U.S. Department of Health and Human Services

Accessing Workers' Compensation Insurance for Consumer-Employed Personal Assistance Service Workers: Issues, Challenges and Promising Practices

Susan A. Flanagan, M.P.H.

Westchester Consulting Group

June 7, 2004

PDF Version (172 PDF pages)

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This report was prepared under contract #HHS-100-02-0018 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Boston College School of Social Work. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, Pamela Doty, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Her e-mail address is: Pamela.Doty@hhs.gov.

The research reported herein was performed pursuant to a contract awarded to Boston College Graduate School of Social Work by the Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE). The opinions and conclusions expressed are solely those of the authors and should not be construed as representing the opinions or policy of Boston College or HHS/ASPE or any agency of the Federal Government.

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TABLE OF CONTENTS

ACKNOWLEDGMENTS

EXECUTIVE SUMMARY

I. INTRODUCTION

A. Scope of This Report

B. Methodology

C. Limitations of This Report

II. WHAT IS WORKERS' COMPENSATION?

A. U.S. Workers' Compensation System: A Historical Overview

B. What are Workers' Compensation Laws?

III. HOW DO WORKERS' COMPENSATION PROGRAMS WORK?

A. What Organizations Administer Workers' Compensation Systems?

B. What Benefits are Provided to Employees Under Workers' Compensation?

C. What Insurance Markets Provide Workers' Compensation Insurance?

D. What are Employment Classification Systems?

E. Establishing Workers' Compensation Rates and Premiums

IV. WHICH JURISDICTIONS AFFORD HOUSEHOLD EMPLOYERS ACCESS TO WORKERS' COMPENSATION FOR THEIR DOMESTIC SERVICE/PERSONAL ASSISTANCE SERVICE WORKERS? HOW DOES ACCESS VARY BY INSURANCE MARKET AND JURISDICTION?

A. Voluntary Insurance Market

B. Exclusive and Competition State Insurance Funds

C. "Insurers/Markets Of Last Resort"

D. Residual Insurance Market

V. HOW DOES THE COST OF WORKERS' COMPENSATION INSURANCE PREMIUMS FOR HOUSEHOLD EMPLOYERS VARY ACROSS JURISDICTIONS AND MARKETS?

A. Voluntary Insurance Market

B. State Insurance Funds

C. Residual Insurance Market

VI. ISSUES AND CHALLENGES RELATED TO THE ADMINISTRATION OF WORKERS' COMPENSATION SYSTEMS AND PROVIDING INSURANCE FOR DOMESTIC SERVICE AND PERSONAL ASSISTANCE SERVICE WORKERS

VII. PROMISING PRACTICES

A. Workers' Compensation Laws That Include Personal Assistance Services in the Definition of Domestic Service -- Hawaii

B. Including PAS in the Employment Classification for Domestic Service -- North Dakota

C. Developing a Classification Code for Personal Assistance Services Under Domestic Service -- Massachusetts

D. Developing a Workers' Compensation Program Specifically Targeted for Domestic Service -- Pennsylvania

E. Accessing Workers' Compensation Insurance Through the Voluntary Insurance Market -- Massachusetts

F. Accessing Workers' Compensation Insurance Through the Residual Market -- Arizona and New Mexico

G. Accessing Workers' Compensation Insurance for Domestic Service Through Homeowners' and Tenants' Insurance Policies -- New Jersey

H. Rate and Premium Setting Methodologies -- Massachusetts and Washington State

I. Using Minimum Premium Data to Develop Benchmarks for Workers' Compensation Premiums -- New Jersey, Idaho and Maryland

J. Using Fiscal Employer Agents to Facilitate Purchasing Workers' Compensation Insurance, and Invoicing and Processing Claims -- Massachusetts, New Jersey and Pennsylvania

K. Allowing Household Employers to Elect Workers' Compensation Insurance Coverage for Family Members Who are Paid Domestic Service Workers, Including PAS Workers -- Hawaii

REFERENCES

NOTES

APPENDICES

APPENDIX A. Domestic Service Worker Classification Codes by Jurisdiction

APPENDIX B. NCCI Workers' Compensation and Employer Liability Insurance Policy

APPENDIX C. Workers' Compensation Law Case Digests by Jurisdiction

APPENDIX D. Tables

TABLES

TABLE 1. Workers' Compensation Laws and Coverage Requirements for Domestic Service Employment by Jurisdiction

TABLE 2. Workers' Compensation Insurance Requirement, Self-Insurance and Penalties for Failure to Insure by Jurisdiction

TABLE 3. Voluntary Workers' Compensation Insurance Market by Jurisdiction

TABLE 4. Residual Market Minimum Premiums for Domestic Service Classification Codes by Jurisdiction

TABLE 5. Administered Pricing Minimum Premiums for Domestic Service Classification Codes by Jurisdiction

TABLE 6. State Insurance Fund Minimum Premiums for Domestic Service Classification Codes by Jurisdiction

TABLE 7. Inclusion of Domestic and Personal Assistance Service Workers and Treatment of Family Members as Covered Workers in Workers' Compensation Laws by Jurisdiction

TABLE 8. Workers' Compensation Administrative, Rating and Claims Appeal Agencies by Jurisdiction

TABLE 9. Top Twenty-Five Commercial Workers' Compensation Insurers

TABLE 10. State Insurance Funds and Pricing Methods by Jurisdiction

TABLE 11. Residual Workers' Compensation Insurance Market by Jurisdiction

TABLE 12. Availability of Workers' Compensation Insurance Through Homeowners' Insurance by Jurisdiction

TABLE 13. Challenges/Issues Reported by State Workers' Compensation Agency and Insurance Carrier Staff Regarding Administration of Workers' Compensation Systems and Providing Insurance for Domestic Service and Personal Assistance Service Workers by Jurisdiction

ACKNOWLEDGMENTS

A number of organizations and individuals made this paper possible. I am grateful to the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation for funding the study under the direction of Boston College Graduate School of Social Work. I also appreciate the assistance of a number of individuals. They include Justin Klotz who assisted with data collection and compilation, Philip D. Murphy, Esq. who assisted with preparing case law digests and for his thoughtful comments regarding workers’ compensation law and issues; and Aaron Grogg who assisted with the production of this report.

The paper also has benefited greatly from the efforts and thoughtful comments and suggestions of a number of individuals. I appreciate the thoughtful comments received from Kevin J. Mahoney, Ph.D., and Pamela Doty, Ph.D., Project Officers for the study, Charles Sabatino, Esq., Marie Squillace, Ph.D. and Larry O. Orr, Ph.D.

EXECUTIVE SUMMARY

Individuals with disabilities of all ages have greater access to publicly-funded, self-directed home and community-based services and supports than ever before (Flanagan, 2001). Some self-directed support service programs offer service recipients the option of being the common law (e.g., household) employer of their personal assistance service (PAS) workers. However, with greater choice and control come individual responsibilities and risk of liability. One possible risk of liability is associated with a PAS worker being injured on the job. One way publicly-funded self-directed support service programs can reduce the risk of liability for workplace injury for themselves and service recipients who are common law employers of PAS workers is by arranging and paying for workers’ compensation insurance.

Workers’ compensation in the United States is essentially a combined government and private “no-fault,” social insurance program, mandated by state or territorial law, administered by one or more state or territorial agencies and paid for entirely by employers. It provides medical, disability and other benefits (e.g., death and burial) for most workers whose injuries and illnesses “arise out of and in the course of employment” (Lencsis, 1998).¹

All 50 states, the District of Columbia and the five territories have enacted workers’ compensation insurance laws and administer systems. These laws and systems are specific to each state and territory and can be complex to understand and administer. A basic objective of workers’ compensation is that coverage under the law should be virtually, if not completely, universal. In most states, coverage is compulsory for employers with penalties for those who do not comply. However, for various historical, political, economic and administrative reasons, no state law covers all forms of employment. The most common classes of exempt employees are casual workers who work only occasionally or intermittently for a given employer such as domestic servants (U.S. Chamber of Commerce, 2002).

Many states and territories, at least informally, include PAS workers under the domestic service employment classification for workers’ compensation purposes. However, the majority of state and territory workers’ compensation agency staff report that the final determination of whether a service recipient’s PAS worker falls into the domestic service classification in a jurisdiction is often made by an administrative law judge when a workers’ compensation claim is disputed. Thus, public programs administering self-directed support service programs and service recipients enrolled in these programs face great uncertainty when trying to assess the obligation to provide workers’ compensation insurance coverage for PAS workers who work for service recipients in and around their homes.

This report focuses on workers’ compensation laws and systems as they pertain to domestic service workers, and in particular, PAS workers in 50 states, the District of Columbia, five U.S. territories and one tribal government² and addresses the following questions:

• How do workers’ compensation programs work?
• What states and territories afford individuals with disabilities who are household employers the opportunity to purchase workers’ compensation insurance coverage for their domestic service workers, and in particular for PAS workers?
• How accessible is workers’ compensation insurance coverage for household employers who hire domestic service, and in particular, PAS workers directly?
• How does the cost of workers’ compensation insurance premiums vary for household employers hiring domestic service/PAS workers across jurisdictions and markets?
• What issues and challenges have been reported by state workers’ compensation agency staff and insurance carriers regarding the administration of the workers’ compensation systems and the provision of insurance for domestic service and PAS workers?
• What promising practices have been implemented by jurisdictions to facilitate public programs arranging and paying for workers’ compensation insurance for service recipients who hire domestic service/PAS workers, thereby reducing the risk of liability related to workplace injury for state program agencies and service recipients?

Workers’ compensation laws and regulations, program material and related literature and published reports pertaining to domestic service, and in particular to personal assistance, were reviewed for each of the 57 jurisdictions. In addition, follow-up calls were conducted with key state and territorial worker’ compensation agency, insurance company and agent staff as needed to obtain information not readily available in the secondary information reviewed.

Key study findings include:

• All 50 states and five U.S. territories have enacted workers’ compensation laws and administer systems, however, they are specific to each jurisdiction and can be complex.
• Twenty-five states and two U.S. territories completely exempt and 22 states, the District of Columbia and two territories partially exempt domestic service workers from their workers’ compensation laws.
• All jurisdictions, except for Wyoming, allow household employers to elect coverage for domestic service workers who are exempt from workers’ compensation laws.
• The majority of jurisdictions’ workers’ compensation laws and employment classification codes do not clearly define domestic service or reference PAS workers in the definition.
• The majority of jurisdictions reported that PAS workers fall under the domestic service employment classification for workers’ compensation purposes.
• The majority of jurisdictions also reported that the final determination of whether a service recipient’s PAS worker falls into the domestic service classification is often made by an administrative law judge when a workers’ compensation claim is disputed.
• Publicly-funded self-directed support service programs and service recipients who are the common law employers of their PAS workers face great uncertainty when trying to assess the obligation to provide workers’ compensation insurance coverage for PAS workers.
• Publicly-funded self-directed support service programs can reduce/eliminate the risk of liability for workplace injury for themselves and service recipients who are the common law employers of their PAS workers and the uncertainty regarding coverage by arranging and paying for workers’ compensation insurance.
• In the majority of jurisdictions, access to workers’ compensation insurance through the voluntary insurance market is extremely limited for publicly-funded self-directed support service programs and service recipients (e.g., household employers), and in some jurisdictions it is “non-existent.” This is due in part to insurance agents and carriers having little incentive to broker/write policies for household employers due to small fees/premiums, significant administrative burden and costs and the perceived high risk of domestic service and PAS worker injury.
• Workers’ compensation claims experience for the Massachusetts Medicaid Personal Care Attendant Program and the New Jersey Personal Preference Program have challenged widely held assumptions regarding the perceived high risk of domestic service and PAS worker injury over the past three years.
• Household employers’ access to workers’ compensation insurance typically is greater through exclusive or competitive State Insurance Funds or through residual insurance markets (e.g., jurisdictions’ Assigned Risk Plans or Insurers of Last Resort).
• Eighteen states, the District of Columbia and two U.S. territories offer household employers the opportunity to purchase a workers’ compensation insurance rider on a conventional homeowner’s and tenant’s insurance policy for occasional domestic service workers with at least three states reporting that the option is mandated by law. However, there is a concern that filing a claim for workers’ compensation through a homeowner’s insurance policy could jeopardize the status of the household employer’s homeowner’s insurance policy (e.g., could be cancelled) and thus jeopardize their mortgage which may have homeowner’s insurance as a requirement.
• The cost of workers’ compensation insurance varies significantly by jurisdiction, with the residual insurance market premiums, in general, being the most costly. This insurance market is often the only option for household employers to purchase workers’ compensation insurance for their domestic service (e.g., PAS) workers.
• The most frequently reported issues/challenges reported by jurisdictions’ workers’ compensation agency staff regarding the administration of workers’ compensation systems and providing insurance for domestic service and PAS workers included:
  • Difficulty classifying PAS workers for workers’ compensation purposes (e.g., are they under domestic service or not; if not, what classification are they in?),
  • Limited access to the voluntary workers’ compensation insurance market for household employers,
  • Premiums for domestic service workers tend to be low and often do not cover the cost of losses incurred,
  • Workers’ compensation agency staff reported they do not many policies or claims related to domestic service so are not knowledgeable regarding the issues (e.g., PAS) and often do not have good premium and claims data to make policy with, and
  • In many jurisdictions, workers’ compensation insurance premiums have gone up for all employers including household employers.

Key promising practices include:

• Workers’ Compensation Laws That Include PAS In The Definition of Domestic Service -- Hawaii

  Hawaii includes the terms “attendant care” and “day care services” in the definition of domestic service included in the state’s workers’ compensation law. This clarifies the classification for PAS in the state’’ workers’ compensation law for household employers, PAS workers, publicly-funded self-directed support service programs and workers’ compensation hearing officers.

• Including PAS In The Employment Classification For Domestic Service -- North Dakota

  North Dakota includes the term personal assistance in its employment classification under domestic service for workers’ compensation purposes as “those individuals performing home help services or providing personal assistance or home care for persons who are convalescent, aged or acutely or chronically ill or disabled.”

• Developing An Employment Classification For PAS Under Domestic Service -- Massachusetts

  Massachusetts has developed an employment classification code, specifically for PAS workers (0918, Domestic Service, Inside, Physical Assistance) that clearly describes the tasks performed while keeping the classification under domestic service.

• Developing A Workers’ Compensation Program Specifically For Domestic Service -- Pennsylvania

  Pennsylvania’s State Workmen’s Insurance Fund (SWIF) has a program and a workers’ compensation insurance policy (Domestic Service Exemption Policy) that is specific to household employers who employ domestic service workers to work in and around their homes. It also has a designated staff who is well trained and knowledgeable regarding domestic service issues and SWIF policies and procedures. The application process has been streamlined and staff is easy to access for assistance.

• Accessing Workers’ Compensation Insurance Through The Voluntary Insurance Market -- Massachusetts

  Massachusetts has successfully recruited an insurance agent and a voluntary insurance carrier to broker and write insurance policies for over 9,000 persons with disabilities enrolled in the State’s Medicaid Personal Attendant Care Program rather than purchasing policies from the residual insurance market.

• Accessing Workers’ Compensation Insurance Through The Residual Market -- Arizona and New Mexico

  Arizona and New Mexico both have residual insurance markets that consist of both “insurers/markets of last resort” and Assigned Risk Plans. Having both options appear to increase small and moderate sized employers access to workers’ compensation insurance at more competitive prices. This approach has the potential of providing increased access to household employers who wish to purchase workers’ compensation insurance for their in-home domestic service workers including personal assistance workers.

• Accessing Workers’ Compensation Insurance For Domestic Service Through Homeowners’ And Tenants’ Insurance Policies -- New Jersey

  New Jersey provides the most comprehensive system for accessing workers’ compensation insurance through homeowners’ and tenants’ insurance by requiring all homeowners’ and tenants’ insurance policies to include an endorsement for workers’ compensation insurance for occasional domestic service workers. Homeowners and tenants can then purchase an endorsement for full-time domestic service workers. Workers’ compensation service endorsements for domestic service are available in both the voluntary and residual insurance markets in New Jersey. One concern regarding household employers accessing workers’ compensation insurance coverage through homeowners’ insurance policies is that a workers’ compensation claim could cause the insurance carrier to either significantly raise the household employer’s homeowner’s insurance premium or cancel the homeowner’s insurance policy, which often is a requirement for a mortgage. New Jersey covers this issue by providing workers’ compensation insurance coverage for occasional and full-time workers in both the voluntary and residual insurance markets.

• Rate And Premium Setting Methods -- Massachusetts, Maryland and Washington State

  Massachusetts and Maryland use the “per $100 payroll” and “per household policy” method to compute workers’ compensation insurance rates and premiums, respectively. These methods reduce the level of administrative burden for the household employer, his or her Fiscal/Employer Agent and the insurer, particularly when the household employer hires multiple PAS workers.

  Washington State uses the “per hour” and “per household” method to compute workers’ compensation insurance rates and premiums, respectively. The “per hour” method more accurately measures the risk of workplace exposure for multiple workers. However, to work effectively, good time reporting must be available for all workers.

• Using Minimum Premium Data To Develop Benchmarks For Workers’ Compensation Premiums -- New Jersey, Idaho And Maryland

  The minimum premium data presented in Table 4, Table 5, and Table 6 demonstrates the variability of workers’ compensation insurance rates by market and jurisdiction for similar employment classifications (e.g., domestic service). Jurisdictions can use this information to develop benchmarks to compare their workers’ compensation premiums and learn from other states’ experience. For example, the jurisdiction that has the lowest actual premiums for a standard domestic service workers’ compensation insurance policy from the voluntary and residual insurance markets is New Jersey. The actual premium for a standard workers’ compensation insurance policy for all occasional domestic service workers in a household is $16.00/household/year. The actual premium for a standard workers’ compensation insurance policy for a full-time domestic service worker is $76.00/year for the first worker and an additional $60/year for each additional full-time worker hired. Under the homeowners’ or tenants’ insurance workers’ compensation endorsement the premium is $1.00/policy/year for all occasional domestic service workers working in the home and $61/year for the first full-time worker and $60/year for each additional full-time worker working in the home. The premiums for the standard workers’ compensation insurance policy and the homeowner’s/tenant’s workers’ compensation endorsement for domestic service are the same for both the voluntary and residual insurance markets.

  Idaho and Maryland also offer low minimum premiums through a State Insurance Fund (e.g., $150 per capita for 0908-occasional and $175.00 per capita for 0913 -- full-time and $175 per household policy for 0913 -- part or full-time, respectively (see Table 6). However, Idaho’s minimum premiums for the residual insurance market are almost twice as much as the State Insurance Fund, whereas Maryland’s minimum premiums are the same in the State Insurance Fund as they are in the residual insurance market (see Table 4).

• Using Fiscal/Employer Agents To Facilitate Purchasing Workers’ Compensation Insurance, And Invoicing and Processing Claims -- Massachusetts, New Jersey And Pennsylvania

  In Massachusetts, New Jersey and Pennsylvania, Fiscal/Employer Agents participating in the State’ s self-directed support service program (e.g., MA Personal Attendant Care Program, NJ Personal Preference Program, and PA Attendant Care Program) will not process a payroll check for a worker unless the service recipient has a current workers’ compensation policy for his or her PAS worker(s). Thus, the Fiscal/Employer Agent ensures the publicly-funded self-directed support service program that workers’ compensation insurance coverage has been obtained for all service recipients and renewed annually.

  In each state, the Fiscal/Employer Agent(s) is the key contact that communicates with either the insurance agent, or the voluntary insurance carrier/State Insurance Fund/residual market administrator or both making sure initial policies are implemented and that policies are renewed in a timely manner. In addition, each state’s Fiscal/Employer Agent(s) is responsible for completing the Wage Statement Form that the insurer needs to accurately compute a benefit for an injured worker.

  In all three states, the Fiscal/Employer Agent(s) is responsible for paying the service recipient’s workers’ compensation premiums out of their public benefit. In Massachusetts, the insurer bulk invoices the four Fiscal/Employer Agents for the service recipients they represent, reducing the insurer’s invoicing efforts from 10,000 to four invoices per year.

• Allowing Household Employers To Elect Workers’ Compensation Insurance Coverage For Family Members Who Are Paid Domestic Service Workers, Including PAS Workers -- Hawaii

  Many states’ workers’ compensation laws are silent on whether family members who are paid domestic service workers, including PAS workers, may be considered covered workers. For the purpose of this study it was determined that these states allowed household employers to elect workers’ compensation insurance coverage for family members who are paid domestic service workers including PAS workers.

  Hawaii exempts family members who provide paid domestic services, including personal assistance services from its workers’ compensation law, but allows household employers to elect coverage for these workers. States should consider clarifying their workers’ compensation laws to allow household employers to elect workers’ compensation insurance coverage for family members who are paid domestic service workers including PAS workers.

I. INTRODUCTION

Over the past decade, individuals with disabilities and chronic conditions have had greater access to publicly-funded, self-directed home and community-based services and supports than ever before (Flanagan, 2001). Under the self-directed service delivery model, individuals have increased choice and control over the services they receive and the individuals who provide them. In some cases, service recipients have the option of being the common law (household) employer of their PAS workers and managing many, if not all, of the employer-related responsibilities.

However, with greater choice and control come individual responsibilities and risk of liability, particularly when the service recipient is the common law (household) employer of his or her PAS worker. One possible risk of liability is associated with a PAS worker being injured on the job. One way public programs can reduce the risk of liability for workplace injury for themselves and service recipients who are household employers of PAS workers is by arranging and paying for workers’ compensation insurance.

Workers’ compensation in the United States is a combination government and private “no-fault,” social insurance³ program that provides medical, disability and other benefits (e.g., death and burial) for most workers whose injuries and illnesses “arise out of and in the course of employment” (Lencsis, 1998). All 50 states, the District of Columbia and the five U.S. territories have enacted workers’ compensation laws and administer systems, however, they are specific to each jurisdiction and can be complex to understand and administer (U.S. Chamber of Commerce, 2002).

A basic objective of workers’ compensation is that coverage under the law should be virtually, if not completely, universal. In most states, coverage is compulsory for employers with penalties for those who do not comply. However, for various historical, political, economic and administrative reasons, no state law covers all forms of employment (U.S. Chamber of Commerce, 2002).

Whether non-business employment (e.g., domestic service) should be covered for workers’ compensation is a subject for debate. From a social policy perspective it has been argued that the ultimate goal of workers’ compensation should be protection for all employees since the losses due to injury for a non-business or domestic worker is no less serious that for an industrial worker. Others argue that workers’ compensation insurance is a “business expense” and as such, the cost of insurance should be passed along to the customer in the price of the product. In the case of non-business or domestic service, the workers’ employment “is not in the course of the trade, business, profession or occupation of the household employer.”⁴ As such, the household employer must assume the total cost of insurance directly.⁵ Larson, a national expert on workers’ compensation law, argues that non-business or domestic service employment should be exempt from workers’ compensation laws (Larson, 2002).

There are a number of barriers that can affect a publicly-funded self-directed support service program’s ability to manage the risk associated with a PAS worker being hired by service recipients being injured on the job and arrange and pay for workers’ compensation insurance on behalf of service recipients who hire PAS workers directly. The first is the lack of clarity in jurisdictions’ workers’ compensation laws and employment classification code language regarding the employment status of PAS workers hired directly by service recipients.

The majority of state and territorial workers’ compensation agency staff reported informally that PAS workers who work for household employers (e.g., service recipients) are included in the domestic service employment classification (see Table 7). These workers are also considered in the domestic service classification by the U.S. Department of Labor⁶ and Internal Revenue Service.⁷ However, the majority of jurisdictions’ workers’ compensation laws and employment classification codes poorly define domestic service and often do not specifically reference support service workers such as PAS workers (See Table 7). Thus, the final determination of whether a service recipient’s PAS worker falls into the domestic service employment classification for workers’ compensation purposes, is often made by an administrative law judge when a workers’ compensation claim is disputed. If an employer’s worker is found to be covered (non-exempt) under the law and the employer is determined to be out of compliance with the law, significant penalties can be levied and the employer may be liable for tort liability (see Table 2).

The second is cost. The household employer, or in the case of publicly-funded self-directed support service programs, the program agency must assume the full cost of insurance.⁸ This is because the service recipient, as household employer, is not engaged in a “trade, occupation or business” and this cannot pass the cost of insurance on to the customer through the price of the product (Larson, 2002). In addition, the cost of workers’ compensation insurance varies significantly by jurisdiction. They also can be significant, particularly if the service recipient hires multiple PAS workers and the jurisdiction uses a per capita methodology to establish rates and premiums for domestic service workers (see Table 4, Table 5 and Table 6).

The third is the concept and procedures related to workers’ compensation are not easy to understand and manage. Some experts in the field recommend using an insurance agent/producer that is familiar with a jurisdiction’s workers’ compensation law and insurance related administrative procedures in order to obtain appropriate access to the insurance and at a reasonable cost. Others, in particular state workers’ compensation agency staff, have reported that agents may not have an incentive to broker workers’ compensation insurance policies for household employers with voluntary or residual market insurance carriers. This is due, in part, to the size of the administrative fee they receive (e.g., $15-20/policy) and the amount of paperwork that is required to quote a policy and manage policy renewals with an insurance carrier.

