employers with 50 or more full-time employees, including full-time equivalent employees, are considered an applicable large employer (ALE) and must provide minimum essential coverage for employees. You need to meet these requirements whether you offer a group health insurance plan or use self-insurance.

If you employ 50 or fewer employees, your business might be eligible to buy coverage through the Small Business Health Options Program, or SHOP Marketplace. Some states allow employees with up to 100 employees to buy coverage through SHOP.

If you have less than 25 full-time employees, your business may be eligible for a Small Business Health Care Tax Credit that covers part of your costs of coverage.

Depending on the size of your company, one option would be to have your employees buy their own private insurance through the marketplace and offer some level of reimbursement to your employees to help with their premiums, co-pays, and other medical costs.

Every employer that provides health insurance to its employees must file an annual return with the IRS that includes the taxpayer identification number (TIN) and coverage information for each covered employee.

Do freelancers and independent contractors need workers’ comp or health insurance?

View video transcript.

As a business owner you might be asking: Do I need workers comp if I have health insurance? The answer is no, and yes, depending on if you operate solely or if you have employees.

While workers' compensation insurance and health insurance both provide protection from illness and injuries, that's where the similarities end.

Workers' comp can provide several benefits if you or your employees are injured on the job or suffer from a work-related illness. And it's required in most states if you have at least one employee.

Health insurance can help pay the medical expenses for non-work related injuries or illnesses if you have fewer than 50 employees, you're not required to offer health insurance. But, if you have 50 or more, you may be obligated to offer this coverage.

When it comes to workers' compensation premiums, you must pay 100 percent of the cost. And with health insurance, you typically contribute a portion of the monthly cost with your employee paying the rest.

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Independent contractors and other “one-person shows” have slightly different insurance obligations than other small businesses. While health insurance is not required for individuals in most states, workers’ compensation isn’t so cut and dry.

If you are an independent contractor, freelancer, or another type of business owner with no employees, you are generally not legally required to carry workers’ comp for yourself. Most states require businesses with one or more employees to provide workers’ comp, but there are exceptions.

For example, California requires all employers with one or more employees to provide workers’ comp for any employee who regularly works in that state. Roofers are required to have workers’ comp, even if they’re a sole proprietor with no employees.

Missouri requires employers with five or more employees to provide workers’ comp insurance, unless you’re a sole proprietor, part of an owner partnership, or an independent contractor.

In most states you can buy workers’ compensation coverage from an insurance company. Workers’ compensation laws in North Dakota, Ohio, Washington, and Wyoming require businesses to obtain their coverage from a state workers’ compensation system.

There are a few other factors that independent contractors and other self-employed individuals need to consider when it comes to considering these policies, including:

Most health insurance plans exclude work injuries and illnesses

This is a gray area that requires a conversation with your health insurance provider. Most health insurance policies contain language that excludes coverage for occupational injuries and illnesses.

Some policies say that coverage is only excluded when the injury or illness can be covered by a workers’ comp policy – which is most of the time unless you are an independent contractor. In some states, you may be covered under a client’s policy because the laws consider contractors to be employees. In other states, you are on your own. Be sure to talk with your insurance agent in order to understand your exposures.

Some states consider subcontractors employees

Perhaps you don’t technically have employees, but you do occasionally hire out your work to a subcontractor or seasonal part-time help. In some states, these workers would be considered “employees” and necessitate workers' comp coverage.

Independent contractors may be able to forego workers’ compensation insurance and health insurance, depending on the laws in their state.

A workers’ compensation claim may include a death benefit

While not every employer offers life insurance, workers’ comp claims can act as a type of life insurance. If an employee dies from a work-related injury or illness, their workers’ comp can provide a cash benefit to the employee’s dependents. The death benefit amount and who may receive it depends on the laws in your state.

Some states allow ghost workers’ comp policies

If you need proof of workers’ comp insurance but don’t have any employees, a ghost policy may be a cost-effective option to consider. It can help you fulfill the terms of a contract or meet state requirements without paying a typical premium. However, ghost policies are also not available in every state.

If you think a workers’ comp ghost policy may be right for your small business, speak with an insurance agent to discuss your options.

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What other types of small business insurance should I consider?

Beyond worker’s comp, there are many types of insurance that small business owners should consider:

General liability insurance

General liability insurance is typically the first insurance policy bought by small business owners, because it’s often required for leases and contracts. It insures against common business risks, such as customer injury, customer property damage, and advertising injury.

Commercial property insurance

Commercial property insurance covers your business’s physical location and equipment in case it’s stolen, lost, or damaged. It may be required to sign a commercial property lease.

Business owner's policy (BOP)

A business owner’s policy (BOP) combines your general liability and commercial property insurance into one policy and usually has lower premiums than buying these coverages separately.

Commercial auto insurance

Commercial auto insurance is required in most states for businesses that own vehicles. It covers legal bills, medical expenses, and property damage if a business-owned vehicle is in an accident.

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What is the difference between workers’ compensation vs. disability insurance?
Although they are similar policies, workers’ comp protects both the employer and employees from the cost of job-related injuries and illnesses, while disability insurance covers an employee for medical issues that happen outside of the workplace.

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Complete Insureon’s easy online application today to compare insurance quotes from top-rated U.S. carriers. You can also consult with an insurance agent on your business insurance needs. Once you find the right types of coverage for your small business, you can begin coverage in less than 24 hours.

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