The fourth is insurance carriers in the voluntary workers’ compensation insurance market often do not have an incentive to write workers’ compensation insurance policies for household employers due to low premiums, significant administrative burden and associated costs and perceived high risk of liability (see Table 3).⁹ The voluntary market’s disinterest in writing workers’ compensation insurance policies for household employers often results in the residual market being the only source of workers’ compensation insurance to them and public agencies operating self-directed support service programs. The residual market is considered the “market of last resort” and is the primary source of insurance for employers that are considered poor risks or have limited and/or poor claims experience. Workers’ compensation premiums can be significantly higher in the residual market than in the voluntary market or state insurance funds (see Table 4, Table 5 and Table 6).

So the key question for publicly-funded self-directed support service programs and service recipients is: “What is the best way to address the potential risk of liability associated with a PAS worker being injured on the job when the service recipient is the common law employer of the worker?”

A. Scope of This Report

This report focuses on workers’ compensation laws and systems as they pertain to domestic service workers, and in particular, PAS workers in 50 states, the District of Columbia, five U.S. territories and one tribal government¹⁰ and addresses the following questions:

• How do workers’ compensation programs work;
• What states and territories afford individuals with disabilities who are household employers the opportunity to purchase workers’ compensation insurance coverage for their domestic service workers, and in particular for PAS workers;
• How accessible is workers’ compensation insurance coverage for household employers who hire domestic service, and in particular, PAS workers directly;
• How affordable are workers’ compensation insurance policies for household employer hiring domestic service/PAS workers;
• What issues and challenges have been reported by state workers’ compensation agency staff and insurance carriers regarding the administration of workers’ compensation systems and the provision of insurance for domestic service and PAS workers; and
• What promising practices have been implemented by jurisdictions to facilitate public programs arranging and paying for workers’ compensation insurance for service recipients who hire domestic service/PAS workers, thereby reducing the risk of liability related to workplace injury for state program agencies and service recipients?

B. Methodology

The methodology for this analysis involved the review of a variety of secondary information sources related to workers’ compensation laws pertaining to domestic service workers, and in particular, PAS workers in 50 states, the District of Columbia and five U.S. territories and one tribal government. Materials reviewed for each of the 57 jurisdictions included, but were not limited to:

• Workers’ compensation laws and regulations,
• Workers’ compensation program and insurance carriers’ materials, and
• Related literature, including published reports.

Follow-up calls were conducted with key state workers’ compensation, insurance company and agent staff in each jurisdiction as needed to obtain information not readily available in the secondary information reviewed.

C. Limitations of This Report

The information presented in this report is the most accurate information available from both primary and secondary sources at the time it was collected. Efforts were made to cross-check the validity of the information presented whenever possible.

Secondary information related to workers’ compensation systems and how they apply to domestic service and PAS workers in state publications, including state web sites, was limited. As a result, agency staff in each of the jurisdictions had to be contacted on an “as needed” basis to “fill in the blanks.” When contacted, state workers’ compensation agency and private insurance agency staff’s interpretation of workers’ compensation law related to the domestic service classification, PAS workers and related policy and procedures was inconsistent. This was due, in part, to how the domestic service workers were include (e.g., either exempt or partially exempt) in the law in many jurisdictions. In addition, the percent of household employers who actually purchase workers’ compensation insurance in a jurisdiction is often small.¹¹

In addition, the accuracy of some secondary information varied. This was due in part to frequent changes in state workers’ compensation laws and policy from 1990 to the present and the timing of published reports.

II. WHAT IS WORKERS’ COMPENSATION?

Workers’ compensation in the United States is a combined government and private insurance program mandated by state or territorial law, administered by one or more state or territorial agencies and paid for entirely by employers. It is a no-fault social insurance concept, similar to no-fault automobile insurance, that mandates the payment of statutorily defined medical, disability¹² and other benefits (e.g., death and burial) to most workers whose injuries and illnesses “arise out of and in the course of employment” (Lencsis, 1998). In general, workers’ compensation is compulsory for employers and significant penalties may be levied for those who do not comply with the law (see Table 1 and Table 2).

All fifty states, the District of Columbia and the five U.S. territories have enacted workers’ compensation insurance laws and systems. They are specific to each jurisdiction and can be complex. A basic objective of workers’ compensation is that coverage under the laws be virtually, if not completely, universal. However, for various historical, political, economic, and/or administrative reasons, no state or territory law covers all forms of employment (U.S. Chamber of Commerce, 2002).

Exempt (non-covered) employees represent a relatively small percent of total employees, but they are important, especially with regard to employers’ liability insurance. The most common classes of non-exempt employees are “casual” workers who work only occasionally or intermittently for a given employer such as domestic servants and agricultural workers, minor employers who employ less than three, four or five workers, and domestic service workers. Currently, 16 states and one U.S. territory exempt minor employers with less than two three, four or five workers from mandatory coverage.¹³ Thirty-four states, the District of Columbia and one territory exempt “casual” employers or “any employee whose employment is not in the trade, business, profession or occupation of the employer” or both.¹⁴ Twenty-five states and two U.S. territories exempt domestic service from their workers’ compensation laws (see Table 1). In addition, 22 states and the District of Columbia and two territories partially exempt domestic service based on specific criteria (e.g., the number of hours worked or payroll for a certain period of time) (see Table 1). Finally, two states and one U.S. territory consider domestic service workers as non-exempt workers under each jurisdiction’s workers’ compensation law.¹⁵

Most state workers’ compensation laws use similar language to describe injuries that are covered under law. Such injuries must be caused by accidents “arising out of and in the course of employment,” means that the accident must be caused by a risk that is “closely,” “directly,” or “distinctly” associated with the employment.¹⁶ If the risk is not associated with the employment but with the employee’s own personal activities, it is considered a personal risk and the accident is never compensable (Lencsis, 1998).

A. U.S. Workers’ Compensation System: A Historical Overview

The current workers’ compensation insurance system in the U.S. developed as a result of the late 1800’s industrial expansion and the subsequent push to protect injured workers who were left with little recourse following accidents but to sue their employer for workplace negligence. Lawsuits rarely were successful due to the significant cost of litigation and the difficulty proving employer negligence (National Conference of Insurance Legislators, 2002).

States developed workers’ compensation laws in the early twentieth century as a means of providing prompt and certain financial relief for workers who suffer employment-related injuries or diseases. These laws established no fault compensation systems for injured workers covering expenses for medical treatment and lost wages. In 1911, Wisconsin enacted the first permanent workers’ compensation law (a 1910 New York statute had been declared unconstitutional). By 1949, each state had adopted its own, state-specific, workers’ compensation system. Currently, all 50 states, the District of Columbia and the six U.S. territories have enacted workers’ compensation laws (National Conference of Insurance Legislators, 2002).

The decades since the enactment of these laws have witnessed expansion of the workers’ compensation coverage across the country, including the establishment of self-insurance programs, state funds, and federally¹⁷ provided coverage. In addition, there has been a broadening of the kinds of injuries workers’ compensation covers, (e.g., soft tissue claims in addition to amputations and other related injury claims) (National Conference of Insurance Legislators, 2002).

In 1972, the National Commission on State Workmen’s Compensation Laws, created through the Occupational Safety and Health Act of 1970, issued a report offering 19 recommendations for improving workers’ compensation coverage, including increasing the benefit levels. The recommendations led to a number of states revising their laws and to a significant increase in costs. By the late 1980’s, the residual effects of the 1970’s statutory changes, combined with other market influences, resulted in soaring loss ratios and costs that rose between 10-15 percent annually (American Academy of Actuaries, 2000).

In the mid-1980’s, the workers’ compensation system was in crisis and the crisis lasted for nearly ten years. During this time, workers’ compensation costs rose much faster than general inflation. In state after state, insurers’ costs increased at a much faster rate than the premiums they took in, creating an instability that could not continue (Hager, 1995).

Reforms throughout the 1990’s addressed many aspects of the state workers’ compensation systems, including decreasing benefit levels, opening competition, instituting workplace safety incentives, and allowing for dispute resolution. The most significant changes addressed were related to medical cost containment (National Conference of Insurance Legislators, 2002).

Rather than overhauling workers’ compensation statutes, many state legislatures are evaluating and modifying the reforms currently in place.¹⁸ Simultaneously, the voluntary insurance market is “tightening.” Some report this tightening is due in part to the industry struggling to recoup from a series of years marked by high combined ratios, and more recently, the fallout of the September 11, 2001 terrorist attacks (National Conference on Insurance Legislators, 2002). Others report the tightening is due in part to the fact that in the mid-1990s, workers’ compensation insurers cut premiums and engaged in an all-out price war to win market share, feeding off high investment returns. Then the stock market crashed and, simultaneously medical costs rose dramatically (LRA, 2003).

In 1986, 870 private commercial insurers actively wrote workers’ compensation insurance in the U.S. In 2003, 791 commercial insurers actively wrote workers’ compensation insurance, a nine percent reduction in total carriers (A.M. Best, 1997 and 2003). One result of the tightening of the U.S. workers’ compensation insurance market reported by workers’ compensation and insurance agency staff has been an increase in the number of employers obtaining workers’ compensation insurance through jurisdictions’ residual markets.

There has been a recent increase in the number of household employers electing to cover their domestic service workers, and in particular, PAS workers, for workers’ compensation. Twenty-five states’ and two U.S. territories’ workers’ compensation laws exempt domestic service workers (see Table 1). All but one state (Wyoming) allow household employers to elect to cover their domestic service workers. State workers’ compensation agency staff recently reported:

Five years ago I could not tell you what the employment classification codes for domestic service were or what tasks were included under the codes. Now we are seeing an increase in household employers electing workers’ compensation insurance coverage for their domestic service workers. If this trend continues, we need to make sure the policies and procedures for classifying and rating domestic service, and in particular, personal assistance service workers accurately reflect the tasks performed and the associated risk.

Some state workers’ compensation agency staff reported that some insurance agents/producers are reluctant to broker workers’ compensation insurance for household employers with voluntary and residual carriers. This is due, in part, to low administrative fees (e.g., $15-20 per policy) and significant administrative burden and related costs.

It also was reported that the majority of voluntary insurance carriers are reluctant to write policies for household employers due to small payrolls, low premiums, significant administrative burden and related costs and perceived high risk of worker injury. As a result, state workers’ compensation and insurance agency staff are seeing an increase in the number of domestic service policies written by the state’s residual workers’ compensation insurance market.

A market conduct examination of the statistical reporting and experience rating procedures of the National Council on Compensation Insurance, Inc. (NCCI) under the examination authorities of the Oregon Insurance Division and twelve other participating insurance departments¹⁹ was performed by Arthur Andersen, LLP in 2001. Two findings of the review, (1) questionable classification code assignments and (2) employee misclassification, were attributed, in part, to the current employment classification code system being confusing and difficult for employers and insurers to use (Arthur Andersen, LLP, 2001).

As a result of the Arthur Andersen review, NCCI has implemented a new Classification Assurance Department that is focused on “systematic research, analysis and maintenance of NCCI’s classification system to ensure it remains healthy, viable and responsive to the needs of the industry (NCCI, 2003). NCCI’s research plan includes a review of codes related to personal care services. This review is forthcoming according to NCCI staff as of December 2003.

B. What Are Workers’ Compensation Laws?

Workers’ compensation laws define the responsibilities of the employer to provide prompt medical, disability and other benefits (e.g., death and burial) for injuries sustained on the job by workers, resulting in partial or total incapacity or death. In return, the employer is shielded from tort liability for those injuries (Lencsis, 1998). All 50 states, the District of Columbia, the five U.S. territories and the Navajo Nation have enacted workers’ compensation laws (see Table 1).

Workers’ compensation laws are either compulsory or elective. Under an elective law, the employer may accept or reject the law, but if rejected, the employer looses the three common law defenses -- contributory negligence, assumption of risk, and negligence of fellow employees. Practically, this means that all laws, in effect, are “compulsory”²⁰ (see Table 1) (US. Chamber of Commerce, 2002).

A compulsory law requires each employer within its scope to accept its provisions and provide for benefits specified (U.S. Chamber of Commerce, 2002). The majority of jurisdictions’ workers’ compensation laws are compulsory and in general, employers are required to purchase insurance at no cost to the employee. Employers who do not obtain insurance for their non-exempt employees are considered out of compliance with the law and may be subject to penalties and at risk of tort liability (see Table 2).²¹

Twenty-three states permit employers to waive their inclusion in the state’s workers’ compensation law under certain circumstances by obtaining a waiver.²² In addition, 49 states, the District of Columbia, and the five U.S. territories allow household employers to elect to provide workers’ compensation coverage for their domestic service workers if they are considered exempt employees (see Table 1).²³

1. What are the Basic Objectives and Underlying Premise of Workers’ Compensation Laws?

There are six basic objectives underlying workers’ compensation laws:

• To provide sure, prompt and reasonable medical and disability benefits to work-accident victims or income benefits to their dependents, regardless of fault;
• To provide a single remedy and reduce court delays, costs and workloads arising out of personal injury litigation;
• To relieve public and private charities of financially draining incidents associated with uncompensated industrial accidents;
• To eliminate payment of fees to lawyers and witnesses as well as time consuming trials and appeals;
• To encourage maximum employer interest in safety and rehabilitation through appropriate experience-rating mechanisms; and
• To promote frank study of the causes of accidents (rather than concealment of fault), thereby reducing the number of preventable accidents and consequent human suffering (U.S. Chamber of Commerce, 2002).

An underlying premise of workers’ compensation laws is that the costs of industrial accidents and diseases, like other costs of doing business, should be borne by the enterprise that engendered them. (King, 1988). Accordingly, the right to workers’ compensation benefits depends on the relationship of the injury to the victim’s work. There is no requirement that the employer have been “at fault.” (King, 1989).

There are two benefits for employers under workers compensation law. First, the remedies available (and the amount of the employer’s liability) under the workers’ compensation statutes are generally limited to medical, disability, death and burial benefits. There is no right to damages for pain and suffering or punitive damages in most states. In addition, workers’ compensation disability, death and burial benefits are typically subject to ceilings limiting potential recovery. Workers’ compensation benefits are usually paid periodically, as compared to lump sum recoveries in tort cases. Second, an employee’s right to workers’ compensation is usually the exclusive remedy against the employer for accidental injuries and occupational diseases falling within the coverage formula of the workers’ compensation act (King, 1988).

There are some situations where the worker may maintain a tort action. First, the immunity granted to the employer is not absolute. The employer is not immune when he intentionally injures an employee. In addition, some jurisdictions permit a tort action when an employer acts in a “dual capacity” with respect to an employee (Haas, 1989).²⁴

Second, should the workplace injury involve a person other than the employer, that victim is entitled to sue the third party in tort. Although there are variations, the general rule is that the tortfeasor pays the entire judgment to the victim and the employer is reimbursed for any workers’ compensation he has paid so that the victim does not receive a “double recovery.” So, even when the employer can be shown to have been negligent, he may not have to pay anything for the work-related injury (Haas, 1989).

2. How Do Workers’ Compensation and Tort Law Differ?

Some consider workers’ compensation a historic outgrowth of tort law. The two systems have similar goals, but there are significant differences between them in both their substantive and procedural rules. They also interact in various ways, most notably in the immunity from tort liability that workers’ compensation statutes grant employers (Haas, 1987).

There are three primary differences between workers’ compensation and tort law:

• First, unlike tort law, workers compensation is a no fault system. As long as the injury occurs from his/her employment and occurs in the course of work, a worker is entitled to compensation. Compensation does not depend on demonstrating that the employer was at fault, nor is it denied because the worker was at fault, except in extreme cases (Haas, 1987).
• Second, unlike tort law, workers’ compensation does not try to compensate the accident victim for the full value of his loss and does not try to make the worker “whole.” Instead, workers compensation replaces pecuniary losses incurred by the victims of work-related injuries. Workers’ compensation insurance fully covers the injured workers’ medical expenses, but only partially covers lost wages. In addition, it does not include any amounts for the injured worker’s “pain and suffering” nor does it include amounts for the loss of consortium²⁵ suffered by the worker’s spouse or children. Assuming the worker’s injury entitled him/her to recovery in tort, it is generally true that the tort judgment would be significantly higher than the workers’ compensation award (Hass, 1987).
• Third, the two systems differ in response time. Workers’ compensation is designed so that the qualifying victim receives payment soon after his/her injury. In a tort action, it can be months and perhaps years before the plaintiff can receive a judgement (Haas, 1987).

Regardless of the differences, the basic goals of the two systems are similar. Both systems’ goals are to compensate victims of accidents and both place the cost of such compensation, at least in the first instance, on the entity with a close causal relation to the injury. To the extent that the payer is able to modify the work situation that gave rise to the injury, the payment has a deterrent effect. It provides the payer and potential payers with an incentive for taking safety measures (Haas, 1987).

3. How Does an Employer Come Into Compliance With Workers’ Compensation Laws?

“Compliance” with workers’ compensation laws is a special term that refers to activities that an employer must do or refrain from doing under the law, other than paying benefits for compensable accidents. First, the employer must comply by either purchasing insurance to cover the entire liability under the law or qualifying as a self-insurer under the applicable rules. The latter option is rarely, if ever, available to household employers (Lencsis, 1998).

Second, in many states, employers must post a prescribed notice in a conspicuous place such as an employee bulletin board, in each place of employment. The notice usually advises the workers of the name of the employer’s current carrier and provides further information about how to make a claim (Lencsis, 1998).

Third, employers often are required to file a written report to the workers’ compensation administrative agency for every significant employee injury. Fourth, employers are often obligated to refrain from discriminating in any way against an employee who has claimed compensation or has been a witness in a compensation case. Finally, many laws provide that an employer may not enter into any agreement with an employee regarding a waiver or surrender of compensation benefits (any such agreement will be unenforceable) (Lencsis, 1998).

4. Should Non-business Employment be Covered Under Workers’ Compensation? The Case of Domestic Service

As discussed earlier, whether non-business employment (e.g., domestic service) should be covered for workers’ compensation is a subject for debate. From a social policy perspective it has been argued that the ultimate goal of workers’ compensation should be protection for all employees since the losses due to injury for a non-business or domestic worker is no less serious than for an industrial worker (Larson, 2002). Moreover, the 1993 Social Security Bulletin Annual Statistical Supplement goes as far as to say, “Workers’ compensation was the first form of social insurance to develop widely in the United States.”

Others argue that workers’ compensation insurance is a “business insurance” and that the associated costs are a “business expense.” As such, the cost of insurance should be passed along to the customer in the price of the product. In the case of non-business or domestic service, employees do not perform tasks in the course of a trade, business, profession or occupation of their employer. As a result, the household employer must assume the total cost of insurance directly.²⁶ Larson, a national expert on workers’ compensation law, argues that non-business or domestic service employment should be exempt from workers’ compensation laws (Larson, 2002). To date, many jurisdictions have followed this logic, exempting many categories of non-business employment including domestic service (see Table 1).

Due to the uncertainty some employers face in determining whether certain employees are truly exempt from the law,²⁷ all states and territories, with the exception of Wyoming, allow employers to elect to provide coverage for employees who are considered exempt. When an employer elects to provide coverage, states often require coverage be provided for all employees and that the employer formally notify the jurisdiction’s workers’ compensation administrative agency of his/her intent to provide or terminate coverage for exempt employees.

5. How are Domestic Service and Personal Assistance Service Defined Workers’ Compensation Laws?

In general, domestic service and personal assistance services are not well defined in workers’ compensation laws. Forty-five states and five territories do not define domestic service in the definition section of their workers’ compensation laws (see Table 7). These jurisdictions basically rely on the definitions included in the NCCI and state-specific domestic service employment classification codes to define the occupations and tasks included under domestic service including personal assistance services. For the six states who specifically define domestic service in their workers’ compensation law²⁸ (see Table 7), two states make no mention of PAS workers (NV and MI) in the law, two states include personal assistance in the domestic service definition (HI and OR) and two states specifically exclude personal assistance from the definition of domestic service if the services are provided to persons with disabilities (New Hampshire and Minnesota).

Hawaii’s workers’ compensation law §381-1(6), for example, defines domestic service to include “attendant care and day care services authorized by the Department of Human Service.” Oregon’s workers’ compensation law §656.026(1), in contrast, defines domestic service to include “home health workers.” New Hampshire’s workers’ compensation laws define domestic service to not including workers employed by individuals with disabilities.²⁹ In the case of Minnesota, individuals with disabilities whose workers receive payment for services rendered directly from the Department of Human Services are considered the employees of the state and not the household employer.³⁰

6. Are Family Members Considered “Covered” Workers Under Workers’ Compensation Laws?

A key feature of self-directed support service programs is that certain family members may be permitted to be paid support service workers for elders and individuals with disabilities.³¹ However, a family member, performing as a paid PAS worker, could be injured while providing personal assistance to their disabled or aged relative the same as a non-related worker. Therefore, a key question for self-directed support service programs is, under what circumstances are family members considered “covered” workers under worker’s compensation laws?

Workers’ compensation laws in 38 states, the District of Columbia and four U.S. territories are silent regarding the status of family members as “covered” employees (see Table 7). Therefore, it is assumed in those jurisdictions that family members are “covered” employees under the respective laws. State workers’ compensation laws in California, Hawaii and Idaho specifically exempt certain family members from coverage. In California, household employers may not elect to provide coverage for exempt family members, however, in Hawaii and Idaho, household employers may elect to cover exempt family members.

Nine jurisdictions have specific provisions for certain types of family members (Table 7). For example:

• In Connecticut, if, in any contract of insurance, the wages or salary of a member of the employer’s family dwelling in his or her home is included in the payroll on which the premium is based, then that person will be deemed an employee and compensated in accordance with the statute if they sustain an injury arising out of and in the course of his employment.³²
• Iowa workers’ compensation law exempts “members of the household” from coverage. The State defines a “member of the household” “as a spouse or relative of the employer, or a relative of the spouse residing in the household of employment.”³³ These individuals are ineligible to be covered under workers’ compensation in Iowa. Staff could not confirm if household employers could elect coverage for these individuals.
• In Kansas, no wages paid to an employee who is a member of the employer’s family by marriage or consanguinity can be used in the computation of gross annual payroll for workers’ compensation purposes.³⁴ In Maine, a parent, spouse or child of a sole proprietor, partner or bona fide owner of 20 percent of the voting stock may waive in writing all the benefits provided by workers’ compensation.³⁵
• Michigan’s workers’ compensation law §118(1) states that no household domestic servant shall be considered an employee if the person is a wife, child or other member of the employer’s family residing in the home.
• Missouri Revised Statutes §287.030(3) states “…an employee who is a member of the employer’s family within the third degree of affinity or co-sanguinity shall be counted in determining the total number of employees of such employer.” Domestic service workers, including paid family members, are exempt from the workers’ compensation law in Missouri. However, household employers may elect to cover these workers, including family members who are paid employees. In addition, Missouri Division of Workers’ Compensation staff volunteered that if a household employer elected to cover their domestic service workers for workers’ compensation, and had family members as paid employees, the insurance company would probably require that the family member be covered under the policy along with any other non-related employees.
• North Dakota specifically prohibits spouses and children under the age of 22 from being considered a covered employee for the purpose of workers' compensation.³⁶ In Oklahoma, an employee with five or less employees, all of whom are related by blood or marriage to the employer are exempt from the State's workers' compensation law. However, employers have the option of electing to provide coverage for these employees.³⁷
• Vermont does not consider members of the employer’s family dwelling in his/her house to be employees under the State’s workers’ compensation law. However, “if in any contract of insurance, the wages or salaries of a member of the employer’s family dwelling in his house is included in the payroll on which the premium is based, then such person must, in the event of his or her sustaining injury arising out of and in the course of his/her employment, be deemed an employee and compensated accordingly.³⁸

When designing self-directed support service programs that allow family members to be paid support workers, it is important for jurisdictions to understand how family members are treated for workers’ compensation purposes so that the service recipients’ risk of liability for worker injury can be minimized. In jurisdictions that exempt family members from the workers’ compensation law but allow employers to elect coverage, self-directed support service program administrators may want to consider arranging and paying for workers’ compensation insurance for these workers. In jurisdictions that exempt family members from the workers’ compensation law with no option for electing insurance coverage, this could result in a potential risk of liability for worker injury in the tort system.

III. HOW DO WORKERS’ COMPENSATION PROGRAMS WORK?

It is important to have a basic understanding of how workers’ compensation programs work in order to assess how they apply to household employers of domestic service and PAS workers of individuals enrolled in self-directed support service programs. The following describes the key characteristics of workers’ compensation programs.

A. What Organizations Administer Workers’ Compensation Systems?

The functions associated with operating workers’ compensation systems often are disbursed across a number of public and private entities and the number can vary significantly by jurisdiction. For example, in Alabama,³⁹ two state agencies administer the workers’ compensation systems, whereas in Oregon, at least seven public entities and one private entity participate in administering the state’s workers’ compensation system.⁴⁰

There are two primary functions that public and/or private entities perform related to the operation of workers’ compensation systems, administration and rating setting. The administrative function may be broadly divided into administering the law and system (e.g., making sure that all covered employers have obtained workers’ compensation insurance for their workers) and conducting hearings for the resolution of both claims and insurance disputes. Industrial commissions or divisions of workers’ compensation usually administer the law and system. In some instances, two state agencies may manage the administrative functions separately, one agency administers the law and system, making sure covered employers have insurance and overseeing and/or disbursing benefits, and the other resolves conflicts (e.g., initial claims disputes and appeals) (e.g., Oregon). These state agencies often have concurrent jurisdiction over claims, with the adjudicating board having superior power. In Alabama and Tennessee, courts administer the claims appeal function (see Table 8) (Nackley, 1989).

Evidence rules for workers’ compensation administrative hearings are different from those applied in courts, and the scope of judicial review is often narrow. Court review generally is limited to determinations of whether the administrative agency abused its discretion, made factual findings without evidentiary support, or made an error in law. In those few states that permit de novo review in court, the court rules of civil procedure usually obtain, but the issues that may be appealed are often limited to allowance of claims or of medical conditions (Nackley, 1989).

Wisconsin is a good example to illustrate the process some states use to resolve claims disputes and appeals. In Wisconsin, the administrative law judges for the Wisconsin Department of Workforce Development, Workers’ Compensation Division first review and render a decision on a particular issue when a claim is disputed. If the decision is appealed, it is first heard by the Wisconsin Labor and Industry Review Commission. In the event of a second appeal, the case goes to the State Circuit Court. The State Circuit Court decision may then be appealed to the State Appeals Court and then finally to the State Supreme Court.

The rate setting function may be performed by a State Insurance Fund or department of insurance (see Table 8). The primary responsibility of state departments of insurance is to regulate the insurance industry in a particular jurisdiction. Tasks may include, but are not limited to, enforcing insurance laws, in particular as they pertain to workers’ compensation, and overseeing, regulating, licensing, investigating and auditing insurance companies to ensure they remain solvent and meet their obligations to policyholders and for licensing and investigating insurance agents/producers. State insurance departments also are responsible for reviewing and approving insurance carriers’ policies and procedures, forms, and other filings including workers’ compensation loss cost multipliers and rates. They may also be responsible for reviewing and approving rating agencies’ rate analyses and filings, conducting hearings, assisting in the resolution of rate disputes and complaints from consumers about insurance companies and agents and providing educational information and assistance to consumers and other interested parties.

Some insurance departments delegate the data analysis and rate setting function to rating bureaus or advisory organizations. These entities collect and analyze data and prepare and rate information and rate filings to the insurance agency for review and approval. The insurance department often conducts regulatory hearings on the proposed rate filings as part of its approval process (Lencsis, 1998).

The largest rating bureau/advisory organization in the United States is the National Council on Compensation Insurance (NCCI), Inc. NCCI operates as a not-for-profit rating, statistical and data management service organization.⁴¹ NCCI products and services assist insurers, regulatory officials, lawmakers, and other industry stakeholders in making informed decisions that support the efficient economic functioning of the workers’ compensation system (NCCI, 2003). NCCI currently has approximately 900 affiliates and performs rating and other functions⁴² for approximately 40 states and the District of Columbia. NCCI does not provide services to any of the U.S. territories. Despite its name, NCCI is not associated with the federal government and does not operate in all states (NCCI, 2003).

There are eleven states that operate independent (e.g., single state) rating or advisory organizations and perform similar functions as NCCI.⁴³ Because of the structure of the State’s rating laws, Texas has no rating or advisory organization nor do the seven jurisdictions that operate exclusive (e.g., monopolistic) state insurance funds where private workers’ compensation is not available (Lencsis, 1998).

B. What Benefits are Provided to Injured Employees Under Workers’ Compensation?

There are a number benefits provided to injured employees under workers’ compensation. They include:

• Medical,
• Disability (income to replace lost wages),
• Scheduled Awards for Selected Injuries,
• Rehabilitation
• Survivor’ Benefits, and
• Funeral Expenses.

1. Medical Benefits

All workers’ compensation laws have one feature in common: they provide medical benefits that are unlimited in dollar amount and in time. They provide full compensation for employee injuries. As a result, medical benefits can be a very costly component of the claim from the insurer’s or self-insured employer’s perspective (Lencsis, 1998).

Although the term “medical” might strictly mean only services provided by physicians and hospitals, medical benefits in most jurisdictions include the services of dentists, chiropractors, podiatrists, psychologists, and other health care professionals. Medical benefits include not only reimbursement for professional service and hospital stays, but also items of expense associated with various kinds of health care, such as diagnostic tests, wheelchairs and crutches, prosthetic devices, other medical appliances, and medications (Lencsis, 1998).

In approximately half the jurisdictions, in order to reduce fraud, there are restrictions regarding the health care provider an employee can choose. In some jurisdictions, the employer is entitled to designate the provider at all stages of treatment, and in others, the employer may initially designate providers, subject to the employee’s right to change providers later during the course of treatment, for personal or other reasons. In a number of jurisdictions, medical benefits are further restricted by the use of fee schedules for physicians and other practitioners (Lencsis, 1998).

2. Disability Benefits

The second most important benefit is the disability⁴⁴ benefit. The worker is entitled to cash benefits to replace his or her lost income, generally for an indefinite period if the disability lasts that long. However, not all workers will receive this type of compensation because disability benefits are always subject to maximum amounts, which provide more than a subsistence level of income in many cases, but do not fully replace workers’ income in other cases. Disability benefits are usually calculated at 2/3^rd of pre-accident wages, subject to a maximum that varies by jurisdiction. In most states, the maximum is a function of an average wage that is derived from labor statistics. In some states (e.g., New York), the maximum is a fixed dollar amount (Lencsis, 1998).

Disability benefits may be payable for total disability (usually defined as a complete loss of wage-earning capacity, not just with reference to medical or physical incapacity) or for partial disability (e.g., reduction in wage-earning capacity due to the injuries sustained). Benefits are further categorized as temporary when an end to the period of disability is foreseeable and as permanent when the disability is expected to endure indefinitely or for the employee’s remaining lifetime (Lencsis, 1998).

3. Scheduled Awards for Selected Injuries

Scheduled awards for selected injuries are fixed amounts payable to the injured worker for the loss or loss of use of certain body parts and functions. They represent payment for a presumed permanent disability, regardless of any actual lost wages, and they include some component of an award for pain and suffering, or the closet thing to such a component that exists in the workers’ compensation field (Lencsis, 1998).

Maximum scheduled awards vary by jurisdiction. Some jurisdictions⁴⁵ do not used scheduled awards and pay benefits according to the actual degree of impairment of the injured worker in each case. Some laws provide for the award to be paid in a lump sum under some circumstances, but it is more common that the award is paid out over a number of years. Finally, jurisdictions differ in their treatment of temporary disability together with schedule award. Depending on the jurisdiction, the temporary disability benefit can be paid in addition to the scheduled award with or without limitation, or it may be deducted from the scheduled award (Lencsis, 1998).

4. Survivors’ and Funeral Benefits

Since workers’ compensation represents a substitute for tort remedies, it provides benefits to surviving spouses and dependent relatives of workers who die as a result of work-related accidents. Benefits are usually paid at the same rate as would apply if the worker were totally disabled. Payment to a spouse may be for as long as the spouse’s lifetime, but it is very common for spouse’s benefits to terminate with a lump-sum payment of two-years’ compensation upon his/her remarriage. Benefits to surviving children usually end at age 18 or 19 with an extension to age 23, 24, or 25 if the child is still a full-time student. Different jurisdictions provide for different adjustments when a spouse and one or more children survive the deceased worker. Finally, each jurisdiction’s law provides a funeral expense or burial allowance for a deceased worker that varies by jurisdiction (Lencsis, 1998).

5. Rehabilitation Benefit

Rehabilitation of injured workers is normally divided into two categories: physical or medical rehabilitation and vocational rehabilitation. Physical or medical rehabilitation refers to the regaining of full use of the body. Vocational rehabilitation refers to retraining and counseling in connection with the resumption of employment. The costs of rehabilitation of injured workers are frequently compensable in addition to medical benefits per se (Lencsis, 1998).

Many jurisdictions specifically require insurance carriers to provide one or the other, or both types of rehabilitation. Many jurisdictions also impose an obligation upon an injured employee to accept certain rehabilitation services as a condition to the continued receipt of full compensation benefits. Jurisdictions vary in their requirements related to the rehabilitation benefit (Lencsis, 1998).

6. Non-Taxability of Benefits and Protection From Creditors

Medical and disability benefits have traditionally been exempt from federal income taxes. This approach anticipates the fact that the payment is a reduced amount compared to what a worker would have received if they were on the job receiving full wages. In some cases these benefits are also exempt from personal income taxes in a given jurisdiction (Lencsis, 1998).

One of the social purposes of workers’ compensation is the prevention of destitution. As a result, workers’ compensation income benefits are invariably made exempt under state laws from creditors of the worker. These exemptions usually only apply to creditors who obtain a money judgment for contractual debts or for other reasons such as negligence in an accident situation (Lencsis, 1998).

C. What Insurance Markets Provide Workers’ Compensation Insurance?

The insurance markets from which an employer can obtain workers’ compensation insurance are:

• Voluntary insurance market (private insurers),
• State insurance funds (both exclusive and competitive),
• Residual insurance market,
• Self-insurance,
• Workers’ compensation endorsements on homeowner’s and tenant’s insurance, and
• Alternative workers compensation plans.

However, most household employers do not meet jurisdictions’ requirements to self-insure for workers’ compensation. The following describes the key features of these markets and the self-insurance and the homeowner’s insurance options for providing workers’ compensation to household employers.

1. Voluntary Insurance Market

The voluntary insurance market is comprised of private insurers who may volunteer or decline to write policies for employers based on their own underwriting criteria. In 2002, there were 791 private commercial insurers actively writing workers’ compensation insurance in the U.S. (A.M. Best Co., 2003). The number of active carriers was down from 870 in 1996, a nine percent reduction in industry capacity. The tightening of the voluntary insurance market is due, in part, to some mergers in the industry (e.g., Zurich Insurance Group and Farmers Insurance) and a number of economic and industry-related issues. Five states⁴⁶ reported that access to voluntary workers’ compensation insurance was “non-existent” for household employers in their states.

Companies writing workers’ compensation insurance may be organized as a stock, mutual or a reciprocal insurer (Lencsis, 1998). Table 9 includes a list of the top 25 commercial insurers writing workers’ compensation based on 2002 premiums. The leading workers’ compensation insurer in 2002 was the State Compensation Insurance Fund (SCIF) of California. The SCIF in California is a non-profit, public enterprise fund that operates much like a mutual insurance carrier and competes in the voluntary workers’ compensation insurance market. In California workers’ compensation insurance for domestic service workers (outside a homeowner’s insurance policy), can only be purchased from the SCIF.

Forty-five states, the District of Columbia and three U. S. territories have a voluntary market for workers’ compensation insurance and in many jurisdictions the number of insurers authorized to write workers’ compensation is significant (Table 3).⁴⁷ However, the majority of jurisdictions reported that access to the voluntary market for small employers, and in particular household employers who employ domestic service workers, is limited (see Table 3).

Writing workers’ compensation in jurisdiction’s voluntary market usually involves three distinct activities:

• Writing policies voluntarily,
• Participating in the state’s residual market as an assigned carrier or as a member of a pool that reinsures assigned risks, and
• Possibly participating in the residual market as a volunteer service carrier (Lencsis, 1998).

In the simplest case, an insurance carrier will write a certain amount of voluntary premium and pay assessments based on its market share to cover losses generated by the insured included in the state’s assigned risk pool. As an alternative, the carrier might agree to accept direct assignments. Many large insurers may wish to participate as servicing carriers, where they earn a fee for issuing policies and paying claims that are completely reinsured by a pool consisting of all licensed carriers in the state (Lencsis, 1998).

Included in the voluntary insurance market is a “default” market that has emerged over the past ten years in response to concerns that small and moderate sized employers had limited access to workers’ compensation insurance outside the residual market. Some are competitive state insurance funds and others may be mutual insurance companies developed specifically to service this population. For example, the State of New Mexico funded the initial development of New Mexico Mutual Insurance Company. An objective of the Company is to service small and moderate sized employers. Operationally, the State made the initial investment to start the mutual insurance company. Then New Mexico Mutual Insurance Company reimbursed the State for its initial investment over a five-year period. Although many have either an explicit or implicit mission to serve small to moderate sized business, their willingness to serve household employers varies by organization.

2. State Insurance Funds

State Insurance Funds are quasi-governmental insurance entities that provide either the sole or an optional source of workers’ compensation in a jurisdiction. State Insurance funds are either exclusive (some call “monopolistic”) or competitive (see Table 10).

Currently, five states and two U.S. territories have Exclusive State Insurance Funds.⁴⁸ They are called exclusive because they are generally the only permitted source of workers’ compensation insurance in a jurisdiction (e.g., private carriers may not write policies in these jurisdictions). In these jurisdictions the state insurance funds act more like a government benefit program than a business insurance program (Lencsis, 1998). Wyoming is the only state that operates an exclusive state fund that does not allow an exempt employer (e.g., household employer of domestic service workers) to elect to purchase workers’ compensation insurance for his or her workers.

Competitive Insurance Funds are primarily governmental or quasi-governmental entities that write workers’ compensation insurance in competition with private insurers (Lencsis, 1998). Nine jurisdictions have “Competitive” State Insurance Funds.⁴⁹ Some State Insurance Funds are not permitted to refuse coverage to an employer, no matter how undesirable the risk, so long as past and current premiums are paid (e.g., PA State Workers’ Insurance Fund). Others often have an explicit or an implicit mandate to serve small or moderate sized employers (e.g., AZ, OR) but may be able to refuse coverage in accordance with approved policies (e.g., State Compensation Fund of Arizona). For example:

• The State Compensation Fund of Arizona can refuse to write a policy for an employer based on approved policies and procedures. In this case, the employer has to go to the state’s Assigned Risk Plan to obtain coverage where they cannot be refused coverage.
• The Pennsylvania State Workmen’s Insurance Fund (SWIF) has a program and an insurance policy specifically for domestic service workers (PA Domestic Service Exemption Policy). The PA SWIF has streamlined the application process and has delegated a knowledgeable and customer-oriented staff person to address issues pertaining to the Domestic Service Exemption Policy.
• In California, the State Compensation Insurance Fund is the only insurer that writes standard workers’ compensation insurance policies for the domestic service classification. However, the Fund can require a household employer to demonstrate that he/she was unsuccessful in obtaining coverage through his/her homeowner’s insurance policy first before the Fund will provide coverage under a standard workers’ compensation policy.

Often competitive state insurance funds refer to themselves as the “insurer or market of last resort.” In some cases, they operate as the sole insurer for the residual market (e.g., Pennsylvania SWIF). Other times, a Fund may operate in addition to the jurisdiction’s Assigned Risk Plan (e.g., State Compensation Fund of Arizona as described above and the Arizona Assigned Risk Plan administered by NCCI).

Historically, state insurance funds typically did not sell or service policies through agents/producers and allowed employers to make applications directly. This eliminates a barrier for household employers to access insurance if agents/producers truly have little or no incentive to broker insurance applications with private or residual market insurers on behalf of household employers. Recently, this policy has begun to change with at least two state insurance funds (e.g., ID and MT) recommending that household employers consider using an agent to access insurance through the state insurance fund. Of all the competitive state insurance funds and mutual insurance companies currently acting as “markets/insurers of last resort,” the California State Compensation Insurance Fund reported the use of agents as “optional.” Six other states⁵⁰ recommend that household employers use an insurance agent/producer while three other states⁵¹ require the use of an insurance agent/producer to access workers’ compensation insurance through the organization (see Table 10 and Table 11).

3. Residual Insurance Market

In general, the residual insurance market is a mechanism established by individual jurisdictions to ensure that employers can obtain workers’ compensation insurance even if insurance carriers are not willing to write such insurance on a voluntary basis. Jurisdictions’ residual markets operate either through Assigned Risk Plans or specific insurers operating as “insurers/markets of last resort” (see Table 11).

The basic concept underlying any Assigned Risk Plan (sometimes referred to as the “Pool”) is the sharing, in an equitable manner among all licensed insurers within a jurisdiction, of the pool or residue of risk that individual carriers do not wish to insure through the voluntary market because of their undesirable underwriting characteristics. In the case of workers’ compensation insurance, these characteristics may include, but are not be limited to, (a) a lack of or poor claims history, (b) deficient safety conditions in workplaces, (c) the small size of the business to be insured, and (d) the low level of approved rates generally in effect for the line of business (referred to as rate inadequacy) (Lencsis, 1998).

Assigned Risk Plans are generally authorized by statute and are filed with and subject to approval by the jurisdiction’s regulatory authority. Key components of these plans include: (a) assigning applicants to carriers, (b) plan administration, (c) determining whether employers are eligible for coverage under the law, and (d) developing and implementing policy issuance requirements (NCCI, 2003).

In jurisdictions that have an Assigned Risk Plan, every insurance company that writes voluntary insurance in the state must participate in the Assigned Risk Plan by assuming a proportionate share of the cost of providing for a market of last resort. This can be done through a variety of mechanisms, such as participating as a direct assignment carrier or participating in a reinsurance pool as a servicing carrier (NCCI, 2003).

A reinsurance pool is an agreement among carriers to share in the operating results (e.g., revenues and expenses) arising from the plan assignments to servicing carriers. In some jurisdictions the relationship is voluntary, whereas in others, it is mandated by statutes or regulation. The largest of these “pooling” arrangements is the National Workers’ Compensation Reinsurance Pool (NWCRP) (see Table 11) (NCCI, 2003).

Forty-five states and the District of Columbia have some type of residual market available to employers. However, none of the U.S. territories have residual workers’ compensation markets available to employers (see Table 11).

Twenty-nine states and the District of Columbia have Assigned Risk Plans. Twenty are administered by NCCI. The remainder are administered by various state rating bureaus or advisory organizations that have a contract with the state’s insurance department to manage the plan (e.g., TN-Aon Risk Services, FL-Florida Workers’ Compensation Joint Underwriting Association, Inc. and MI-the Compensation Advisory Organization of Michigan) (see Table 11).

Often, employers must obtain a certain number of refusals (e.g., declination letters) from carriers in the voluntary market in order to access the jurisdictions’ Assigned Risk Plan. This could be considered a barrier to the residual market for household employers. Currently, Michigan, North Carolina and Wisconsin do not require any refusals to access their Assigned Risk Plan and Minnesota and Oregon require one refusal. In addition, 18 states⁵² and the District of Columbia require two refusals, Arizona, Idaho, Indiana, Kansas and New Jersey require three. Finally, Georgia requires four refusals to access the Assigned Risk Plan (see Table 11).

Some jurisdictions require an employer to use an insurance agent/producer to access workers’ compensation insurance through their Assigned Risk Plans. Some may see the use of agents as a way to facilitate access to an Assigned Risk Plan while others may see the requirement as a barrier. One reason why using an agent may be a barrier for household employers to access workers’ compensation insurance through an Assigned Risk Plan is that agents often have a disincentive to broker policies for individual household employers due to small fees and significant administrative effort. Twenty-two states’⁵³ and the District of Columbia’s Assigned Risk Plans require employers to use an agent in order to access their Assigned Risk Plans. The majority of these Plans are administered by NCCI. Alaska, Arizona, and Delaware recommend using an agent, while Michigan, North Carolina, Wisconsin do not require an insurance agent be used to access the state’s Assigned Risk Plan (see Table 11).

Residual markets also may be implemented through an “insurer or market of last resort.” These entities often are competitive state insurance funds or mutual insurance companies that have a contract with the state to administer the residual market (e.g., MO and PA-SWIF). Twenty-one states have “insurers/markets of last resort” that perform as the residual market for jurisdictions (see Table 11). These entities provide insurance to all applicants and may assume the total risk of loss for the residual market up to some pre-determined amount. In the case of Missouri, Travelers Insurance is the agent, administrator and service carrier for the State’s residual market. Travelers Insurance assumes all of the residual market risk up to a 100 percent loss ratio. Any additional losses are distributed across all of the insurers authorized to write workers’ compensation in the State.⁵⁴ Five states⁵⁵ have both an Assigned Risk Plan and a “default” voluntary carrier (“insurer of last resort”) that provides coverage to small and moderate-sized businesses (see Table 11).

4. Self-Insurance

Under the self-insurance option, large employers, usually upon depositing a surety bond, are allowed to pay directly the claims filed by their own workers and are given a great deal of discretion in administering their own risks. Self-insured employers are required to pay their workers the same benefits as workers would receive under private insurance or the state insurance fund. Self-insurance is not an option for household employers due, in part, to payroll size and the significant fiscal and due diligence requirements imposed by state and territorial governments.

5. Workers’ Compensation Endorsements On Homeowners’ And Tenants’ Insurance Policies

Some jurisdictions provide household employers with the option of purchasing workers’ compensation coverage for their domestic workers through an endorsement on their homeowner’s, or, in some cases, tenant’s insurance policies (see Table 12). Nineteen states,⁵⁶ the District of Columbia and two U.S. territories (AS and NMI) reported that household employers could obtain workers’ compensation for their domestic service workers through this option (see Table 12). A least three states, (CA, NH, NJ) reported that availability of the homeowner’s/tenant’s insurance option was mandated by law.⁵⁷

NCCI endorsements fall into two major categories: general and state endorsements. General endorsements are broken down into federal, maritime miscellaneous coverage, and exclusion, premium and retrospective rating. State endorsements relate to matters such as deductibles, cancellation and non-renewal, special rating plans, and employee leasing. An important endorsement within the miscellaneous category is the Voluntary Compensation and Employers Liability Coverage for Residence Employees Endorsement (WC 00 03 12 [Ed. 4-84]) (Appendix B). The endorsement was developed for use with Insurance Service Organization (ISO) homeowners’ insurance policies, comprehensive personal liability policies or other policies that provide similar personal liability coverage. The endorsement provides voluntary compensation and employers liability coverage for domestic service when not covered by a standard workers’ compensation policy.

NCCI has filed this endorsement for use in 39 states and the District of Columbia (see Table 12). However, 31 states (79.5%) reported either the endorsement was not being used or staff could not confirm that the endorsement was available for use. A number of states reported that property and casualty insurers (e.g., who typically write homeowners’ and tenant’s insurance) would be reluctant to write the endorsement, particularly if they did not have experience with workers’ compensation insurance. Moreover, they knew of very few carriers that actually wrote this endorsement with any frequency.

Some states have their own statutes that mandate the availability of workers’ compensation coverage for domestic service workers through a homeowners’ (or in some states, tenant’s) insurance policy. New Jersey Statutes Annotated Section 17:36-5.29, mandates that all homeowners’ and tenant’s insurance policies include workers’ compensation endorsement for occasional domestic service workers. The premium is $1.00/policy/year and covers occasional help (e.g., those who work less than 40 hours/week) working in and around the home. The endorsement also covers workers who may have occasional driving duties (e.g., taking the person to the store or doctor). A homeowner must inform their insurance carrier if they hire one or more full-time workers under the endorsement.

The annual policy fee for full-time domestic service workers under the homeowner’s/tenant’s insurance option is $1 plus $60/full time person hired /policy/year. The endorsement may be purchased from a voluntary insurance carrier or the residual market. Household employers also have the option of purchasing a standard workers’ compensation insurance policy from the state’s voluntary or residual markets.

California, Nevada, New Hampshire, New Jersey and New York and American Samoa mandate the availability of workers’ compensation coverage for domestic service. Section 11590 of the CA Insurance Code mandates the availability of a workers’ compensation endorsement for domestic service workers in a homeowner’s insurance policy if coverage is not already available through a separate policy covering domestics. Carriers must submit their rating for this endorsement to the State Department of Insurance for approval. Carriers are permitted to modify the endorsement and the criteria for coverage (e.g., define the number of hours worked in order for a worker to be covered). The cost of the endorsement varies by carrier and carriers may choose not to write or renew an endorsement for a household employer based on specific policies.

In Nevada, Title 53, Chapter 616B, Section 32 of the Nevada Revised Statutes permits a private carrier to provide industrial insurance (workers’ compensation) as a part of a homeowner’s insurance policy to a person who employs a domestic service worker. A covered domestic service worker is defined as an individual who is employed more than 20 hours per week or earns $150/month if he/she is not employed more than 20 hours per week. Private carriers may, with approval of the commissioner, determine and fix the premium rates.

In New Hampshire, Title XXII, Section 281-A:6 mandates that all insurance companies authorized to provide comprehensive personal liability, tenant’s or homeowners’ insurance must, in connection with such insurance, provide workers’ compensation insurance covering domestics unless the employer has a separate policy covering his/her workers. Premiums, rates and policy forms or endorsements used by a company to provide workers’ compensation insurance in accordance with the statute are subject to the approval of the insurance commissioner. The annual premium was quoted to be $3.00/policy. One drawback of the New Hampshire law is that individuals with disabilities can not take advantage of this option because the state’s workers’ compensation law prohibits a person with a disability from classifying his/her PAS worker as a domestic service worker. One state workers’ compensation agency staff person reported this feature was part supported by the state’s home health industry which has not supported the state implementing a self-directed support service model that allows individual service recipients to be the common law employer of their workers. Currently, New Hampshire only allows the Agency with Choice model to be used to implement self-directed support services where the agency and the service recipient have a “joint employment” relationship.

Since 1985, NY Insurance Law §3420(j) mandates that every homeowner’s insurance policy that provides comprehensive personal liability insurance on a one-; two-; three-; or four- family owner-occupied dwelling, must make available compensation coverage for employees who work less than 40 hours a week in and around the home, if and only if, they are covered employees under the law. The major shortfall of this provision is that domestic service workers are exempt from the state’s workers’ compensation law if the employee works less than 40 hours a week. Therefore, household employers who hire occasional domestic/PAS workers can not use this option and must purchase a standard workers’ compensation insurance policy to provide coverage for these workers (Stogel, 1998).

Colorado permits insurance carriers to provide workers’ compensation coverage through a homeowner’s insurance policy for occasional workers. Insurers can modify the endorsement to provide more coverage than insurance law requires. No statute or rate information was available from state agency staff.

With the exception of California, Colorado, Nevada, New Hampshire, New Jersey and New York, it is not clear how jurisdictions that reported the availability of workers’ compensation insurance coverage through homeowners’ and tenants’ insurance policies are administering the option and what it costs to purchase such an endorsement. Moreover, it is not clear how many carriers are writing the endorsement and how may household employers are purchasing it to cover their workers for workers’ compensation. Overall, the majority of state workers’ compensation and insurance agency staff contacted appeared to be not well versed regarding the availability and use of this option or the status of the endorsement filed with the state for use by NCCI for that purpose.

In the jurisdictions where the option is technically available, many workers’ compensation and insurance department staff reported that they knew of very few, if any, insurance carriers currently writing an endorsement for workers’ compensation for domestic service (outside of New Jersey, California and New Hampshire). It was reported that this was due, in part, to insurance carriers’ inexperience with workers’ compensation insurance and their perception that the domestic service classification group is high risk.

Finally, it may be “risky” for homeowners and tenants to have a workers’ compensation claim filed on his/her homeowner’s or tenant’s insurance policy that includes an endorsement for workers’ compensation insurance. Recently, there have been a number of articles in the press (both newspaper and television news), regarding the tightening of the homeowners’ insurance market and the difficulty that some homeowners have had filing insurance claims and subsequently having their homeowners’ insurance premiums significantly increased or their policies cancelled. For example, some insurance companies recommend that homeowners and tenants not file insurance claims under $500 to avoid either having their homeowners’ or tenants’ insurance premiums increased substantially or their policies cancelled. Although the prevalence of workers’ compensation claims for consumer-directed personal assistance has been low,⁵⁸ one claim could be for a significant sum, depending on the nature of the injury. Homeowners may not want to risk having their homeowners’ insurance premiums substantially increased or policies cancelled (since homeowners’ insurance is usually a requirement of a mortgage) by having a worker’s compensation claim filed. Once a homeowner’s or tenant’s insurance policy containing a workers’ compensation insurance endorsement is cancelled, it may be difficult or impossible for the consumer to find a worker’s compensation endorsement for domestic service available through a state’s residual workers’ compensation insurance market.⁵⁹ Thus, publicly-funded self-directed support service programs and program participants who are common law employers of their personal care workers may prefer to obtain a separate standard workers’ compensation policy for their personal assistance workers, and either a homeowner’s or tenant’s insurance policy.

6. Alternative Workers’ Compensation Plan

The final option available to household employers to access workers’ compensation insurance for their domestic service workers is an Alternative Workers’ Compensation Plan. Alabama, Georgia and Louisiana provide employers, including householders, the option of purchasing an Alternative Workers’ Compensation Plan. The Plan is commercial insurance purchased in the voluntary market from life-health insurance companies. It may consist of any combination of life, disability, accident, health, or other insurance provided that the coverage insures without limitation or exclusion all of the workers’ compensation benefits as defined in the State’s workers’ compensation law. Sometimes the coverage is sold together with employer liability policies issued by affiliated or non-affiliated liability insurers. In the absence of an affiliation, the liability insurer would normally be a joint venturer, or involved in a “strategic alliance” or similar group enterprise with the life insurer (Lencsis, 1998).

Alabama was the only jurisdiction that reported the availability of Alternative Workers’ Compensation Plans for employers. However, there was a reference to the availability of Alternative Workers’ Compensation Plans for employers in Louisiana and Georgia, but, no further details could be obtained.

D. What are Employment Classification Systems?

One of the fundamental tasks in pricing workers’ compensation insurance is developing a system for classifying different workplace exposures into a system of codes, each one with a rate commensurate with the associated risk. For example, the classification of a clerical worker should carry a significantly lower rate than the code for a roofer, because the average workplace exposures of the two types of employment are quite different (Advanced Insurance Management, 2003).

In approximately 40 states and Guam, the classification system used is the one originally developed and currently maintained by the National Council on Compensation Insurance (NCCI) (see Table 7). NCCI has developed and maintains approximately 600 classification codes covering a variety of workplace exposures including domestic service. NCCI publishes these codes in their manual, National Scopes Manual (NCCI, 2003).

In addition, a small number of jurisdictions either use a jurisdiction-specific code(s) that is included in the NCCI manual (e.g., MA, NV) or jurisdiction-specific codes that are maintained in jurisdiction-specific classification manuals (e.g., Puerto Rico) (see Table 7).

In general, the NCCI classification system seeks to classify the overall business enterprise of an employer, not the particular work performed by specific employees. For that reason, a janitor working at a manufacturing plan will be assigned to the overall manufacturing classification used by the plant, not to a janitorial classification. However, the NCCI classification system makes an exception to this approach for construction-type classifications. For these employers, multiple classifications may be assigned to employees, depending on the actual work done (e.g., a clerical worker versus a construction worker) (Advanced Insurance Management, 2003).

A basic tenet of an employment classification systems is, the more credible the data used to develop a classification, the better the classification will reflect the risks of workplace exposure associated with the business enterprise and the better the rates and premiums will cover the risk. When accurate and credible data are available, the classification system can be self-correcting, and codes can be updated as needed to reflect the new risk information.

Some might argue that developing codes solely based on the overall business enterprise, without considering the tasks performed by specific employees, does not accurately measure the risk of workplace exposure. For example, under the code 0913, Domestic Service, Inside (Full-time), the business enterprise provided in and around a residence is defined in broad terms.⁶⁰ However, the terminology used to define domestic service may not accurately measure the risk of workplace exposure, particularly for PAS workers. For example, the risk of workplace injury for a housekeeper providing chore services may be different than for a PAS worker providing both chore and personal assistance services.⁶¹

However, focusing solely on specific workers’ tasks, to the exclusion of the overall business enterprise, also may not accurately measure risk of workplace exposure. For example, workplace exposure for a domestic service worker providing chore and PAS for one household employer may be different than a PAS worker working for an agency-based provider who sends the worker out to multiple clients in different home-settings on a daily basis. This may be due in part because the agency-based PAS worker is serving more clients and traveling more, thus having more opportunity for injury.

In developing and maintaining employment classification codes, jurisdictions must address at least two issues. First, are a sufficient number of employers included in the employment classification code to provide meaningful risk information and to spread the risk and associated costs? Second, how should the jurisdiction balance the employer classification code’s ability to predict risk of workplace exposure with the time, effort and costs required to collect and analyze the required data to maximize the code’s predictive ability?

1. Are Personal Assistance Services Included Under the Domestic Service Classification?

Developing and maintaining employer classification systems and determining what the proper employment classification code is for a particular employer is not always an easy task. It is particularly difficult for household employers who employ PAS workers.

There are four NCCI employment classification codes that specifically apply to domestic/personal assistance services activities:

• 0908   Domestic Workers – Inside – Occasional,
• 0913   Domestic Workers - Inside (Full-time),
• 0909   Domestic Workers – Outside – Occasional – Including Occasional Private Chauffeurs, and
• 0912   Domestic Service – Out-Side (Full-time).

There is also code 0917, Domestic Service Contractor, which applies to employers furnishing employees under contract for domestic service performed inside a customer’s residence and includes operation of training schools. Since this category is not applicable for household employers, it was not included in the study.

The two codes that are primarily used for PAS workers are 0908 Domestic Workers – Inside – Occasional and 0913 Domestic Workers – Inside (Full-time). The two worker categories within these codes cited by workers’ compensation program and rating staff as reflecting personal assistance services are “nurse” and “companion.” Although the majority of state agency staff reported that personal care fell under domestic service primarily due to the “nurse” and “companion” categories they also reported that the final determination of a worker’s employment classification would be based on the results of a workers’ compensation claim appeal.

There are three tasks that may be performed by a PAS worker that are particularly troublesome for workers’ compensation program and rating staff to reconcile when determining what classification code PAS workers should fall into. These are:(1) assisting with the administration of prescription medication that would be administered by the individual in the absence of the disability, (2) providing occasional transportation, and (3) assisting with bowel and bladder and related health needs. The majority of jurisdictions reported that if a worker assists with the administration of medications, the worker would automatically move out of the domestic service classification category.

Jurisdictions were mixed regarding their approach to managing occasional driving. Workers’ compensation insurance staff in Maryland and Nebraska reported that occasional driving was included in classification code 0913. However, New Jersey Rating Bureau staff reported that if occasional driving was provided, the worker should be classified as 0912 Private Residences – Outside, Full-time (Appendix A), to reflect the increased risk associated with driving even though 90 percent of the workers’ tasks fall under Domestic, In-servant.

Some workers’ compensation agency staff reported being concerned with the potential risk associated with a PAS worker assisting with bowel/bladder and related health needs but had no clear policy on how they would address it except to say that they would review each situation on a case-by-case basis. Again, the final determination of what workers’ compensation employment classification a PAS worker assisting with bowel/bladder and related health needs would fall into, would be based on the result of a workers’ compensation claims appeal decision.

However, only classification codes 0918 Domestic Service Workers – Inside – Physical Assistance (MA), 9002 Domestic (ND), and 0912-011 Domestic Service and Housekeepers (PR) specifically include personal assistance/attendant care services (Appendix A). In addition, Wisconsin has developed policy separating PAS workers (e.g., home care providers hired by household employers) from domestic service. However, both domestic service and home care providers are exempt from the state’s workers’ compensation law and both types of workers are rated under the domestic service classification codes (see Table 7).

New Hampshire’s workers’ compensation law states that household employers with disabilities who have PAS workers cannot consider their workers as domestic servants (See Table 7). New Hampshire Title XXIII §281-A:2 V-b(a) states “Domestic labor or domestic services mean the performance of such duties as housekeeping, childcare, gardening, handy person work, and serving as a companion or caregiver for children or others who are not physically or mentally infirmed.” This law was supported by the state’s home health services industry that was opposed to the state implementing self-directed support service programs where the service recipient or his or her representative was the common law employer of the PAS worker.

Minnesota workers’ compensation law states that if funding for services comes directly from the State commissioner of human services, then the worker is an employee of the state for workers’ compensation purposes (see Table 7). Minnesota Statute 2002 §176 subd. 9(17) states that a worker who renders in-home attendant care services to a physically handicapped person, and who is paid directly by the commissioner of human services for these services, shall be the employee of the state within the meaning of this subdivision (workers’ compensation) but for no other purpose. This corresponds with an unemployment law in Minnesota stating that individuals with disabilities who receive public funds for their service may not be considered the employer of their workers. The Minnesota law was enacted in response to an unfavorable experience the encountered in treating PAS workers as independent providers (e.g., independent contractors).⁶²

Massachusetts has successfully blended aspects of both the overall business enterprise (e.g., domestic service) and employee-specific tasks for a PAS worker in developing classification code 0918 Domestic Service Workers – Inside – Physical Assistance (both part and full-time). The State has left the code under the domestic service classification (09) (which applied to household employers) while effectively describing the occupation of a PAS worker and the tasks he/she might perform for a household employer who may have a functional disability (Appendix A).

2. Workers’ Compensation Case Law Related to Domestic Service and Personal Assistance Service Workers

Ambiguities in workers’ compensation statutes frequently are resolved in favor of coverage and otherwise valid claims frequently are not denied on the basis of a technicality (Nackley, 1989).⁶³ This was seen a number of times in the case law reviewed for this study, in particular when a worker not covered under the statute filed a workers’ compensation claim when no insurance was available to cover the claim.

This study reviewed workers’ compensation cases that were related to domestic service and PAS workers decided in 16 jurisdictions⁶⁴ (see Appendix C). Five of them specifically involved publicly-funded support service programs.⁶⁵ A number of themes emerged from the cases reviewed.

The majority of the cases reviewed involved whether there is an employer-employee relationship⁶⁶ – a pre-requisite to the obligation to provide workers’ compensation insurance coverage – or the nature of the employee’s services⁶⁷ – which are sometimes partially or fully exempted if they are considered domestic services or do not meet minimum weekly hours worked. The decisions are often fact-specific or rest on creative legal theories not likely to be known to or anticipated by household employers, service recipients or self-directed support service staff. Workers with professional licenses, in some cases, are considered independent contractors (e.g., registered nurse, licensed therapist), not employees, and are therefore are deemed outside the protection of the workers’ compensation system.⁶⁸ If the services are deemed to be for an individual rather than for the household in general⁶⁹ or include sufficient practical nursing⁷⁰ then coverage might be found because it is determined that the common domestic service exemption does not apply.

The tendency of a workers’ compensation law judge to attempt to find coverage for an injured worker under the workers’ compensation system is sometimes counterbalanced by concern for household employers who face great uncertainty about their obligations to provide coverage and their inability to pass on their coverage costs to some type of customers.⁷¹ On the other hand, sometimes courts and administrative agencies go to great lengths to find an employer that will afford coverage, stretching employment concepts to find a “dual employment” relationship with employers that do not benefit from relevant exclusions from coverage. For example, decision makers might find that a domestic service exclusion applies to protect a household employer from the obligation to provide coverage but nevertheless find an obligation for a state agency to be an employer by virtue of its role in funding or other aspect of the worker’s employment.⁷²

Finally, in one state, it appears that the state workers’ compensation hearing officers were confused about the role of the Fiscal/Employer Agent operating under section 3504 of the IRS code for publicly-funded self-directed support service programs. In both Pennsylvania workers’ compensation settlements, the workers’ compensation hearing officer required the Fiscal/Employer Agent to provide workers’ compensation insurance coverage for the worker even though the service recipients had separate workers’ compensation insurance policies executed through the State’s Domestic Service Exemption Program for this purpose.⁷³

The only thing that one can say with certainty after reviewing the cases cited in this study is that a household employer faces great uncertainty when trying to assess the obligation to provide workers’ compensation insurance coverage for a worker providing personal assistance services to a member of that household. One way to address this uncertainty is for the household employer, or in the case of publicly-funded self-directed support service programs, the program agency, to arrange and pay for workers’ compensation insurance for personal assistance workers who work directly for service recipients in and around their homes. However, state self-directed support service program staff must make sure that state’s workers’ compensation agency staff, including the division responsible for claims adjudication, are fully briefed on the key features of the program and the Fiscal/Employer Agent function. Hopefully, this will prevent issues such as those that occurred in Pennsylvania from occurring in the future.

E. Establishing Workers’ Compensation Rates and Premiums

A number of methods are used by jurisdictions to establish workers’ compensation rates and premiums. The following describes the key methods used.

1. Establishing Standard Rates

Jurisdictions reported using two basic pricing methods for setting workers’ compensation rates for employment classification codes for the voluntary market: administered and competitive pricing. Administered pricing is the setting of full manual rates by a rating organization subject to insurance department approval, for use by all insurers that come under the jurisdiction of the rating organization. Manual rating is a process by which historic insurance statistical information is compiled, analyzed and projected into the future by trained actuarial professionals in order to produce manual premium rates (Lencsis, 1998). Eleven states⁷⁴ use administered pricing methods to establish rates for the voluntary workers’ compensation insurance market.

Competitive pricing, in contrast, is the setting of advisory rates or loss costs by a rating bureau or an advisory association (NCCI), often subject to a jurisdiction’s department of insurance approval, on behalf of its member insurers. Under competitive rating laws, insurers may be allowed to file for deviations from advisory rates, be required to file their own rates based on the advisory loss costs, or be allowed to file their own independent rates or loss costs with or without using advisory indications, depending on the state (American Academy of Actuaries, 2000). Thirty-nine states, the District of Columbia and three U.S. territories use competitive pricing methods to establish rates for the voluntary insurance market (see Table 3).

In a competitive pricing environment, the role of the rating bureau or advisory organization is to collect historical (actual) loss information, to apply actuarial techniques called “loss development” and “loss trending” to loss information and to produce either advisory loss costs (NCCI states) or advisory “pure premiums” (e.g., MD) for each employment classification code. Loss costs or a pure premium are the part of the premium rate attributable only to losses and loss adjustment expense. There are no general expenses, taxes or profits included in these costs. This information is usually filed with the state’s department of insurance annually for review (e.g., including conducting rate hearings) and approval (Lencsis, 1998).

After the loss costs or pure premiums are approved and published, each individual insurer must make a filing with the state department of insurance adopting them with or without modification. In addition, they must file, their own specific proposed loss cost multiplier(s) for each employment classification code (and for each risk tier the state permits insurers to generate deviated standard rates). General expenses, taxes and profit are included in the loss costs multiplier (Lencsis, 1998). A standard premium is computed by multiplying the advisory loss costs by the loss costs multiplier for each classification code (and risk tier, if applicable). Then other factors may be applied to the standard premium based on state insurance rules and the insurer’s policies and procedures. Even in competitive rating states, standard premium rates for policies under the residual market (e.g., Assigned Risk Plans) are usually the result of a separate administered pricing system whereby the rating organization files final rates for use by all assigned risk carriers.

Once workers’ compensation rates are computed and approved by a state insurance department, they are compiled in manuals (and often published on state insurance agency web sites). One important resource is the multi-state Basic Manual of Workers’ Compensation and Employers Liability Insurance, prepared and published by NCCI. The NCCI manual applies to jurisdictions that do not have independent rating bureaus or have exclusive state insurance funds.⁷⁵ The manual has three major parts, Rules, Classifications, and Rate and State Exceptions. It is updated on an ongoing basis as rate revisions and other changes occur (Lencsis, 1998). Household employers should be careful when reviewing standard rates for carriers since they only reflect a portion of the total premium he or she will be paying for his/her domestic service workers.

2. Establishing Premiums

In order to determine a premium for a classification code a number of other constants, adjustments and assessments may be computed and applied to a standard rate. An expense constant frequently is applied to the standard premium. It was reported that in some states the expense constant is included in the loss costs multiplier. This constant reflects the administrative costs to the insurance carrier if the policy were cancelled prematurely by the consumer-employer. The expense constant can be mandated by a state or vary by insurer and the amount can very significantly by state. For example, the expense constant in Montana was reported to be $115 whereas, in New York it was reported to be $180.

Often experience rating is applied to a standard premium rate. It is an adjustment to the standard premium rate for a current policy based on the insured’s claims experience during earlier periods of coverage (Lencsis, 1998). Whether or not experience rating is applied to a standard premium rate depends on the size of an employer’s total premiums over a one-to-two year period. For example, in Mississippi, an employer must have $4,500 in premiums annually, whereas, in Kentucky an employer must have $10,000 in premiums over a two-year period. As a result, experience rating may or may not be applied to a premium for domestic service and its application will vary by state.

Schedule rating is another adjustment that may be applied to the standard premium rates. This is a discretionary premium adjustment based on the underwriter’s evaluation of special characteristics of a risk not reflected in experience rating (Advanced Insurance Management, 2003). Whether or not schedule rating is applied to a standard premium rate often depends on whether the employer is experience rated. Some states do not allow schedule rating, particularly in the residual market while other states leave it to the discretion of the insurance carrier.

A number of special assessments may be applied to the standard premium rate to compute a premium for employer. They include, but are not limited to:

• Second, Subsequent and/or Multiple Injury Fund assessments;
• Assessments to fund the State’s Workers’ Compensation System; and
• Terrorism assessments (as a result of the terrorism attack of 9/11/01).

Some states may apply a special assessment to premiums used by carriers servicing the Assigned Risk Plan. For example, Idaho applies a 30 percent Assigned Risk Premium Surcharge to the premiums used for the state’s Assigned Risk Plan.

A small number of states allow insurers to establish “tiered rates” (e.g., deviations from the standard rates within a classification code, Maine and Utah). For example, Utah uses a three-tier system, Nonstandard, Standard and Preferred. State staff reported that household employers would fall in the nonstandard tier if he or she was a new employer or had a 100 percent loss ratio. The only way a household employer can get into the Preferred tier is if he/she had a loss ratio of 50 percent or less.

States reported that standard rates and premiums for the domestic service classification codes are expressed per capita, per $100 payroll, per hour worked, or per household policy (see Table 4, Table 5, and Table 6). The per capita method is used most frequently by jurisdictions for domestic service classification codes. Forty states⁷⁶ and the District of Columbia express standard rates for domestic service in per capita terms. The per capita method is good for insurers because each worker has a premium computed that hopefully covers the risk of workplace exposure. It should be noted, however, that a number of insurers in various states reported that because domestic service premiums tend to be low in comparison to other business enterprises, one large claim can often use up all the premiums paid and then some.

The per capita approach also can result in significant tracking and paperwork activities, and related expense, for household employers and insurers. Domestic service workers, and in particular, PAS workers, often work part-time and turnover of staff can be significant. Under the per capita approach, premiums often are computed for each worker employed by the household employer. In addition, employers and insurers must keep track of the number of employees working in the home on an ongoing basis to make sure that the proper coverage has been obtained and premiums charged. Some states (e.g., PA) and NCCI have tried to streamline the rate and premiums setting process and to find economies for premiums by developing a part-time rate/premium setting methodology. Under such methods, an employer may have three part-time workers who work in a total of 40 hours. Instead of paying three premiums, the employer would pay two premiums (e.g., 40/20 (the part-time threshold figure) = 2). A problem identified regarding the part-time methodology was not all NCCI states and NCCI regional staff reported that they were aware of this methodology or used it. Rather, they reported establishing rates and premiums on a “per capita” (e.g., “per worker”) basis.

The “per $100 payroll” method streamlines the process for establishing rates and premiums for household employers because the employer no longer needs to “count heads” and premium covers all workers employed in the household under the particular classification code for the policy. This is a beneficial feature for the household employer however, it could introduce added risk of workplace exposure for the insurer. For example, a household employer might hire one worker and have an annual payroll of $10,000. Then the worker stops working for the employer and the employer replaces the worker with two workers at the same payroll amount ($10,000). Insurers feel the risk of workplace exposure now is greater because there are two workers who could be injured on the job versus one. However, the premium remains the same. Nine states⁷⁷ and five U.S. territories⁷⁸ reported using the “per $100 payroll” method for computing standard rates which resulted in premiums that were “per household policy” for household employers who hired domestic service workers (see Table 4, Table 5 and Table 6). It should be noted that at least two states, (e.g., CA and TX) use both approaches to establishing rates and premiums. They use the per capita approach when computing rates and premiums for occasional domestic service workers and they use the per $100/payroll and the per household policy approach when computing full-time rates and premiums, respectively.

Washington State is the only state that uses the “per hour worked” and “per household” policy approach to establish rates and premiums, respectively. The theory behind the per hours worked approach is that the more hours worked by domestic employees for a household employer the greater the possible risk of workplace exposure, resulting in premiums that effectively reflect the potential risk of workplace exposure for all workers employed. However, this method is dependent on good time sheet data. This typically would be readily available from the Fiscal/Employer Agent, however, it’s unclear if household employers paying their domestic service workers out-of-pocket would be able to provide accurate hours information on a consistent basis.

New Jersey is the only state that establishes both rates and premiums based on an all inclusive (for the classification code) per household policy method for occasional domestic service workers. They use the per capita method to compute rates and premiums for full-time domestic service workers.

Finally, workers’ compensation insurance is initially written based on estimated premiums. This is because it is not possible to know ahead of time exactly how many workers will be employed by or what the exact payroll will be for an employer. Thus, once a policy year ends, there is normally some kind of effort made by the insurance carrier to determine actual number of workers/total actual payroll for the policy period. Depending on the size of the premiums, an insurance carrier might send a premium auditor to determine actual number of workers/total payroll. After this information is collected, the insurance carrier will compute and issue an “audited premium” to the employer (Advanced Insurance Management, 2003).

3. What are Minimum Premiums?

A minimum premium is the lowest premium required to provide insurance under a standard policy in a particular insurance market and jurisdiction. For the household employer, this means the minimum premium amount is the least he/she will pay for a premium in the state. Minimum premiums can vary by market (voluntary, state fund and residual) and by jurisdiction, however actual premiums vary by insurer and employer in the voluntary insurance market. Therefore, it was decided to report premium information using minimum premiums in order to assess the affordability of workers’ compensation insurance for household employers who employ domestic/PAS workers in a consistent manner by the insurance market (see Table 4, Table 5 and Table 6).

A number of jurisdictions reported minimum premiums based on an employer hypothetically having “no payroll.” They advised household employers to purchase at least this level of coverage so they can demonstrate they have a basic level of coverage should their worker be injured and file a claim.

IV. WHICH JURISDICTIONS AFFORD HOUSEHOLD EMPLOYERS ACCESS TO WORKERS’ COMPENSATION FOR THEIR DOMESTIC SERVICE/PERSONAL ASSISTANCE SERVICE WORKERS? HOW DOES ACCESS VARY BY INSURANCE MARKET AND JURISDICTION?

There are a number of factors that affect a household employer’s access to workers’ compensation insurance for their domestic and PAS workers. The factors include, but are not limited to:

• Statutory requirements;
• Insurance agents/producers’ willingness to process household employer’s applications with voluntary carriers;
• Insurance carriers’ willingness to write policies for household employers;
• The requirement to use an insurance agent/producer;
• The requirement to obtain refusals (declination letters) from the voluntary market to access the residual market; and
• The cost of workers’ compensation insurance premiums.

Except for Wyoming, all states, the District of Columbia and the five U.S. territories⁷⁹ allow household employers of domestic service workers to elect to provide workers’ compensation coverage for their worker (see Table 1).

The following discusses the level of access to workers’ compensation insurance for household employers by insurance market sector.

A. Voluntary Insurance Market

State workers’ compensation agency staff in the majority of jurisdictions reported that access to workers’ compensation insurance for household employers in the voluntary market is extremely limited and in some cases, “non-existent” (see Table 3). The major reasons reported were small payrolls with small premiums, significant administrative paperwork and related costs, and perceived risk of liability related to the domestic service classification and, in particular, related to PAS workers (see Table 3).

Using an insurance agent/producer could be seen as both an advantage and a barrier to accessing the voluntary market. Conventional wisdom says that using an insurance agent/producer facilitates a household employer’s accessing worker’s compensation insurance since the agent understands the insurance business and can provide the voluntary carrier with the information it needs to process a household employer’s application in an efficient manner. However, state workers’ compensation agency staff reported that using an insurance agent can be a barrier for a household employer accessing the voluntary market for a number of reasons. First, not all agents are familiar with workers’ compensation insurance. If he or she is not knowledgeable regarding workers’ compensation laws and policies for household employers in his or her jurisdiction, access could be more difficult and the policy more costly.⁸⁰ Second, insurance agents may have little or no incentive to process a household employer’s application with a private insurer due to the low fee they receive and the administrative burden and associated costs related to processing policies for individual household employers. Insurance agents typically receive $15-20 for each policy they broker. Insurance agents reported that their administrative fee does not cover the cost of managing the administrative paperwork and does not provide a reasonable return.⁸¹

Twenty-four states⁸² and the District of Columbia require and 10 states⁸³ recommend household employers use insurance agents/producers when accessing workers’ compensation through the residual workers’ compensation insurance market. In California, using and insurance agent/producer is optional (see Table 10 and Table 11). One insurance agent in Massachusetts suggested a minimum number of policies (3,600) and premiums ($1.3 million) that might provide an insurance agent and a voluntary insurance carrier with the incentive to write workers’ compensation insurance policies for a group of household employers such as those enrolled in publicly-funded self-directed support service programs that use Fiscal/Employer Agents.

B. Exclusive and Competitive State Insurance Funds

Household employers had the best success accessing workers’ compensation insurance from exclusive state insurance funds, with the exception of Wyoming (see Table 10). The primary reason for this was that the Fund was the only source of workers’ compensation insurance in a state and, in general, accepted all comers. Household employers had moderate success accessing workers’ compensation insurance from competitive state insurance funds. In fact, a number of competitive state insurance funds provided a high level of access (CA and PA).

For example, in California, the State Compensation Insurance Fund is the only source of workers’ compensation insurance for household employers hiring domestic service workers, however, they are supposed to make an attempt to cover their workers through an endorsement for workers’ compensation on their homeowners’ policies first. In addition, Pennsylvania has developed a streamlined “Domestic Service Exemption Policy” for household employers guaranteeing access to workers’ compensation insurance at a relatively affordable price.

Not all competitive State Insurance Funds are enthusiastic about proving workers’ compensation insurance to household employers. During an economic slowdown in 1989, the Oregon SAIF reportedly cancelled policies for approximately 10,000 small employers. This resulted in a significant outcry across the State that the SAIF was no longer a “main street” insurer (Oregonians for Accountability, 2003). In addition, SAIF staff reported that they were concerned about household employees being “a high risk for work-related injury” but did not provide any specific examples or statistics to support their argument.

C. “Insurers/Markets of Last Resort”

Although many “Insurers/Markets of Last Resort,” have an explicit or implicit mandate to serve small and moderate sized employers, overall they were less likely than exclusive and competitive state insurance funds to provide workers’ compensation insurance coverage for household employers who hire domestic servants (see Table 11). For example, staff at the Minnesota State Mutual Fund Company reported that even though they focus on small to medium-sized employers, they probably would not write a policy for a household employer. In addition, an agent/producer (which is required to be used to access the company) probably would not approach the company with a household employer’s application due to low fee ($15-20 per policy) compared to the paperwork burden. Thus, the household employer would have to go to the State’s Assigned Risk Plan to access workers’ compensation insurance (which also requires that an agent be used).

Arizona and New Mexico are examples of states that more effectively focus the mission of their insurer/market of last resort towards small to moderate sized employers. This approach provides small and moderate sized employers with an alternative to purchasing workers’ compensation insurance other than the state’s residual market (e.g., Assigned Risk Pool). However, it is to be determined exactly how useful this option will be for household employers residing in Arizona and New Mexico who wish to purchase workers’ compensation insurance for their in-home domestic service workers, including personal assistance workers.

D. Residual Insurance Market

Household access to workers’ compensation insurance through residual markets in the majority of jurisdictions is at least moderate, particularly in states that have both “insurers/markets of last resort” and Assigned Risk Plans (see Table 11). However, the key to access in this market depends on: (1) whether an employer must use an agent, (2) how many declination letters must be obtained, and (3) the price of the premiums. Twenty-four states’ and the District of Columbia’s Assigned Risk Plans and or “market/insurer of last resort require that an employer use an insurance agent/producer to access the residual market (see Table 11). The majority of states that require declination letters require at least two.⁸⁴ Michigan and North Carolina do not require any declination letters. Georgia requires four declination letters. Insurance agents willing to broker workers’ compensation insurance for a household employer often can facilitate the receipt of declination letters from the voluntary insurance market.

It is unclear whether a household employer in states where domestic service is exempt from a state’s workers’ compensation law can access an Assigned Risk Plan administered by NCCI. At first NCCI staff reported this was not be possible. Subsequently, it was reported that it would be up to the state workers’ compensation agency (all of which said householders could access coverage through the State’s Assigned Risk Plan) and the direct assignment or servicing carrier that NCCI assigned the application. The only case reported where an application from an employer in an exempt classification (domestic service) was denied by a direct assignment or serving carrier was in Vermont related to its self-directed support service programs. According to NCCI staff, Vermont is currently working with NCCI (the State’s Assigned Risk Plan administrator) to develop an effective process to cover consumer-employers who are enrolled in the various self-directed support services programs operating in the State.

V. HOW DOES THE COST OF WORKERS’ COMPENSATION INSURANCE PREMIUMS FOR HOUSEHOLD EMPLOYERS VARY ACROSS JURISDICTIONS AND MARKETS?

The workers’ compensation insurance premiums for household employers who employ domestic service workers, including PAS workers, vary significantly by insurance market and jurisdiction (see Table 4, Table 5 and Table 6). Minimum premium information from the various jurisdictions and markets was analyzed as a proxy for actual premiums in the various insurance markets because minimum premiums represent the lowest premiums that would be paid by an employer in order to provide insurance under a standard policy.

It should be noted that jurisdictions that establish workers’ compensation insurance rates and premiums on a per capita basis may cost the household employer more in total premiums paid due to the fact that rates and premiums are “per employee” versus “per household.” Moreover, it also should be noted that minimum premiums for the occasional worker classifications often cover up to two part-time workers.⁸⁵ The following discusses the affordability of workers’ compensation insurance for household employers of domestic service/PAS workers by insurance market and jurisdiction.

A. Voluntary Insurance Market

It was not possible to analyze workers’ compensation insurance premiums in the voluntary insurance market since they vary by insurance carrier. However, it was possible to evaluate minimum premiums for the administered pricing states (see Table 5). Minimum premiums for Domestic Service, Inside, Occasional (Classification 0908) for states that use administered pricing ranged from a low of $16.00 per year per household policy in New Jersey (actual premium rather than minimum premium) to a high of $427.00 per capita per year in Florida. If a Floridian has more than two part-time domestic/personal care workers, the cost of workers’ compensation insurance can become prohibitive very quickly.

The minimum premiums for Domestic Service, Inside, Full-time, (Classification 0913) ranged from a low of $76.00 per year per household policy (actual premium in NJ) to $750 per capita per year in Florida. Moreover, if a Floridian had more than two full-time domestic/personal care workers, the cost of workers’ compensation insurance could become prohibitive very quickly. New Jersey was found to offer the most affordable workers’ compensation premiums of all the jurisdictions.

B. State Insurance Funds

In general, minimum premiums for states and U.S. territories with State Insurance Funds were less than residual workers’ compensation insurance market⁸⁶. They also tended to use the per $100/payroll and per household policy methods to establish rates and premiums more often (see Table 6). Minimum premiums for state insurance funds for Domestic Service, Inside, Occasional (Classification 0908) ranged from a low of $130.88 per year household policy in New York to a high of $400 per year per capita in Utah. Minimum premiums for state insurance funds for Domestic Service, Inside, Full-time (Classification 0913) ranged from a low of $175 per household policy per year in Maryland to a high of $505 per year per capita in Pennsylvania.

C. Residual Insurance Market

In general, minimum premiums for the residual insurance market were the highest for household employers and used the per capita rate and premium method most often (see Table 4). Minimum premiums for the residual market for Domestic Service, Inside, Occasional (Classification 0908) ranged from a low of $130.88 per year household policy in New York to a high of $664 per year per capita in Florida. Minimum premiums for the residual insurance market for Domestic Service, Inside, Full-time (Classification 0913) ranged from a low of $175 per household policy per year in Maryland to a high of $1,542 per year capita in Florida.

VI. ISSUES AND CHALLENGES REGARDING THE ADMINISTRATION OF WORKERS’ COMPENSATION SYSTEMS AND PROVIDING INSURANCE FOR DOMESTIC SERVICE AND PERSONAL ASSISTANCE SERVICE WORKERS

Workers’ compensation agency staff and insurance carriers in reported a number of issues and challenges regarding the administration of workers’ compensation systems and providing insurance for domestic service and PAS workers (see Table 13). The most frequently reported issue or challenge was related to classifying personal assistance under domestic service. Forty-five states, the District of Columbia and two territories (Guam and the Virgin Islands) reported that final determination of whether a PAS worker is included in the domestic service classification code for workers’ compensation purposes could only be determined based on the results of a claim appeal decision. This represents significant uncertainty for household employers, particularly those living in states where domestic service workers are exempt from the workers’ compensation law. A decision that a worker is nonexempt not only means that the household employer would have to incur the expense of workers’ compensation insurance but also additional expenses related to penalties for non-coverage and risk of possible tort liability.

Another issue reported was that household employers’ access to the voluntary insurance market is very limited. Of the 28 states that reported limited access to the voluntary market for household employers, five states⁸⁷ reported that the voluntary market was “non-existent” for household employers. Workers’ compensation agency staff in Kentucky reported it was “virtually impossible” for household employers to access the voluntary insurance market. The major reason reported was that voluntary insurers carriers have little financial incentive to write policies for small (household) employers due to small payrolls and premiums; and significant burden and cost of paperwork; and the perceived risk related to household employers.

Maryland, New Jersey and the District of Columbia workers’ compensation agency staff reported that insurance agents/producers may not have a financial incentive to broker workers’ compensation insurance with an insurance carrier for household employers. The primary reason given was the amount of paperwork and cost related to processing a large number of individual employer applications compared to the small fee ($15-20.00/policy) agencies receive to broker workers’ compensation insurance with insurance carriers for this type of employer. The insurance agent that brokers workers’ compensation insurance policies for service recipients enrolled in the New Jersey Personal Preference Program, for example, stopped performing this function in the Fall of 2003 because of the costs associated with processing large numbers (500) of initial individual policies and policy renewals. Workers’ compensation agency staff in Maryland added that it is very important to use an insurance agent who is familiar with workers’ compensation insurance, otherwise it could limit access to insurance and be more costly for the household employer.

Four states’ workers’ compensation agency staff⁸⁸ reported that the premiums for household employers tended to be low and may not cover the cost of losses incurred. Moreover, staff at the Ohio Bureau of Workers’ Compensation reported “occasional users of domestic services should not be allowed to avoid tort liability at a cost unfairly low for the employer, and because of low premiums, unreasonably high to the State workers’ compensation system.”

Workers’ compensation agency staff in Montana, South Carolina, Tennessee and Virginia indicated that determining who is included under domestic service and who is not is a particular challenge, especially determining whether a worker is an employee or an independent contractor. Virginia workers’ compensation agency staff reported that they consider the majority of domestic service workers to be independent contractors, contrary to IRS policy. Workers’ compensation staff in Montana reported, “it’s difficult to verify that workers are performing the duties that are included in the domestic service classifications.”

Two states with self-directed support service programs (MA and NJ) reported low and no workers’ compensation claims, respectively since workers’ compensation policies were purchased for all service recipients’ workers three years ago. For the period 2001-2002, Atlantic Charter received approximately $2,380,620 in audited premiums. For that same period, the insurer paid out $489,900 for 68 claims based on a total payroll of $119,385.197.⁸⁹ As of March 31, 2004, no workers’ compensation insurance claims had been filed for PAS workers working for service recipients enrolled in the New Jersey Personal Preference Program. However, less than a dozen workers have filed disability insurance claims with the state.⁹⁰

In contrast, Maine Employers’ Mutual Insurance Company (MEMIC) reported experiencing significant losses related to household employers who had purchased workers’ compensation for their domestic service workers. MEMIC is the insurer for one state-funded and two Medicaid-funded self-directed support service programs administered by Alpha One in South Portland, Maine. Staff at the Louisiana Workers’ Compensation Corporation added “there may be a higher risk of injury for PAS workers than for traditional domestic service workers so the NCCI classification codes 0908 and 0913 may not always be appropriate for PAS workers.”

Workers’ compensation agency staff in Missouri, Washington State and Wisconsin indicated that workers’ compensation insurance premiums have gone up for all employers, including household employers. Workers’ compensation agency staff in Wisconsin similarly reported that a few years ago, premiums were affordable, but they have gone up significantly for household employers.

Workers’ compensation agency staff in Kansas, New York and Rhode Island purported that they do not see a lot of household employer polices or claims. As a result, workers’ compensation agency and insurance carriers do not address issues regarding household employers and domestic service very often. In addition, workers’ compensation agency staff in Kansas and Montana reported that small numbers of claims make it difficult for states to compile meaningful loss data and fairly assess the risk of workplace exposure for domestic service workers.

Minnesota and New Hampshire restricted employers with disabilities from including their workers under the domestic service classification. Minnesota workers’ compensation insurance staff noted that individuals who have disabilities and receive public funding to pay for their services may not be considered as employers in Minnesota according to state unemployment laws. In addition, Minnesota Statute 2002 §176 subd. 9(17) states, “a worker who provides in-home attendant care services to a physically disabled person and who is paid by the Department of Human Services for services rendered is considered an employee of the State and not the person with the disability.”

In New Hampshire Title XXIII, Section 281-A:2 Definitions V-b.(a) states that “domestic employee” or “domestic worker” means a person performing domestic services in a private residence for children or others who are not physically or mentally infirmed. Moreover, state workers’ compensation insurance staff noted that they could not identify what classification the worker would fall into. All employees, including domestic service workers, must be covered for workers’ compensation insurance.

Massachusetts reported a number of operational issues related to workers’ compensation insurance for household employers. First, the traditional NCCI classification codes did not properly classify PAS workers for workers’ compensation purposes. As a result, the State developed a domestic service code specific for personal assistance services (0918) (see Section VII - Promising Practices in this report). In addition, per capita-based premiums were problematic because of difficulty in estimating the number of employees working in a residence at any given period of time due to worker turnover. Moreover, per capita premiums represent significant paperwork burden and costs for both household employers and insurance carriers. As a result, rates for classification 0918 are computed on a per payroll basis and premiums are per household policy (see Section VII - Promising Practices in this report).

The agent brokering workers’ compensation polices for the Massachusetts Personal Care Attendant program reported that there may be a minimum number of household employers needed to provide a voluntary carrier with the financial incentive to write policies for individual household employers. The insurance agent for the State suggested a minimum number of 3,600 policies that reflect approximately $1.3 million in premiums. The insurance agent in Massachusetts also reported that the Commonwealth’s Rating Bureau finally has accumulated significant loss data based on three years of experience. This data showed that the risk of workplace exposure for PAS workers in self-directed support service programs may not reflect the high risk perception of many rating bureau and insurance company staff. However, this information was not reflected in the new rates for FY 04 for classification code 0918 since the rate went up $0.10/$100/payroll.

The voluntary carrier writing policies for Massachusetts Personal Care Attendant Program participants cited two areas where Fiscal Employer Agents have facilitated obtaining and maintaining workers’ compensation insurance policies for program participants and processing support service workers’ claims. The Fiscal Employer Agent is the primary contact for the insurance carrier and provides the information necessary to initiate new policies and renew existing ones for the consumer-employers it represents. In addition, the burden and related expense of billing 10,000 consumer-employers has been reduced by allowing the insurance carrier to issue four invoices, one to each Fiscal Employer Agent for the consumer-employers they represent. Finally, the Fiscal Employer Agent is responsible for completing Wage Statement forms and submitting them to the insurer in a timely manner so the insurer can issue accurate benefits checks to the injured workers in the required time period.

Oregon workers’ compensation agency staff reported that under the law pertaining to domestic service, if a home health agency has five or fewer clients registered with the Department of Human Services at a foster care site, the agency does not have to provide workers’ compensation insurance coverage for the workers. This means the agency could have a chain of foster care sites, with many employees and still not have to purchase workers’ compensation insurance for their workers. This was reported as a significant issue for state workers’ compensation agency staff and local labor unions.

California State Insurance Fund staff reported that if a household employer hires a spouse, parent or child, they can never be covered by workers’ compensation insurance either through a standard workers’ compensation insurance policy or homeowners’ insurance endorsement.

The U.S. territories reported the following issues/challenges:

• Making sure that employers have the proper coverage is a challenge (AS, GU, PR, and VI);
• Don’t know of any household employers who have purchased workers’ compensation insurance for their workers (GU and NMI); and
• Obtaining accurate reporting of domestic service workers’ actual duties and hours worked (NMI).

Finally, the majority of state and territory workers’ compensation insurance staff recommended that household employers purchase some type of workers’ compensation insurance coverage for their workers, even in states where domestic service is exempt from the law. Wisconsin workers’ compensation staff explained, “I wish all household employers would cover their workers for workers’ compensation.” Staff noted that having some coverage would protect the household employer from the uncertainty and risk of finding out they should have had coverage after the fact, when penalties for noncompliance are applied.

VII. PROMISING PRACTICES

There are a number of promising practices that have been identified in this study. The following describes them by topic and jurisdiction.

A. Workers’ Compensation Laws That Include Personal Assistance Services in the Definition of Domestic Service – Hawaii

Hawaii’s workers’ compensation law includes the term “attendant care” in the definition of domestic service. Hawaii Workers’ Compensation Law §381-1(6) Domestic, includes attendant care and day care services authorized by the Department of Human Service under the Social Security Act, as amended, performed by an individual in the employ of a recipient of social service payments (see Table 7). Hawaii partially exempts domestic service workers from its workers’ compensation law.⁹¹ By including attendant care in its definition of domestic service for workers’ compensation insurance purposes, it has removed a significant amount of uncertainty for state self-directed support service program agencies and household employers, including service recipients who hire their attendant care workers directly. However, the Hawaii uses the standard NCCI domestic service classifications for rating purposes which is not clearly describe the duties performed by a personal assistance (attendant care) worker (see Appendix A).

B. Including PAS in the Employment Classification for Domestic Service – North Dakota

North Dakota Century Code 65-01-02.17(b), Definitions, states that “any person whose employment is both casual and not in the course of the trade, business, profession, or occupation of that person’s employer…..” is not covered under the State’s workers’ compensation law. According to workers’ compensation agency staff, this language exempts domestic service workers from the law. The state’s employment classification for Domestics (9002) includes “those individuals performing home help services or providing personal assistance or home care for persons who are convalescent, aged or acutely or chronically ill or disabled” under the domestic service classification (see Table 7). Thus, PAS workers hired by a household employer to work principally inside the employer’s home is exempt from the State’s workers’ compensation law (see Appendix A).

State workers’ compensation hearing officers, primarily look to the law when making a decision regarding a claims dispute. Although it is a positive step for states to include personal assistance in its employment classification under “Domestics,” it does not eliminate the risk of a hearing officer determining that a PAS worker does not fall under the domestic service classification. To make sure that personal assistance falls under domestic service by law, domestic service needs to be clearly defined in a state’s workers’ compensation law and include PAS workers hired by household employers. Then if a state chooses to exempt domestic service workers from coverage under its workers’ compensation law, it should allow household employers to elect coverage for their domestic service workers including personal assistance workers.

C. Developing a Classification Code for Personal Assistance Services – Massachusetts

Massachusetts has created an employment classification code specifically for personal assistance service. It is listed as 0918, Domestic Service Workers, Inside, Physical Assistance, and it is included in the National Scopes Manual (see Appendix C). This code applies to domestics who provide physical assistance in activities of daily living principally inside the insured’s residence. In addition, it includes activities such as (1) assisting with bowel and bladder needs, (2) providing transportation, (3) assisting with health related needs, and (4) assisting with taking medications prescribed by a physician that otherwise would be self-administered (see Appendix A).

What would reduce a household employer’s risk of liability further would be if a state defined “Domestic Service” in its workers’ compensation law and included personal assistance in the definition. Having the law and the employment codes consistent with each other would reduce subjectivity of hearing officers when making decisions in workers’ compensation claims appeals. In the case of Massachusetts, personal assistance workers is not explicitly included under domestic service in the state’s workers’ compensation law. However, staff from the Medicaid Personal Care Attendant Program⁹² and the state’s Division of Health Care Financing and Policy have worked closely with the State’s Rating Bureau and Workers’ Compensation Agency to develop the classification so all the stakeholders are in agreement with its application. Moreover, all services recipients enrolled in the Medicaid Personal Attendant Care Program have executed workers’ compensation insurance policies for their personal care attendants.

D. Developing a Program Specifically Targeted for Domestic Service – Pennsylvania

Pennsylvania’s State Workmen’s Insurance Fund (SWIF) has a program and a workers’ compensation insurance policy, (e.g., Domestic Service Exemption Policy), specific to household employers who employ domestic service workers to work in and around their homes. It also has designated SWIF staff who are well trained and extremely knowledgeable regarding domestic service issues and SWIF policies and procedures. The application process for domestic service has been streamlined and SWIF staff is easy to access and extremely helpful.

E. Accessing Workers’ Compensation Insurance Through the Voluntary Insurance Market – Massachusetts

Massachusetts successfully recruited an insurance agent⁹³ and voluntary insurance carrier⁹⁴ to broker and write workers’ compensation insurance policies for over 9,000 persons with disabilities enrolled in the State’s Medicaid Personal Attendant Care Program rather than obtaining insurance through the more costly residual insurance market. The insurance agent for service recipients enrolled in the MA Medicaid PCA Program suggested that a minimum number of 3,600 policies that reflect approximately $1.3 million in premiums would provide an agent and voluntary carrier with an incentive to broker/write workers’ compensation insurance policies for household employers enrolled in a self-directed support service program.

F. Accessing Workers’ Compensation Insurance Through the Residual Market – Arizona and New Mexico

Arizona and New Mexico both have residual insurance markets that consist of both “insurers/markets of last resort” and Assigned Risk Plans. Having both options appear to increase small and moderate sized employers access to workers’ compensation insurance at more competitive prices. This approach has the potential of providing increased access to household employers who wish to purchase workers’ compensation insurance for their in-home domestic service workers including personal assistance workers.

G. Accessing Workers’ Compensation Insurance for Domestic Service Through Homeowners’ and Tenants’ Insurance Policies – New Jersey

New Jersey provides the most comprehensive system for accessing workers’ compensation insurance for part-time and full-time domestic service workers, including PAS workers at the lowest rates of any jurisdiction and through both standard workers’ compensation insurance policies⁹⁵ and workers’ compensation insurance endorsements on homeowners’ and tenants’ insurance policies. By requiring all homeowners’ and tenants’ insurance policies to provide comprehensive personal liability insurance including workers’ compensation insurance for domestic service workers, the State has addressed the following issues:

• The State has limited insurance carriers’ workers’ compensation insurance exposure only to domestic service workers. This is important because most property and casualty insurers may not feel capable of writing workers’ compensation insurance policies for all occupations.
• By requiring all homeowners’ and tenants’ insurance policies to include workers’ compensation insurance endorsements for domestic service, the State has spread the costs of insurance over a large number of homeowners and tenants, achieved economies of scale and kept the cost of the endorsement low.⁹⁶ In addition, New Jersey is an administered pricing state so the premium rates for the workers’ compensation endorsement on homeowners’ and tenants’ insurance policies are the same.
• Purchasing workers’ compensation insurance coverage through a homeowners’ or tenants’ insurance policy reduces the administrative burden for household employers who employ domestic service workers.

There are a number of potential disadvantages in providing workers’ compensation through homeowners’ and tenants’ insurance policies. They include:

• The cost of the workers' compensation insurance claims, if in significant number and size, could eventually drive up the cost of homeowners’ and tenants’ insurance overall for all policyholders, regardless of whether they employ domestic service workers.
• The majority of State’s workers’ compensation insurance endorsements are meant to cover “occasional” domestic service workers. In the case of New Jersey, household employers must report if they hire one or more full time workers. Then, rather than paying the $1.00 premium for the endorsement for occasional domestic service workers, the household employer is charged $61.00/year for the first full-time worker employed and $60/year for each additional full-time worker employed. If a household employer does not accurately report the work status of his/her domestic workers, he or she could be underinsured and increase the costs to the system.

Some homeowners and tenants may not want to include coverage for workers’ compensation insurance in their homeowners’ or tenants’ insurance policies due to the fear that filing a workers’ compensation claim might jeopardize their homeowners’ insurance either due to significant premium increases or cancellation. (see Section III C (5) in this report).⁹⁷ It may be more prudent for a homeowner or tenant to obtain a separate, standard, workers’ compensation insurance policy in addition to his or her homeowner’s tenant’s insurance policy to address the potential risk of liability of job-related injuries for their PAS workers.

H. Rate and Premium Setting Methods -- Massachusetts and Washington State

Massachusetts uses the per $100 payroll method to compute workers’ compensation rates and the per household policy method for workers’ compensation premiums. The per $100 payroll method reduces the paperwork burden and related expense for both the household employer and insurer compared to the per capita method. In addition, the per household policy method for establishing premiums can represent a significant cost savings for household employers, particularly those who hire multiple part-time and/or full-time PAS workers.

However, using a per $100 payroll method may not project the risk of workplace exposure accurately/adequately for the insurer. For example, a household employer may have a payroll of $10,000 and have one worker. The worker may quit and the household employer may replace the worker with two part-time workers. Thus, the potential risk for injury has increased due to an increase in workers on the job site. However, the payroll amount and associated premium remains the same.

Washington State uses a “per hour” method for computing workers’ compensation rates and the “per household policy” method for computing workers’ compensation premiums. The per hour method more accurately measures the risk of workplace exposure for multiple workers since the number of hours worked is a good measure for projecting the risk of workplace exposure, especially if workers’ wages are allowed to vary. However, the key to making this method “work” is the availability of accurate “hours worked” information. These data can be collected using a standard time sheet and time sheet collection, processing and data reporting can be facilitated by using a Fiscal/Employer Agent. However, it may be more difficult to get consistent timesheet information from self-pay household employers who are not receiving services through a publicly-funded self-directed support service program that uses one or more Fiscal/Employer Agents.

I. Using Minimum Premium Data to Develop Benchmarks for Workers’ Compensation Premiums – New Jersey, Idaho and Maryland

The minimum premium data presented in Table 4, Table 5, and Table 6 demonstrates the variability of workers’ compensation insurance rates by market and jurisdiction for similar employment classifications (e.g., domestic service). Jurisdictions can use this information to develop benchmarks to compare their workers’ compensation premiums and learn from other states’ experience. For example, the jurisdiction that has the lowest actual premiums for a standard domestic service workers’ compensation insurance policy from the voluntary and residual insurance markets is New Jersey. The actual premium for a standard workers’ compensation insurance policy for all occasional domestic service workers in a household is $16.00/household/year. The actual premium for a standard workers’ compensation insurance policy for a full-time domestic service worker is $76.00/year for the first worker and an additional $60/year for each additional full-time worker hired. Under the homeowners’ or tenants’ insurance workers’ compensation endorsement the premium is $1.00/policy/year for all occasional domestic service workers working in the home and $61/year for the first full-time worker and $60/year for each additional full-time worker working in the home. The premiums for the standard workers’ compensation insurance policy and the homeowner’s/tenant’s workers’ compensation endorsement for domestic service are the same for both the voluntary and residual insurance markets.

Idaho and Maryland also offer low minimum premiums through a State Insurance Fund (e.g., $150 per capita for 0908-occasional and $175.00 per capita for 0913 – full-time and $175 per household policy for 0913 – part or full-time, respectively (see Table 6). However, Idaho’s minimum premiums for the residual insurance market are almost twice as much as the State Insurance Fund, whereas Maryland’s minimum premiums are the same in the State Insurance Fund as they are in the residual insurance market (see Table 4).

J. Using Fiscal/Employer Agents to Facilitate Purchasing Workers’ Compensation Insurance, and Invoicing and Processing Claims – Massachusetts, New Jersey and Pennsylvania

In Massachusetts, New Jersey and Pennsylvania, Fiscal/Employer Agents participating in the states’ self-directed support service program (e.g., MA Personal Attendant Care Program, NJ Personal Preference Program, and PA Attendant Care Program) will not process a payroll check for a worker unless the service recipient has an executed workers’ compensation policy for his/her PAS worker(s). Thus, the Fiscal/Employer Agent ensures the state self-directed support service program agency that workers’ compensation insurance coverage has been obtained for all service recipients and renewed annually.

In each state, the Fiscal/Employer Agent is the key contact that communicates with either the insurance agent, voluntary insurance carrier/residual market administrator or both making sure initial policies are executed and that policies are renewed in a timely manner. In addition, each state’s Fiscal/Employer Agent is responsible for completing the Wage Statement Form that the insurer needs to receive to accurately compute a benefit for an injured worker. The Fiscal/Employer Agent, in all three states is responsible for paying the service recipient’s workers’ compensation premiums out of their public benefit. In Massachusetts, the insurance carrier bulk invoices the four Fiscal/Employer Agents for the service recipients they represent, reducing the insurers invoicing effort from 10,000 to four invoices per year.

K. Allowing Household Employers to Elect Workers’ Compensation Insurance Coverage for Family Members Who are Paid Domestic Service Workers, Including PAS Workers – Hawaii

Many states’ workers’ compensation laws are silent on whether family members who are paid domestic service workers, including PAS workers, may be considered covered workers. For the purpose of this study it was determined that these states allowed household employers to elect workers’ compensation insurance coverage for family members who are paid domestic service workers including PAS workers.

Hawaii exempts family members who provide paid domestic services, including personal assistance services from its workers’ compensation law, but allows household employers to elect coverage for these workers. States should consider clarifying their workers’ compensation laws to allow household employers to elect workers’ compensation insurance coverage for family members who are paid domestic service workers including PAS workers.

REFERENCES

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American Academy of Actuaries, (200) “The Workers’ Compensation System: An Analysis of Past, Present and Potential Future Crisis, Washington, DC, Spring, 2000.

Conerly, William, B. (2003). The Benefits from Unlocking SAIF: Why Oregon Should Open Its Workers’ Compensation Market. Cascade Policy Institute, Portland, OR, March.

Haas, Theodore, F. (1987). On Reintegrating Workers’ Compensation and Employers’ Liability, 21 GA. L. Rev. 843, Georgia Law Review Association, University of Georgia, Spring, pp.1-42.

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Labor Research Association (2003). “Workers’ Compensation Crisis Revisited.” October 24^th, LRA Online, www.laborresearch.org/story2.php/330, pp. 1-3.

Larson, A. (2002). Typical Compensation Act Summarized, Larson’s Workers’ Compensation Law, Part 1, Introduction to Workers’ Compensation, Chapter 1, The Nature of Workers’ Compensation, § 1.01, Mathew Bender & Company, New York, p.1.

Larson, A. (2002). Compensation Contrasted with Tort, Larson’s Workers’ Compensation Law, Part 1, Introduction to Workers’ Compensation, Chapter 1, The Nature of Workers’ Compensation, § 1.03, Mathew Bender & Company, New York, p.1-5.

Larson, A. (2002). American System Distinguished From Social Insurance, Larson’s Workers’ Compensation Law, Part 1, Introduction to Workers’ Compensation, Chapter 1, The Nature of Workers’ Compensation, § 1.04, Mathew Bender & Company, New York, pp. 1-2.

Larson, A. (2002). General Nonbusiness Exemptions, Larson’s Workers’ Compensation Law, Part 8, Specific Inclusions or Exemptions, Chapter 72, Nonbusiness Employments, § 72.02, Mathew Bender & Company, New York, pp. 1-8.

Larson, A. (2002). Domesitic Servants, Larson’s Workers’ Compensation Law, Part 8, Specific Inclusions or Exemptions, Chapter 72, Nonbusiness Employments, § 72.03, Mathew Bender & Company, New York, pp. 1-2.

Larson, A. (2002). Employment Not in Course of Employer’s Business, Larson’s Workers’ Compensation Law, Part 8, Specific Inclusions or Exemptions, Chapter 7, Casual Employment Not in Course of Usual Business, § 73.03, Mathew Bender & Company, New York, pp. 1-4.

Lencsis, Peter, M. (1998). Workers’ Compensation: A Reference and Guide. Quorum Books, Westport Connecticut and London.

Nackley, Jeffrey V. (1989) Premier on Workers’ Compensation. The Bureau of National Affairs, Inc. Washington, DC.

Stogel, Elaine (1998). Workers’ Compensation Insurance Required for Household Employees. New York Law Journal, New York Paw Publishing Company, New York, New York, August 10^th, pp.1-9.

NOTES

1. Except in the case of Washington State and Oregon. Under Washington State law, a portion of the workers' compensation insurance premium, equal to one-half of both the medical-aid rate and supplemental-pension assessment may be paid by employee contribution. The Department of Labor and Industries does not collect each worker' share directly. Instead, employers have the option to collect their employees' portion through payroll deductions. Oregon has implemented the Workers' Benefit Fund Assessment ("Cents-Per-Hour") Rate to pay for certain programs that provide direct benefits to injured workers and their beneficiaries. In 2003, the assessment rate was 3.6 cents per hour or partial hour worked by each paid employee that an employer provides with workers' compensation insurance coverage. Employers contribute at least half (1.8%) deducting no more than half of it (1.8%) from workers' wages. Employers then submit the total to the state through OR Combined-Payroll-Tax Reporting System.

2. Five territories include American Samoa, Guam, Commonwealth of Northern Mariana Islands, Puerto Rico and the Virgin Islands. The tribal government is the Navajo Nation.

3. The 1993 Social Security Annual Statistical Supplement reported that "Workers' Compensation was the first form of social insurance to develop widely in the United States."

4. Section 102.07(4)(a) of the Wisconsin Workers' Compensation Law.

5. Under Washington State law, a portion of the workers' compensation insurance premium, equal to one-half of both the medical-aid rate and supplemental-pension assessment may be paid by employee contribution. The Department of Labor and Industries does not collect each worker's share directly. Instead, employers have the option to collect their employees' portion through payroll deductions. Oregon has implemented the Workers' Benefit Fund Assessment ("Cents-Per-Hour") Rate to pay for certain programs that provide direct benefits to injured workers and their beneficiaries. In 2003, the assessment rate was 3.6 cents per hour or partial hour worked by each paid employee that an employer provides with workers' compensation insurance coverage. Employers contribute at least half (1.8%) deducting no more than half of it (1.8%) from workers' wages. Employers then submit the total to the state through Oregon Combined-Payroll-Tax Reporting System.

6. Department of Labor Employment Standards Administration, Wage and Hour Division, 29 CFR 552, Application of the Fair Labor Standards Act to Domestic Services, Federal Register, vol. 66, No.13, January 19, 2001, pp. 5481-5489.

7. IRS National Taxpayer Advocate FY 2001 Annual Report to Congress, Taxpayer Advocate Service, Washington, DC 20016.

8. Except Washington State and Oregon (see Footnote #5).

9. Actual loss experience for two Medicaid-funded self-directed support service program has not supported the insurance industry's perception of workplace risk for personal assistance service workers. The MA Medicaid PCA Program (9,291 consumer-employers in 2003-2004) has had a low claims experience since workers' compensation insurance policies have been required of all consumer-employers in 1999. In 1999-2000 there were 4,581 consumer-employers and 70 claims, all closed as of 6/30/03. In 2000-2001 there were 5,666 consumer-employers and 52 claims, all closed as of 6/30/03. In 2001-2002 there were 6,938 consumer-employers and 68 claims, with 5 claims still open as of 6/30/03. In 2002-2003 there were 8,144 consumer-employers with 80 claims, with 22 open as of 6/30/03. For the period 2001-2002, McCarthy Insurance Agency reported that Atlantic Charter, the voluntary insurance carrier for consumers enrolled in the MA Medicaid PCA Program, received approximately $2,389,620 in audited premiums and paid out approximately $489,900 for 68 claims based on approximately $119,385,197 in total payroll. Program staff for the NJ Personal Preference Program (500 consumer-employers in 2003) reported there have been no claims filed from the date consumers started receiving services in May 2000 to the present (9/30/03).

10. The five territories include, American Samoa, Guam, the Commonwealth of Northern Mariana Islands, Puerto Rico and the Virgin Islands. The one tribal government is the Navajo Nation.

11. State workers' compensation agency staff often reported that they do not address issues related to domestic service and personal assistance service workers on a routine basis.

12. Disability includes payment for loss wages

13. AL, AR, GA, KY, ME, MI, MS, MO, NM, NC, SC, TN, VA, WA, WV, TX, and American Samoa.

14. AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, LA, ME, NE, NV, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, UT, VT, VA, WA, WI and A.S.

15. NH, NJ and PR require domestic service workers, including personal assistance service workers to be covered under the jurisdiction's workers' compensation laws.

16. See for example, New York Workers' Compensation Law Sec. 10(1).

17. The Federal Employment Compensation Act (F.E.C.A) provides workers' compensation insurance for non-military, federal employees; the Federal Employment Liability Act (F.E.L.A.) for railroads and their employees; the Merchant Marine Act (the Jones Act) for seamen; the Longshore and Harbor Workers' Compensation Act (LWWCA); and the Black Lung Benefits Act provides compensation for miners suffering from "black lung" disease.

18. California currently is in the process of a major re-engineering of its workers' compensation system.

19. AK, AR, DC, IL, IA, KS, ME, NC, RI, UT, WI, and VT.

20. Texas is the only state that allows employers to elect whether or not to provide coverage (§406.002-Coverage Generally Elective). However, public employers and employers that enter into a building or construction contract with a government entity must provide coverage.

21. For example, in New York, if an employer has not secured the necessary workers' compensation insurance, he/she is personally liable to pay all causally related medical bills as well as weekly benefits and is also liable for statutorily mandated assessment penalties. Furthermore, the failure to secure the payment of compensation is a misdemeanor, punishable by a fine of not less than $500 or more than $2,500, or imprisonment for not more than one year or both (NY WCL @ 52(1)(a)).

22. U.S. Department of Labor, Table 1: Type of Law and Insurance Requirements for Private Employment.

23. The State of Wyoming's exclusive State Insurance Fund does not allow household employers to elect to provide workers' compensation insurance for their domestic service workers.

24. Under the dual capacity doctrine an employer apparently protected by the exclusive remedy principle may become liable to the employee in tort if, in respect to that tort, he or she occupies a position which places upon him obligations independent and distinct from his role as an employer (2A Larson, Workmen's Compensation 72.80, at 14-112). An example of dual capacity is when the employer is liable as the employer and also as the manufacturer of the product that proves to be faulty. One scenario might be the liability related to an organization that makes its own ladders and has a worker injured as a result of a ladder breaking underneath him/her as a result of faulty construction.

25. Consortium in this case refers to "fellowship or companionship."

26. Except Washington State and Oregon. Under Washington State law, a portion of the workers' compensation insurance premium, equal to one-half of both the medical-aid rate and supplemental-pension assessment may be paid by employee contribution. The Department of Labor and Industries does not collect each worker's share directly. Instead, employers have the option to collect their employees' portion through payroll deductions. Oregon has implemented the Workers' Benefit Fund Assessment ("Cents-Per-Hour") Rate to pay for certain programs that provide direct benefits to injured workers and their beneficiaries. In 2003, the assessment rate was 3.6 cents per hour or partial hour worked by each paid employee that an employer provides with workers' compensation insurance coverage. Employers contribute at least half (1.8%) deducting no more than half of it (1.8%) from workers' wages. Employers then submit the total to the state through Oregon Combined-Payroll-Tax Reporting System.

27. The definition of domestic service is unclear and does not include personal assistance in the definition. Moreover, domestic service classification codes developed by NCCI and by jurisdictions often are vague and use antiquated terminology. Often the final ruling on the exempt status of a worker can only be determined based on a claims appeal decision.

28. HI, MI, MN, NV, NH and OR.

29. New Hampshire Title XXIII 281A:2 V-b(b).

30. MN Statutes 2002 §176.011 subd. 9(17) states "a worker who renders in-home attendant care services to a physically handicapped person, and who is paid directly by the commissioner of human services for these services, shall be an employee of the state within the meaning of the subdivision, but for no other purpose."

31. Two of the three RWJ Cash & Counseling Program Demonstration states (FL and NJ) allow family members to be paid support service workers.

32. CT Revised Statutes §31-275(9)(b)(iii).

33. IA Code 2003, Section 85.3(b)(1).

34. K.S.A. §44-404(a)(2).

35. ME Title 39-A§102(11)(4).

36. North Dakota Century Code 65-01-02 Definitions (17)(b)(3).

37. OK Title 85 §2.6.

38. VT Statutes §601(14)(D).

39. The Workers' Compensation Division of the AL Dept of Industrial Relations and the AL Department of Insurance. AL uses the court system to process workers' compensation claims appeals.

40. Under the OR Dept of Consumer and Business Services, the Workers' Compensation Division, Workers' Compensation Board, Workers' Compensation Management - Labor Advisory Committee, Ombudsman for Injured Workers, Ombudsman for Small Business, Insurance Division and the State Accident Insurance Fund Corporation and NCCI are involved in managing the workers' compensation program in Oregon.

41. NCCI initially was an unincorporated association, however, in the mid-1990s, it became a not-for-profit corporation.

42. For example, NCCI compiles and updates the National Scopes Manual of employment classification codes and administers the assigned risk plan in 18 states and the District of Columbia.

43. CA, DE, HI, IN, MA, MN, NJ, NY, NC, PA, WI.

44. Also commonly referred to as the income, indemnity, or wage-loss benefit.

45. FL, ME, MN, MT, NV, VT, and WY.

46. AR, FL, NH, NM, and NC.

47. These figures include the competitive state insurance funds.

48. ND, OH, WA, WV, WY, PR and VI.

49. AZ, CA, ID, MD, MT, NY, OR, PA and VT.

50. HI, ID, ME, MO, MT, and RI.

51. KY, LA, and MN.

52. AL, AK, AR, CT, DE, FL, IL, IA, MA, MS, NV, NH, NM, SC, SD,TN, VT, and VA.

53. AL, AR, CT, FL, GA, ID, IL, IN, IA, KS, MA, MN, MS, NV, NH, NJ, NM, OR, SC, SD, VT and VA.

54. To date, this provision has never had to be implemented in Missouri.

55. AZ, ID, MN, NM and OR.

56. AZ, CA, CO, CT, HI, ID, IL, IN, IA, LA, MS, MT, NV, NH, NJ, NY, ND, SD, and VA.

57. No specific information was available on legislation, coverage or rates for American Samoa.

58. Massachusetts and New Jersey's Medicaid self-directed support service programs have had very low (MA) or no claims experience (NJ) since they started providing workers' compensation insurance for all workers three years ago. Actual loss experience for two Medicaid-funded self-directed support service program has not supported the insurance industry's perception of workplace risk for personal assistance service workers. The MA Medicaid PCA Program (9,291 consumer-employers in 2003-2004) has had a low number claims since workers' compensation insurance policies have been required of all consumer-employers in 1999. In 1999-2000 there were 4,581 consumer-employers and 70 claims, all closed as of 6/30/03. In 2000-2001 there were 5,666 consumer-employers and 52 claims, all closed as of 6/30/03. In 2001-2002 there were 6,938 consumer-employers and 68 claims, with 5 claims still open as of 6/30/03. In 2002-2003 there were 8,144 consumer-employers with 80 claims, with 22 open as of 6/30/03. For the period 2001-2002, McCarthy Insurance Agency reported that Atlantic Charter, the voluntary insurance carrier for consumers enrolled in the MA Medicaid PCA Program, received approximately $2,389,620 in audited premiums and paid out approximately $489,900 for 68 claims based on approximately $119,385,197 in total payroll. Program staff for the NJ Personal Preference Program (500 consumer-employers in 2003) reported there have been no claims filed from the date consumers started receiving services in May 2000 to the present (9/30/03).

59. This is not the case in New Jersey.

60. 0913 states that domestics include: "a cook, housekeeper, laundry worker, maid, butler, companion, nurse and babysitter."

61. These are the two work categories that states often reported personal assistance service workers falling under.

62. As independent contractors, workers were not paying their self-employment taxes in compliance with federal and state employment tax laws.

63. One way for a household employer or a self-directed service program that allows a service recipient to be the common law employer of their personal assistance service workers to eliminate the uncertainty and potential liability inherent in the tendency of courts and administrative hearing officers to find coverage under a jurisdiction's workers' compensation law is to arrange for and purchase workers' compensation insurance.

64. CA, CO, CT, FL, MD, NE, NV, NH, NY, OK, OR, PA, TX, WA State, WV, and WI.

65. See In Home Supportive Services v. Workers' Compensation Appeals Board, 152 Cal. App. 3d 720, 199 Cal. Rptr 697 (3d App. Dist. 1984); Bonnette v. California Health and Welfare Agency, 704 F. 2d 1465 (Ninth Cir. 1982); McFarland v. SAIF Corporation, 89 Ore. App. 184; 748 P. 2d 150 (Ore. App. CT., 1988); Linda J. Bromley, Docket Nos. 93 3892 & 93 5100; Claims No. N-071072; Washington State Board of Industrial Insurance Appeals (1995); and Odell B. Henderson, Docket No. 93 4609; Claim No. N-390500, Washington State Board of Industrial Insurance Appeals (1995).

66. In In Home Support Services v. Workers' Compensation Appeals Board, 152 Cal. App. 3d 720, 199 Cal. Rptr 697 (3d App. Dist. 1984) the Court held that implicit in the legislative history of the CA domestic service exclusion was a legislative purpose to impose the obligation of providing workers' compensation coverage for household domestic employers only when the risk spreading mechanism of insurance is available, as it might be in a case as this where dual employment could be found. In Bonnette v. California Health and Welfare Agency, 704 F. 2d 1465 (Ninth Cir. 1982), the Court found that the agencies exercised considerable control over the nature and structure of the employment relationship along with complete economic control and, hence, were held to be employer for the purpose of minimum wage requirements. This was not altered by the fact that the agencies delegated to the service recipients various employer responsibilities; that merely made them joint employers.

67. In McCallister v. Workers' Compensation Appeals Board, 61 Cal. App. 3^rd 524, 132 Cal. Rptr.527 the Court found that services provided in a private home solely to care for and wait upon a frail elder and that included no duties in connection with the maintenance or functioning of a household, was not domestic service excluded from coverage under then California Workers' Compensation Act. In Viola v. Workman's Compensation Appeal Board, 549 A. 2d 1367, 121 PA. Commw. 47 (1988) the Court struggled to find coverage for the injured worker looking for an employment relationship that would afford that coverage where the relationship between the recipient employer and worker would have been excluded as domestic service. The Court held that because the injured workers' job involved duties similar to a nurse's aide and did not involve household duties, she was not an excluded domestic servant.

68. See McCrory v. Thomas, 40 Misc. 2d 904, 244 N.Y.S. 2d 111 (S.CT., Kings County 1963).

69. See McCallister v. Workers' Compensation Appeals Board, 61 Cal. App. 3^rd 524, 132 Cal. Rptr.527 and In Viola v. Workman's Compensation Appeal Board, 549 A. 2d 1367, 121 PA. Commw. 47 (1988).

70. See Dunagan v. Folkers, Nebraska Workers' Compensation Court, Doc: 195 No: 2116, 1996 and Nelson v. Bradshaw, 791 P. 2d 485, 1990 Ok. Civ. App. (1990).

71. See Smith v. Ford, 472 So. 2d 1223 (1985, FL 1^st Dist. CT. App.).

72. See In Home Supportive Services v. Workers' Compensation Appeals Board, 152 Cal. App. 3d 720 199 Cal Rptr. 697 (3d app. Dist. 1984).

73. See Dorothy Stock v. Abilities in Motion, Pennsylvania Department of Labor and Industry Bureau of Workers' Compensation Claims Settlement (August 20, 2001) and Community Resources For Independence, Erie, Pennsylvania, Pennsylvania Department of Labor and Industry Bureau of Workers' Compensation Settlement (2001).

74. AZ, FL, ID, IL, IN, IA, MA,NV, NJ, NY, and WI.

75. CA, DE, NJ, NY and PA do not have rating bureaus. ND, OH, WA State, WV, WY, PR and VI have exclusive State Insurance Funds.

76. AL, AK, AR, AZ, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MI, MN, MS, MO, NE, NV, NH, NJ for FT workers only, NM, NY, NC, OK, PA, RI, SC, SD, TN, TX for FT workers only, UT, VT, VA, WI.

77. CA, MD, MA, MT, OR, TX for PT workers, ND, OH, WV.

78. American Samoa, Commonwealth of Northern Mariana Islands, Guam, Puerto Rico and Virgin Islands.

79. Household employers residing in the Navajo Nation must purchase workers' compensation insurance from an Arizona voluntary carrier or through the residual market.

80. Per discussion with staff at the MD Injured Workers' Insurance Fund.

81. Per discussion with DC Office of Workers' Compensation staff and Agent for the New Jersey Personal Preference Program.

82. AL, AR, CT, FL, GA, ID, IL, IN, IA, KS, KY, LA, MA, MN, MS, NV, NH, NJ, NM, OR, SC, SD, VT, and VA.

83. AK, AZ, DE, ME, MO, MT, RI, and TN.

84. In cases where the policy is being renewed, often one declination letter can be from the insurance company that is canceling the employer's workers' compensation insurance policy.

85. Per NCCI's formula for computing premiums for part-time domestic service workers.

86. It was reported they were often less than the voluntary market for domestic service also but data was not available to confirm this.

87. AR, FL, NH, NM, and NC.

88. LA, OH, OK and WA.

89. Information provided by The C.J. McCarthy Insurance Agency in September 2003.

90. New Jersey has a mandatory, statewide disability insurance program for workers who become ill/disabled, but not in the course of their employment.

91. Hawaii's Workers' Compensation Law §381-1 (5) states, "Service performed by an individual for another person solely for the personal, family or household purposes if cash remuneration received is less than $225 during the current calendar quarter and during each completed calendar quarter of the preceding twelve month period" is exempt from the state's workers' compensation law.

92. This program allows service recipient or their representatives to be the common law employer of their workers and use one of four Fiscal/Employer Agents to manage the payroll on recipients/representatives' behalf.

93. C.J. McCarthy Insurance Agency, Inc. in Wilmington, MA.

94. Atlantic Charter, Boston, MA.

95. $16.00 premium/policy for occasional workers and $76.00 premium/household policy for the first full-time worker/policy/year and $60.00 for each additional full-time worker.

96. $1/policy premium for occasional workers and $61/policy premium for the first full-time worker and an additional $60 for each additional full-time worker.

97. Homeowners insurance is often required for a mortgage and recently insurance carriers have been known to either significantly increase premiums or cancel policies when claims are filed.

APPENDIX A. Domestic Service Worker Classification Codes By Jurisdiction

0405 Domestic Services¹

Scope

All employees working as domestic engineers and exclusively in the private residence of employers. Includes cooks, maids, nurses, gardeners, private chauffeurs and messengers.

0908 Domestic Workers – Inside – Occasional²

Scope

Occasional domestic workers are domestic workers who are employed part-time. Any domestic workers employed more than one-half of the customary full-time shall be assigned and rated as a full-time domestic worker.

Code 0908 applies to domestics engaged exclusively in household or domestic work performed principally inside the insured residence. This would include a cook, housekeeper, laundry worker, maid, butler, companion, nurse, and babysitter.

Code 0908 is available for domestic operations described above which are conducted at a commercial farm location.

In regard to maintenance, repair or construction activities, Code 0908 contemplates ordinary and/or minor repair or maintenance by occasional domestic workers. Building maintenance or repair by employees hired only for that purpose shall be assigned to Code 9015 – Buildings, - NOC.

Extraordinary repairs, alterations, new construction, erection or demolition of structures shall be assigned to construction or erection classifications.

Refer to Basic Manual Rule 3-C-5-b (Rule XIV-E, 1996 edition), which indicates that the application of the per capita charge is not based on the total number of occasional domestics employed during a policy term but rather on the aggregate time of all domestic workers employed during the policy term.

0913 Domestic Workers - Inside³

Scope

Code 0913 applies to domestics engaged exclusively in household or domestic work performed principally inside of the insured’s residence. This would include a cook, housekeeper, laundry worker, maid, butler, companion, nurse and babysitter.

Code 0913 is available for domestic operations described above which are conducted at a commercial farm location. In regard to maintenance, repair or construction activities, Code 0913 contemplates ordinary and/or minor repair or maintenance of the insured’s premises or equipment when performed by inside domestic workers. Building maintenance or repair by employees hired only for that purpose shall be assigned Code 9015 – Building – NOC. Extraordinary repairs, alternations, new construction, erection or demolition of structures shall be assigned to construction or erection classifications.

0909 Domestic Workers – Outside – Occasional – Including Occasional Private Chauffeurs⁴

Scope

Occasional domestic workers are domestic workers who are employed part-time. Any domestic worker employed more than one-half of the customary full-time shall be assigned and rated as a full-time domestic worker.

Code 0909 does not apply to any operations conducted at a commercial farm location. In regard to maintenance, repair or construction activities, Code 0909 contemplates ordinary and/or minor repair or maintenance of the insured’s premises or equipment when performed by outside domestic workers. Building maintenance or repair by employees hired only for that purpose shall be assigned to Code 9015 – Buildings – NOC. Extraordinary repairs, alterations, new construction, erection or demolition of structures shall be assigned to construction or erection of classifications.

Refer to Code 0908 for occasional inside domestic employees.

Refer to Basic Manual Rule 3-C-5-b (Rule XIV-E, 1996 edition), which indicates that the application of the per capita charge is not based on the total number of occasional domestics employed during a policy term but rather on the aggregate time of all occasional domestic workers employed during the policy term.

0912 Domestic Workers – Outside⁵

Scope

Code 0912 applies to domestic engaged exclusively in household or domestic work performed principally outside of the insured’s residence. This would include persons engaged on certain days for gardening work or work as a part-time private chauffeur.

Code 0912 does not apply to any operations conducted at a commercial farm location.

In regard to maintenance, repair or construction activities, Code 0912 contemplates ordinary and/or minor repair or maintenance of the insured’s premises or equipment when performed by outside domestic workers. Building maintenance or repair by employees hired only for that purpose shall be assigned to Code 9015 – Building – NOC. Extraordinary repairs, alterations, new construction, erection or demolition of structures shall be assigned to construction or erection classifications.

0912-011 Domestic Service and Housekeepers⁶

Scope

Applicable only to employees of the insured in private residences engaged in domestic services, such as cooks, maids, baby sitters, attendants, nurses, gardeners, chauffeurs, and their helpers. Also includes, contractors that provide domestic service inside the residence. With regards to maintenance, repair or construction activities. Code 0912 includes ordinary and or minor repairs or maintenance of the facilities or equipment insured when performed by domestic employees under contract solely for this purpose shall be assigned Code 9015. Extraordinary repairs, alterations, new construction, erection or demolition of structures shall be assigned to erection or construction classifications.

0918 Domestic Service Workers – Inside – Physical Assistance⁷

Code 0918 applies to domestics who provide physical assistance in activities of daily living to the elderly or persons who are convalescent, acutely or chronically ill, or physically or mentally disabled.

Scope

Code 0918 applies to domestics who provide physical assistance in activities of daily living principally inside the insured’s residence.

For purposes of assigning Code 0918, physical assistance in activities of daily living shall mean the performance of any one or more of the following functions: physically assisting a household member with walking or using prescribed equipment; physically assisting a household member to take medications prescribed by a physician that otherwise would be self-administered; physically assisting a household member with bowel or bladder needs; physically assisting a household member with bathing, personal hygiene, dressing, or grooming; physically assisting a household member with meal preparation, eating (including tube feeding and special nutritional/dietary needs), and clean-up; physically assisting in transferring a household member in and out of bed; physically assisting in the body repositioning of a household member; motion exercises, and physically assisting a household member with health related needs.

In addition to providing physical assistance with activities of daily living, a domestic worker properly assigned to Code 0918 may also perform functions such as cooking, laundry, shopping, housekeeping, providing transportation or assistance with paperwork and reading.

Code 0918 is available for domestic operations described above that are conducted at a commercial farm location. In regard to maintenance, repair or construction activities, Code 0918 contemplates ordinary and/or minor repair or maintenance of the insured’s premises or equipment when performed by a domestic worker. Building maintenance or repair by a domestic worker. Building maintenance or repair by employees hired only for that purpose shall be assigned to Code 9015 – Building – NOC. Extraordinary repairs, alterations, new construction, erection or demolition of structures shall be assigned to construction or erection classifications.

Refer to Codes 0908 and 0913 for those inside domestic workers, part-time or full time, engaged exclusively in household or domestic work without providing any physical assistance in activities of daily living.

Refer to MA Manual Rule XIV-E-1, which indicates that the premium basis of Code 0918 is payroll, subject to manual rating. Given the premium basis for Code 0918, Payroll, full-time or part-time employment is not a consideration affecting classification assignment.

0001 Domestics and Domestic Maintenance – Elective Coverage⁸

Scope

Code 0001 applies to full-time employees of the employer’s private home or estate. Such employees include both out-servants and in-servants or domestics such as caretakers, watch persons, janitors, chauffeurs, gardeners and other employees engaged solely in the maintenance, operation or care of the property. Out-servants performing operations at a commercial farm are to be separately classified to the appropriate farm classification.

In regard to maintenance, repair or construction activities, Code 0001 contemplates ordinary and/or minor repair or maintenance of the insured’s premise or equipment when performed by domestic workers.

Refer to Code 0002 for occasional domestic workers.

0002 Domestics and Domestic Maintenance – Occasional - Elective⁹

Scope

Occasional domestic workers are domestic workers who are employed part-time. Any domestic worker employed more than one-half the customary full-time must be assigned and rates as a full-time domestic worker.

Code 0002 applies to employees of the employer’s private home or estate. Such employees include both out-servants and in-servants or domestics such as caretakers, watch persons, janitors, chauffeurs, gardeners, and other employees engaged solely in the maintenance, operation or the care of the property. Out-servants performing operations at a commercial farm are to be separately classified to the appropriate farm classification.

In regard to maintenance, repair or construction activities, Code 0002 contemplates ordinary and/or minor repair or maintenance of the insured’s premises or equipment when performed by occasional domestic workers.

Refer to Code 001 for full-time domestic workers.

0910(A) Occasional Private Residence Employees¹⁰

- Per PolicyRequires H.O. Underwriting Approval

Scope

This classification shall not apply to any employee who is covered for workers’ compensation benefit on a policy also affording comprehensive personal liability insurance nor any person who is employed by his parent, spouse or child.

Subject to the above paragraph, this classification shall apply to any person who is employed by the owner or occupant of a residential dwelling whose duties are incidental to the ownership, maintenance, or use of the dwelling, including the care and supervision of children, or whose duties are personal and not in the owner or occupant, and who is employed by the employer for less than 52 hours during 90 consecutive calendar days or who earns less than $100 in wages from the employer during 90 consecutive calendar days. Premium for this classification will be charged at a non-refundable flat rate due and payable on an annual basis.

0913 (A) Private Residence Employees¹¹

- Per CapitaRequires H.O. Underwriting Approval

Scope

This classification shall not apply to any employee who is covered for workers’ compensation benefit on a policy also affording comprehensive personal liability insurance nor any person who is employed by his parent, spouse or child.

Subject to the above paragraph, this classification shall apply to any person who is employed by the owner or occupant of a residential dwelling whose duties are incidental to the ownership, maintenance, or use of the dwelling, including the care and supervision of children, or who duties are personal and not in the course of the trade, business, profession or occupation of the owner or occupant, and who is employed by the employer for 52 hours or more and who earns $100 or more in wages from the employer during 90 consecutive calendar days.

Premium for this classification will be calculated based on a per capita charge. The premium for any one employee described above who is employed for a period less than a full year shall be no less than 25% of the annual per capita charge for each such employee, but in any event the total premium due shall be no less than the minimum premium stated in the policy.

0913 Private Residences – Inservants, Full-Time¹²

Private Residence – Definition

Private Residence as used in this Manual shall mean an establishment consisting of:

A tenement, flat or apartment definitely described as a part of any building if occupied exclusively as a residence by not more than one family.

A building designed for an occupied exclusively as a residence by not more than two families, together with the land upon which it is situated, including barns, stables, garages, and customary outbuildings used for household purposes and provided that no farming or dairying operations are carried on for commercial purposes. If, however, such an establishment comprised a tract of land exceeding five acres and more than five full-time servants are employed (whether inside or outside), it shall be treated as a “private estate.”

The private residence of a physician, surgeon or dentist in which office quarters are maintained for professional purposes (no other portion of the residence except such office being so used) shall qualify as a private residence under these rules.

In-servants – Definition.

In-servants shall mean all employees by whatever name they may be designated, engaged in household or domestic service whose principal duties are performed inside the residence. The term includes, but is not limited to such employees as cooks. Laundresses, maids, butlers, seamstresses, nurses, companions, governesses, and housekeepers.

0912 Private Residences: Out-servant, Full-time¹³

Out-servant Definition.

Out-servants shall mean all employees engaged exclusively in household or domestic service whose duties are performed principally outside the residence. The term includes but is not limited to private chauffeurs (not chauffeurs of public or commercial motor vehicles); employees engaged in cultivating flowers, vegetables, or other agricultural products for noncommercial purposes or employees engaged in the care of lawns, shrubs, or grounds surrounding the residences and maintained exclusively for appearance.

0910 Occasional Servants¹⁴

Scope

The term occasional servant as used in this Manual shall mean all out-servants and in-servants whose employment is not continuous but whose duties are a regular and continuing part of the customary household or domestic duties. This definition apples only where a fair estimate of the time during which an occasional servant is employed is less than 40 hours per week. Under all other circumstances such as servant shall be classified as a full-time servant and rated accordingly. The term “Occasional Servants” includes such employees as a laundress for certain days in the week or a chore person who takes care of the furnace, removes ashes, shovels snow in season or does other work of this character using as much time at frequent intervals as the requirements of the work make necessary.

Domestic Workers – Residences¹⁵

Scope

Applies to full or part-time domestic workers employed inside or outside a private residence and includes private chauffeurs.

Scope

This classification is applicable to the following domestic workers:

1. Inside Domestic Workers: Domestic Workers-Inside are employees engaged exclusively in household or domestic work performed principally inside the residence. Examples include a cook, housekeeper, laundry worker, maid, butler, companion, nurse and babysitter.
2. Outside Domestic Workers: Domestic Workers – Outside are employees engaged exclusively in household of domestic work performed principally outside the residence. Examples include a private chauffeur and a gardener.
3. Occasional Domestic Workers: Domestic Workers – Occasional are domestic workers, inside or outside, who are employed part-time. Examples of occasional domestic workers are persons engaged on certain days for gardening, cleaning, laundering, or babysitting.

This is a payroll-based classification and is to be used in lieu of the per capita classifications of 0908, 0909, 0912 and 0913.

9002 Domestics¹⁶

Scope

Employees engaged in household or domestic work performed principally inside the insured’s residence. This would include a cook, housekeeper, laundry worker, maid, butler, companion, or baby sitter. The classification contemplates employees who may perform various services for the private residents. Principal duties pertain to the general operations of the household.

Also contemplated by this classification are those individuals performing home help services or providing personal assistance or home care for persons who are convalescent, aged, or acutely or chronically ill or disabled.

Home services providing principally nursing care by licensed nurses rated separately under 9040.

Does not include farm activities.

Lawn and garden service employees rated separately under 9007.

Commercial janitorial services, cleaning services or contractors providing workers who specialize in cleaning operations only rated separately under 9007.

Group homes for the developmentally disabled rated separately.

0923/0913 Domestic Workers – Residences¹⁷

Scope

Employees of commercial nursing services, maid services or companion services, as well as employees whose duties are within the scope of a farm classification shall not be assigned to this classification.

Per capita Basis   0913 Payroll Basis   0923

6510-00 Domestic Servants Employed In or About the Private Residence of a Home Owner¹⁸

Scope

Applies to individuals employed by a homeowner to provide domestic services in the home owner’s private residence. This classification includes services such as, but not limited to, cooking, housekeeping, caring for children, running errands, shopping, and transporting members of the household by vehicle to appointments, after school activities, or similar activities.

This classification is subject to the provisions of RCW 51.12.020 – Employments excluded – which states in part: The following are the only employments which shall not be included within the mandatory coverage of this title: Any person employed as a domestic servant in a private home by an employer who has less than two employees regularly employed forty or more hours a week in such employment.” This classification is also subject to the provisions of RCW 52.12.110 which allows the employer to elect optional coverage for domestic servants.

This classification excludes chore services which are to be reported separately in classification 6511; domestic (residential) cleaning or janitorial services which are to be reported separately in classification 6602; and skilled or semiskilled nursing care which is to be reported separately in classification 6110.

6511-00 Chore Services¹⁹

Scope

Applies to establishments engaged in providing chore services to private individuals. Chore services performed by the chore workers/home care assistants include, but are not limited to, general household chores, meal planning and preparation, shopping and errands either with or without the client, personal care such as bathing, body care, dressing and helping with ambulating, as well as companionship. Frequently the recipients of service are also available to those who pay privately.

This classification excludes individuals working under a welfare special works training program who are to be reported separately in classification 6505; domestic (residential) cleaning or janitorial services which are to be reported separately in classification 6602; and skilled or semi-skilled nursing care which is to be reported separately in classification 6110.

8828 Domestics (Light Maintenance), Maids in Private Residence²⁰

Scope

Domestic, Light Maintenance Maids in Private Residences

Notes

1. Source: Government of the Virgin Islands Handbook on Worker's Compensation Insurance.
2. Source: 1990-2003 National Compensation Insurance, Inc. Scopes Manual.
3. Source: 1990 - 2003 National Council on Compensation Insurance, Inc. Scopes Manual.
4. Source: 1990 - 2003 National Council on Compensation Insurance, Inc. Scopes Manual.
5. Source: 1990 - 2003 National Council on Compensation Insurance, Inc. Scopes Manual.
6. Puerto Rico State Insurance Fund Corporation, Manual of Classifications and Rates For Workers' Compensation Insurance, July 1, 1999 to June 30, 2000.
7. Source: 1990 - 2003 National Council on Compensation Insurance, Inc. Scopes Manual.
8. Source: 1990 - 2003 National Council on Compensation Insurance, Inc. Scopes Manual.
9. Source: 1990 - 2003 National Council on Compensation Insurance, Inc. Scopes Manual.
10. Source: CA Workers' Compensation Classification for Private Residence Employees, SCIF Manual.
11. Source: CA Workers' Compensation Classification for Private Residence Employees, SCIF Manual.
12. Source: New Jersey Workers' Compensation and Employers Liability Insurance Manual.
13. Source: New Jersey Workers' Compensation and Employers Liability Insurance Manual.
14. Source: New Jersey Workers' Compensation and Employers Liability Insurance Manual.
15. Source: 1999-2003 National Council on Compensation Insurance, Inc. Scopes Manual.
16. Source: ND Classification Manual.
17. Source: Texas Workers' Compensation and Employers' Liability Manual, Effective 3/2001.
18. Source: WA Statutory Authority: RCW 51.16.035 98-18-042 § 296-17-72201, filed 8/28/98 , effective 10/1/98.
19. Source: WA Statutory Authority: RCW 51.16.035. 99-18-068 § 296-17-7220, filed 8/31/099, effective 10/1/99.
20. Source: WV Workers' Compensation Division Classes and Rates Publication, 8/4/03.

APPENDIX B. NCCI Workers' Compensation And Employer Liability Insurance Policy

Voluntary Compensation and Employers Liability Coverage for Residence Employees Endorsement

This endorsement adds Voluntary Compensation Coverage and Employers Liability Coverage to the policy.

"Bodily injury," "business," "residence employee," "residence premises," "you," and "we" have the meanings stated in the policy.

Voluntary Compensation Coverage

A. How This Coverage Applies

This Coverage applies to bodily injury by accident or bodily injury by disease sustained by your residence employees.

1. The bodily injury must arise out of and in the course of the residence employee's employment by you.
2. The employment must be necessary or incidental to work in the state of the residence premises or a state listed in the Schedule.
3. Bodily injury by accident must occur during the policy period.
4. Bodily injury by disease must be caused or aggravated by the conditions of your residence employee's employment to you. The residence employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period.

B. We Will Pay

We will pay an amount equal to the benefits that would be required of you if you and your residence employees were subject to the workers compensation law shown in the Schedule. We will pay those amounts to the persons who would be entitled to them under the law.

C. Other Insurance

We will not pay more than our share of benefits and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid.

D. Exclusions

This Coverage does not cover

1. bodily injury arising out of any of your business pursuits.
2. bodily injury intentionally caused or aggravated by you.
3. any obligation imposed by a workers compensation or occupational disease law or any similar law.

E. Before We Pay

Before we pay benefits to the persons entitled to them, they must:

1. release you and us, in writing, of all responsibility for the injury or death.
2. transfer to us their right to recover from others who may be responsible for the injury or death.
3. cooperate with us and do everything necessary to enable us to enforce the right to recover from others.

If the persons entitled to the benefits of this Coverage fail to do those things, our duty to pay ends at once. If they claim damages from you or from us for the injury or death, our duty to pay ends at once.

Employers Liability Coverage

A. How This Coverage Applies

This Coverage applies to bodily injury by accident or bodily injury by disease sustained by your residence employees.

1. The bodily injury must arise out of and in the course of the residence employee's employment by you.
2. The employment must be necessary or incidental to work in the state of the residence premises or a state listed in the Schedule.
3. Bodily injury by accident must occur during the policy period.
4. Bodily injury by disease must be caused or aggravated by the conditions of your residence employee's employment by you. The residence employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period.

B. We Will Pay

We will pay all sums you legally must pay as damages because of bodily injury to your employees, provided the bodily injury is covered by this Employers Liability Insurance.

The damages we will pay, where recovery is permitted by law, include damages:

1. for which you are liable to a third party by reason of a claim or suit against you to recover damages obtained from the third party;
2. for care and loss of services; and
3. for consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and
4. because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer.

C. Exclusions

This Coverage does not apply to:

1. bodily injury arisnig out of any of your business pursuits.
2. bodily injury intentionally cause or aggravated by you.
3. any obligation imposed by a workers compensation or occupational disease law or any similar law.

D. Other Insurance

We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid.

E. Limits of Liability

Our liability to pay for damages is limited. Our limits of liability are shown in the Schedule. They apply as explained below, regardless of the number of insureds, claims or suits, or persons who sustain bodily injury.

1. Bodily Injury by Accident. The limit show for "bodily injury by accident--each accident" is the most we will pay for damages because of bodily injury to one or more residence employees arising out of any one accident. That limit includes damages for death, care, and loss of services.
2. Bodily Injury by Disease. This limit shown for "bodily injury by disease--coverage limit" is the most we will pay for damages because of all bodily injury by disease to one or more residence employees. The limit shown for "bodily injury by disease--each employee" is the msot we will pay for all damages because of bodily injury by disease to any one employee. The limits include damages for death, care, and loss of services.
3. We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance

Policy Provisions

Voluntary Compensation Coverage and Employers Liability Coverage are subject to the provisions of the policy relating to the defense of suits; payment of claim expenses; duties after loss; waiver or changes of policy provisions; cancelation and nonrenewal; suborgation or recovery from others; assignment or death of the insured; premium; and bankruptcy.

Schedule
1.	Residence EmployeesInservantsOutservants, includingprivate chauffeurs	Number	Rates	Premium
2.	State:		Workers Compensation Law
3.	Limits of Liability for Employers Liability Coverage
	Bodily Injury by Accident	$_______________ each accident
	Bodily Injury by Disease	$_______________ coverage limit
		$_______________ each employee
	This endorse changes the policy to which it is attached and is effective no the date issued unless otherwise stated.(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
	Endorsement EffectiveInsured	Policy No.		Endorsement No.Premium $
	Insurance Company	Countersigned by__________________________________________

APPENDIX C. Workers’ Compensation Law Case Digests By Jurisdiction

California

In Home Supportive Services v. Workers’ Compensation Appeals Board, 152 Cal. App. 3d 720, 199 Cal. Rptr. 697 (3d App. Dist. 1984)

This case involved a worker injured while providing in-home support services designed to enable frail elders and persons with disabilities and sight-impairments to remain in their own homes. The services were provided in a private home but were paid for by a state agency called the In-Home Support Services Program. The State argued that the controlling employment relationship for purposes of workers' compensation coverage was between the recipient of the services and the worker--a relationship that did not include enough wages or hours to require coverage under the California law. The Court found that there was a "dual employment" relationship that included the state agency as an employer, in addition to the recipient as employer. Moreover, the Court called it a concept that has long been recognized in situations of general and special employment where a general employer furnishes an employee to another person with both employers having some right of control during the engagement. The Court found that there was sufficient direction and control by the State to make it at least a dual employer regardless of how the actual payments were made to the worker providing services, (in this case by a state agency although in some cases the state pays the recipient of services directly, who, in turn pays the worker),. The Court very strictly construed a statutory exception for limited coverage of domestic service to apply only as to the employment relationship with the recipient of services and not to the employment relationship with the State. The Court found that implicit in the legislative history of the California domestic service exclusion was a legislative purpose to impose the obligation of providing workers’ compensation coverage for household domestic employers only when the risk spreading mechanism of insurance is available, as it might be in a case such as this where dual employment could be found.

The Court struggled to find coverage for the injured worker in this case, looking for an employment relationship that would afford that coverage where the relationship between the recipient employer and worker would have been excluded as domestic service.

McCallister v. Workers’ Compensation Appeals Board, 61 Cal. App. 3rd 524, 132 Cal. Rptr. 527 (1976)

In this often-cited case, the Court found that services provided in a private home solely to care for and wait upon a frail elder and that included no duties in connection with the maintenance or functioning of a household, was not domestic service excluded from coverage under the California Workers' Compensation Act. The Court noted the dearth of authority distinguishing between what it referred to as "the lower echelons of health care services provided in the home to a member of the household." It found that cases such as this each must be determined on their own facts. Based on the record in this case that the Court characterized as showing that the injured worker performed only those duties directly related to the care and comfort of the frail elder and not to the general operation and maintenance of the household, the Court held that the exclusion for "household domestic service" did not apply.

This case draws a distinction between services provided for an individual within a household as opposed to services provided to the household in general. While the latter might be excluded as "household domestic service," by state workers’ compensation hearing officers while the former are not.

However, it should be noted that domestic service employment classifications described in Appendix B and used by states do not distinguish between services provided to one or all of the individuals residing in or around a private residence. Thus, one could argue the basis of the decision in McCallister v. Workers Compensation Appeals Board and other similar cases (Viola v. Workmen’s Compensation Appeal Board, 549 A.2d 1367,121 Pa. Commw. 47 (1988) saying that both should have qualified under the classification of domestic service.

Bonnette v. California Health and Welfare Agency, 704 F. 2d 1465 (Ninth Cir. 1982)

This federal court decision involved the employment relationship and minimum wage requirements where state and county agencies provided domestic in-home services to aged, the blind and the disabled enabling them to remain in their own homes. The Court found that the agencies exercised considerable control over the nature and structure of the employment relationship along with complete economic control and, hence, were held to be employers for purposes of minimum wage requirements. This was not altered by the fact that the agencies delegated to the recipients of the services various employer responsibilities; that merely made them joint employers. This is similar to the logic that applied in the In-Home Support Services decision discussed earlier where "dual employment" led to a finding of coverage under the state workers' compensation system.

Cases like this illustrate the use of liberal construction of a statute in order to achieve beneficent effects of a statutory scheme.

Bue v. Workers' Compensation Appeals Board, 43 Cal. Comp. Cas 396 (3rd App. Dist. 1978)

This case involved a daughter injured while lifting her invalid mother from a wheelchair. The Workers’ Compensation Judge concluded that lifting the wheelchair was incidental to the daughter's performance of normal routine domestic services and therefore she was not an employee entitled to workers' compensation benefits. The reviewing Court upheld the Workers' Compensation Judge's decision.

Colorado

Melnick v. Industrial Commission of the State of Colorado, 656 P. 2d 1318 (Colorado Ct. of Appeals, Div. Two 1982)

This case involved penalties imposed under the Colorado Workers' Compensation Act when a household employer failed to file a notice of contest or admission of coverage when notified that a nurse's aide was injured while performed services for the household employer's wife. The Court upheld the hearing officer's determination that the injured aide was covered by the Workers’' Compensation Act and which penalties were appropriate. The Court held that the hearing officer's finding that the injured nurse's aide was an employee rather than an independent contractor was supported by the evidence. The hearing officer had found that the nurse's aide was not a licensed professional nurse, she was paid an hourly wage, there was no contract regarding duration of services and the family hired her and continually gave her instructions.

Connecticut

Smith v. Yurkovsky, Case No. 4324 CRB-3-00-12, Conn, WC Comm. Comp. Rev. Bd (Dec. 2001).

This case involved a worker injured while providing nursing services in a private home. At issue was an exclusion from the definition of employee in the Connecticut workers’ compensation law for “any person working in a private residence provided he is not regularly employed by the owner or occupier over 26 hours per week.” Under the facts of the case, the injured worker’s hours per week varied during the course of the year. Some weeks her hours exceeded 26; while other weeks she did not. The Compensation Review Board found that an average of hours worked over the 26 weeks prior to the date of injury should be used to determine whether the threshold was reached. In the absence of a statutory definition of “regularly employed” the Board reasoned that the legislature introduced the works “regularly employed” into the WC law. The Board noted that the term must be given meaning that allows employers to predict when WC insurance will be necessary – and to do so requires some ascertainable boundaries rather than case-by-case determinations. Otherwise, it would be unfair to household employers trying to determine their legal obligations to provide coverage.

This case emphasizes the important of household employers collecting and maintaining accurate hours worked information for all workers, preferably using a standard time sheet format that is signed by the employer and employee for each time period.

Florida

Smith v. Ford, 472 So. 2d 1223 (1985, FL 1st Dist. Ct. App.)

The court held that the claimant was ineligible for workers’ compensation benefits under the Florida law because she was a "domestic servant in a private home" which is excluded by Section 440.02(13(c)1.

The deputy commissioner at the administrative level had determined the facts to be that the claimant's normal duties were both domestic and personal care of her employer in a private home. Reversing the lower administrative decision which held that her duties as a "personal or home attendant" at least 50 percent of the time afforded her coverage under the Florida law, the Court in this decision reversed and ruled that the claimant's duties result in her being a domestic servant in a private home, regardless of the mixture of duties which included those of a personal attendant which arguably were non domestic.

The Court cited the intent of the workers’ compensation law, as articulated by Larson in his treatise, that the costs be placed on the industry involved and ultimately on the consumer through the medium of insurance, whose premiums are passed on in the cost of the product. Citing Larson, it appeared willing to strictly construe the exclusion from coverage in the Florida law because of the difficulty facing householders in determining whether and to what extent they face liability when directly hiring workers’ to perform tasks in their households, as opposed to in their trades or businesses.

Maryland

Nationwide Ins. Co. v. Rhodes, 732 A. 2d 388, 127 Md. App. 231 (1999) (Exerpt)

The court held that a homeowners insurer had no duty to defend a claim for workers’ compensation coverage because the household employer's policy it issued excluded any potentiality for workers’ compensation liability. The claim involved a home health aide.

Interestingly, the homeowner’s insurer did defend the policyholder against a negligence claim for the same injuries brought in tort. However, the insurer refused to defend a workers’ compensation claim that ultimately succeeded, the latter claim resulting in coverage under the Maryland Uninsured Workers' Compensation Fund because the household employer did not carry workers' compensation insurance.

The excerpt from this case is instructive insofar as it discusses the many potential areas of coverage for injuries to someone performing domestic services or personal assistance in a private home directly for the household employer. There were potential claims in tort, workers’ compensation and contractually under the Medical Payments to Others section of the household employers policy. In this case dealing with a home health aide, coverage was ultimately found under Maryland workers' compensation and, more specifically, in the Maryland Uninsured Workers' Compensation Fund.

This case deals with the obligations of the homeowner’s insurer to defend a household employer against a workers’ compensation brought by a directly employed home health aide. It was decided after it was determined by another court that there was coverage under Maryland workers' compensation so it does not go into any detail about the basis for that underlying finding.

Another interesting sidelight of this case is that it illustrates that, aside from actual liability and coverage, whole cases can involve the liability for the legal costs incurred to determine where that coverage and liability lies. This duty to defend against liability and coverage is a little recognized but very significant coverage afforded in insurance policies. Household employers do not want to incur this cost any more than the cost of insurance or ultimate liability but it should be addressed.

Nebraska

Dunagan v. Folkers, Nebraska Workers' Compensation Court, Doc: 195 No: 2116, 1996

This decision addressed the issue of whether a "private duty nurse" was a "household domestic servant" and therefore exempt from coverage under the Nebraska Workers' Compensation Act. The Court found that the injured plaintiff devoted most of her time to the special needs of a quadraplegic patient in her private home although some of plaintiff's time was spent performing household tasks such as cleaning, cooking, laundry and child care for another. It also noted that the worker was injured while transferring the patient from her wheelchair, a duty within her function as a nurses assistant. The Court cited the oft-stated rule of construction that the Workers' Compensation Act should be liberally construed, and exceptions strictly construed, in order to obtain the beneficient purposes of the Act. The Nebraska Court looked to decisions in Oklahoma, Nelson v. Bradshaw, 791 P.2d 485 (Okl. App. 1990), California, McCallister v. Workers' Compensation Appeal Board, 61 Cal. App. 3rd 524, 132 Cal. Rptr. 527 (1976) and Pennsylvania, Viola v. Workmen's Compensation Appeal Board, 549 A. 2d 1367 (Penn. 1988) to find coverage in close factual questions. The Court embraced Larson's treatise argument that "Even if the employment is within a private household, it may be distinguishable from domestic service if its essence is not that of performing household duties, but is rather that of practical nursing--for example, the care of an elderly invalid." The Court was not swayed by the fact that the injured worker was placed in the private home by an agency. Neither was the Court persuaded by the argument that the household employers were not engaged in a "trade, business profession or vocation." Instead, the Court found that they employed several licensed nurses and nurse care providers, withheld taxes and social security, provided vacation time and had an employer ID number; the Court said that they were in the "business of providing the services necessary to maintain [the patient's] quality of life."

It is not surprising that the Court found that the services at issue in this case were more those of a practical nurse than a household domestic servant under the facts presented to it. However, it is somewhat surprising that the Court found that the frail elder and her relative who hired people to care for the frail elder were in a business and, therefore, were required to provide workers' compensation coverage.

Pettit v. State Of Nebraska Department of Social Services, 249 Neb. 666 (1996, SC, No. S-94-797)

The issue in this case was whether Donna Pettit, a chore provider of an aged and disabled individuals who received services under the Nebraska Medicaid Waiver Program was an employee of the Nebraska Department of Social Services (DSS) when she injured her lower back while providing chore services. The worker had been engaged to provide personal assistance services by a Medicaid waiver recipient. State DSS staff had informed Pettit that she was an independent contractor and that she would not receive sick leave, vacation leave or insurance. Staff further informed Pettit that the Medicaid waiver recipient was her employer and that she was not covered by workers’ compensation. Pettit received an IRS Form W-2 that reflected withholding for FICA by DSS (acting as the recipient’s agent under Section 3504 of the IRS code and IRS Revenue Procedure 80-4).

The Workers’ Compensation Court found that Pettit did not prove that she was a DDS employee. Upon appeal, the Nebraska Court of Appeals reversed the Workers’ Compensation Court and held that, as a matter of law, Pettit was a DSS employee when she was injured (Pettit v. State 95 NCA No. 28, case No. A-94-797 (not designated for permanent publication). The Court found that the record failed to reflect that there was a clear inference as to whether Pettit was an employee or an independent contractor when she was injured. It held that there was sufficient competent evidence in the record to support the Workers’ Compensation Court’s determination that Pettit was not an employee of DSS. The Nebraska Supreme Court reversed the holding of the Court of Appeals.

This case did not address any potential liability due to work place injury for the Medicaid waiver recipient as the common law employer of the chore provider. It only finds that the State is not the employer of the chore worker. Facts in the case include DSS staff informing Pettit that the Poels (Medicaid recipient) were her employer and “boss.” In addition, Pettit received an IRS Form W-2 from the State, as employer agent for the Poels not an IRS Form 1099. However, potential liability for the Medicaid recipient related to work place injury appears to be minimal since Missouri workers’ compensation law exempts employers with fewer than five workers and employers of domestic service workers from the law. If the worker truly performs only chore-related duties, he or she would fall under the state’s definition of domestic service. However, if the chore worker performed also personal assistance-related tasks, final determination of whether the worker falls under the domestic service employment classification would be based on the results of a workers’ compensation claims appeal decision

Nevada

Sullivan v. Second Judicial District Court, 331 P. 2d 602, 74 Nev. 334 (1958, S.Ct.)

This case involved the sole issue of voluntary coverage under Nevada Industrial Insurance (that is, workers’ compensation insurance) for a nurse employed directly by a household employer. More specifically, the case concerned voluntary coverage for two nurses when the household employer had voluntarily elected coverage for three domestic servants but failed to elect coverage for the nurses. Did the election for the domestic servants constitute acceptance of the Nevada law for all of the household employer's employees, including the two nurses?

It was admitted in pleadings that the nurses were employees of the household employer and coverage under the Nevada workers' compensation was compulsory as to them. Domestic servants are expressly excluded from the law although an employer can voluntarily elect coverage for them. The Court had to decide whether a voluntary election as to domestic servants (which the household employer in this case made) constituted acceptance of the law as to nurses he also employed directly in his household. Procedurally, this issue had to be resolved to determine whether the claimant nurse could continue to proceed in his action in tort for negligence; under Nevada law, an injured employee can proceed in tort if the employer fails to provide coverage where it is required. The court held that the workers’ compensation that was admittedly required for the nurse was not accepted by the household employer by virtue of his voluntary election to cover the domestic servants, therefore the nurse could continue to proceed with his tort action against the household employer/employer.

This case illustrates the interplay between the workers’ compensation system and the tort system. A finding of exclusion or non-coverage in one can open up remedies in the other for the injured worker and corresponding liabilities for the household employer/employer.

New Hampshire

Appeal of Richard Routhier, 143 N.H. 404, 725 A.2d 665 (NH S. Ct., 1999)

This case involved whether a sole proprietor of a cleaning business was entitled to workers’ compensation benefits under mandatory household employers insurance coverage of domestics under the New Hampshire workers’ compensation law or, alternatively, under the language of the household employers insurance policy affording the mandatory coverage. The petitioner had been injured when he fell from a ladder after washing an outside window at a private household. The New Hampshire Supreme Court upheld the New Hampshire Compensation Appeals Board decision that the injured plaintiff was not entitled to workers’ compensation benefits.

The New Hampshire Supreme Court analyzed the language of RSA 281-A:6, which requires all comprehensive personal liability, tenant’s and household employer’s insurance policies in New Hampshire provide workers’ compensation insurance covering domestics. The petitioner argued that he was a domestic because he was performing household duties and maintenance for a household employer at the time of his injury. The household employer’s insurance carrier responded that the petitioner was not a domestic because he was not an employee of the household employer. Petitioner agreed that he was not an employee but countered that the statute negated the usual statutory requirement that the injured party be an employee. The Supreme Court disagreed with petitioner.

The petitioner caused the Court to look closely at legislative history that demonstrated that at least one state senator assumed that coverage of domestics would extend to “individuals hired on a very short term basis who are injured while working around the house, mowing the lawn, washing windows and so forth.” Absent more formal legislative history, however, the Court found that a domestic must be an employee of the household employer to receive workers’ compensation benefits. The Court did, however, encourage the legislature to define the term domestic rather than require courts to define it on a case-by-case basis.

The Court also analyzed the language of the household employer’s insurance policy. It found that the policy language, like the statute itself, required that the injured party be an employee in order to receive workers’ compensation coverage. The petitioner did not contest that he was not an employee of the household employer so there was no coverage.

New York

McCrory v. Thomas, 40 Misc. 2d 904, 244 N.Y.S. 2d 111 (S. Ct., Kings County 1963)

This case involved injury to a licensed practical nurse while rendering services in a private home. The Court dismissed the injured LPN's claim based on failure to provide workers' compensation coverage because there was no evidence that the relationship of master-servant existed which is a pre-requisite to coverage under the Act. Quoting another New York decision, it said "a trained nurse called in on a special case is not in the service or the servant of the employer. She is a professional person like a physician, employed to exercise her calling to the best of her ability according to her own discretion." This case points out the critical distinction in employment relationship that can arise when the injured party is operating under a professional license.

Oklahoma

Nelson v. Bradshaw, 791 P. 2d 485, 1990 Ok. Civ. App. 29 (1990)

This case involved an injured worker who testified that she was hired to provide services to an individual in his home "in a nursing capacity" despite the fact that she also performed incidental household chores. The Court found that out of state legal authority was both scarce and in conflict on the issue of whether a nurse such as the injured worker in this case was a domestic servant. The Oklahoma Court did not think that the Oklahoma legislature contemplated a person engaged in practical nursing for which a professional license is required to be the same as a domestic servant. Noting that any employment is covered under the Oklahoma Workers' Compensation Act unless it is specifically excluded, the Court found that the claimant's employment as a private or practical nurse was not excluded by the Oklahoma Workers’ Compensation Act exception for domestic servants.

Oregon

Gunter v. Mersereau, 7 Ore. App. 470; 491 P. 2d205 (Ore. App. Ct., 1971)

This appeal, in the words of the Court, raised the sole issues of whether a person employed to care for an invalid in the invalid’s home comes within the exclusion from workmen’s compensation coverage for “domestic servants.” The injured worker cared for a stroke victim who required round-the-clock care involving food preparation and clean-up, administration of medication, and assistance with bathing, dressing and transferring. The worker injured her back while transferring the person from her wheelchair. The Court rejected the claimant’s argument that she was not a domestic servant because domestic service connotes care of the home rather than the person. In addition, the Court rejected the claimant’s argument that occasional administration of medication changed the nature of her duties to those of a nurse’s aide rather than a domestic servant. “The true test is the nature of the work actually done” said the Court as it affirmed the lower court holding that the domestic servant exclusion applied to her based on the work she actually performed so that coverage was denied.

Kerns v. Guido-Lee, 813 P. 2d 578, 107 Or. App. 721 (1991)

At issue in this case was the exclusion from Oregon workers' compensation of a housekeeper employed by a referral service under a former version of the Oregon law that excluded domestic servants without qualifying the nature of the employer. The housekeeper was paid by the household employers but paid a portion of the money to the employer agency that was the defendant in this case.

The Court strictly construed the statutory exclusion that applied at the time, noting that the Oregon legislature had limited the exclusion for agricultural workers with the phrase "in or about the private home of the person employing the worker," whereas the domestic servant exclusion had no similar qualifier. The Court concluded that the legislature clearly intended that the exclusion for domestic servants apply to the entire class of workers regardless of the identity of their employer.

As noted above, the Oregon legislature later amended the domestic servant exclusion of apply only to service "by private employment contract." As in the case described in the digest above, presumably the outcome of this case would be different if it arose under the new statute.

Matter of Lewis, WCB Case No. 91-10026 (Oregon Workers' Compensation Board, 1992)

This administrative decision by the Oregon Workers' Compensation Board followed the reasoning in Kerns v. Guido-Lee, 813 P. 2d 578, 107 Or. App. 721 (1991) and held that a former Oregon workers’ compensation law exclusion for a "domestic servant in or about a private home" applied because of the nature of the work regardless of the identity of the persons arranging for, supervising, controlling or benefiting from the service. The underlying facts are not fully developed in the reported decision, however, a footnote alludes to the injured claimant as one who "works for an employer engaged for profit in the business of housekeeping." One can infer from this description, that the injured worker was employed by a housekeeping agency, not directly by the household employer. The Board concluded that the nature of the employer was irrelevant to the exclusion and the employee was excluded from workers' compensation because of the nature of the work as a domestic servant in a private home.

This a very strict and draconian reading of the then-applicable Oregon statute. One gleans from Larson's treatise that the domestic service exclusion is designed to protect the household employer who directly employs help in his/her home rather than the agency that employs and places employees in private homes for a fee.

Note that the applicable provision of the law (ORS Section 656.027 (1)) was subsequently amended and now defines domestic servant to mean "any worker engaged in household domestic service by private employment contract, including, but not limited to, home health workers." (Underline added.) Presumably, this would change the result in a case involving similar facts that arose today.

McFarland v. SAIF Corporation, 89 Ore. App. 184; 748 P. 2d 150 (Ore. App. Ct., 1988)

This Court of Appeals decision involved a worker injured while employed as a domestic servant in a household job that she got through the OR Department of Human Resources Division of Senior Services (the “Division”). The Court found that the duties performed were those of a domestic servant – meal preparation and clean-up, assisting the individual with bathing, dressing, eating and positioning in bed – regardless of the claimant’s certification as a nurse’s aide. The Court also cited a provision in the law applicable at the time that said domestic servants of persons receiving public assistance from the Division were not subject to the State’s workers’ compensation law even if the workers were paid directly by the Division (as the injured worker was) rather than by the person receiving the services. The Court concluded that the Board had not erred in its underlying decision by denying workers’ compensation coverage for the claim.

Pennsylvania

Viola v. Workmen's Compensation Appeal Board, 549 A. 2d 1367, 121 Pa. Commw. 47 (1988)

This case involved a worker injured while employed by an individual to care in his home for his wife who was disabled and confined to a wheelchair. The evidence showed that the injured worker did not serve the needs of the household, rather, her duties related solely to the unique needs of the wife who was disabled. In this case, the injured worker was found not to have performed housework nor domestic or maid services. The Court held that because the injured worker’s job involved duties similar to a nurse’s aide and did not involve household duties, she was not an excluded domestic servant.

The Court struggled to find coverage for the injured worker in this case, looking for an employment relationship that would afford that coverage where the relationship between the recipient employer and worker would have been excluded as domestic service. In a conversation with State Workmen’s Insurance Fund (SWIF) staff, she strongly disagreed with the decision of the Workmen’s Compensation Appeal Board in this case. She reported that domestic service covers a worker providing chore/personal assistance services to a elder or person with a disability in his/her home, regardless of the work performed for the general household. SWIF staff also reported that the employer was allowed to buy workers’ compensation insurance coverage through the SWIF’s domestic service exemption policy.

Dorothy Stock v. Abilities in Motion, PA Department of Labor and Industry Bureau of Workers’ Compensation Claims Settlement (August 20, 2001)

This case is a settlement that involved a program participant of the Pennsylvania Attendant Care Program, a Center for Independent Living (Abilities in Motion) that acts as the fiscal intermediary for the program participant and a personal care worker who reported being injured on the job. Abilities in Motion requires that all program participants participating in the self-directed portion of the PA Attendant Care Program purchase and have a current workers’ compensation insurance policy (domestic service exemption policy) for their personal care workers either through a private insurer or the SWIF. Abilities in Motion will not pay any wages to a personal care worker hired by the program participant until a program participant has workers’ compensation coverage for his or her workers. The program participant in this case had a current and fully executed workers’ compensation policy at the time the claimant (Dorothy Stock) reported being injured (back sprain) as a result of assisting the program participant with activities of daily living.

The claimant lived with her father. He owned his own home and had homeowner’s insurance. At the time of the injury, the father thought the worker’s claim would go against his homeowner’s insurance and was afraid his homeowner’s insurance would be cancelled as a result of the claim. For some reason, he did not understand that his daughter was fully covered through her own, Domestic Service Exemption Policy obtained through the SWIF.

The claimant retained an attorney and made a claim against Abilities in Motion’s workers’ compensation policy claiming that the organization was her employer. Abilities In Motion countered this claim by saying it was just the fiscal intermediary for the program participant for payroll purposes and that the program participant was the employer of the claimant. Thus, the claim should be processed against the program participant’s executed workers’ compensation insurance policy.

Two things went against Abilities in Motion in this decision. First, Abilities in Motion provides direct care services in addition to fiscal intermediary services. As a result, the hearing officer highlighted their direct care employer status. Second, the program participant, on direct

examination, reported that she was not her worker’s employer even though she directed and controlled all aspects of her workers’ activities with the exception of payroll.

The hearing officer then passed over the consumer’s executed workers’ compensation insurance policy and held that Abilities in Motion was the employer of the claimant for worker’s compensation and the claim should be processed against Abilities in Motion’s workers’ compensation insurance policy. A settlement was agreed to, however, the terms were a bit peculiar. First, the injured worker had to agree to voluntarily resign from employment and execute a document evidencing the worker’s intent to resign effective immediately, waiving any rights, remedies and/or causes of action to which the worker may be entitled under the Americans with Disabilities Act. The Agreement also could not be construed as an admission of liability on the part of Abilities in Motion or their insurer. Finally, the claimant had to keep the settlement confidential.

This case emphasizes the need for fiscal intermediaries to clearly define their roles and responsibilities and not to perform any activities that would give the perception that they are the employer of an individual’s personal care worker. In addition, individuals enrolled in a self-directed support service program such as the PA Attendant Care Program, and their representatives, should be thoroughly educated regarding their roles and responsibilities related to the personal care workers they recruit, hire and manage and the workers’ compensation insurance coverage they have. Finally, the PA Workers’ Compensation Hearing Officers should be educated regarding the role and responsibilities of fiscal intermediaries versus an employer of direct care workers.

Community Resources for Independence, Erie PA, Settlement with the PA Department of Labor and Industry Bureau of Workers’ Compensation, (2001).

This case is a settlement that involved a program participant of the PA Attendant Care Program, a Center for Independent Living (Community Resources for Independence that acts as the fiscal intermediary for a participant in the PA Attendant Care Program and a personal care worker who reported being injured on the job.

Community Resources for Independence (CRI) requires all program participants participating in the self-directed portion of the PA Attendant Care Program purchase and have a current workers’ compensation insurance policy (domestic service exemption policy) for their personal care workers either through a private insurer or the SWIF before CRI will pay any wages to a personal care worker hired by the program participant. The program participant in this case had a fully executed workers’ compensation insurance policy. The worker filed a claim against CRI rather than the program participant. The hearing officer, passed over the program participant’s workers’ compensation policy and allowed the claim to be made against CRI’s policy even though CRI made the case that they were the program participant’s fiscal intermediary. CRI staff reported that during the hearing the hearing officer did not understand the concept of a fiscal intermediary and the IRS designation of being an agent on behalf of the common law employer (the program participant) and made it clear that he was confused. The hearing officer also demonstrated his bias against persons with disabilities by stating he did not understand how a person with a disability could ever be considered an employer. Finally, CSRI workers’ compensation insurance carrier made very little effort to argue CSRI’s position. Once again, this case emphasizes the importance of fiscal intermediaries clearly articulating and executing its role and responsibility as the program participant’s agent rather than the common law employer of the personal care workers’ the program participant recruits and hires directly.

As mentioned in the case above, the Pennsylvania Workers’ Compensation hearing officers should be educated regarding the role and responsibilities of Fiscal/Employer Agents versus an employer of personal assistance service workers.

Texas

Finch v. Texas Employers' Insurance Association, 564 S.W. 2d 807 (5th Dist. Ct. Civ. App., 1978)

This case involved a workers' compensation award to a paraplegic husband who was injured in the course of his employment. The principal issue was the amount of the award to him for the value of certain nursing services rendered by his wife. A lower court jury had ordered the couple $25 per month for the wife's nursing services after the insurer refused to pay anything under its original settlement wherein it had agreed to pay all medical and hospital expenses incurred by the husband as a result of his work injury. This court rejected the couple's argument that the lower court jury should have included the value of the wife's usual domestic services in awarding an amount for her nursing services to the husband. This Court upheld the lower court's jury instruction that permitted the jury to weigh the evidence and determine how much of the wife's services were extraordinary services rendered because of the husband's disability (compensable nursing services) and how much were services usually rendered as part of the marital obligation (non-compensable). This Court could not say that the lower court jury award of $25 per month was against the great weight and preponderance of the evidence, therefore it affirmed the decision.

This case is interesting insofar as it illustrates the difficulty of determining an appropriate amount to compensate a spouse who provides services to a work-injured spouse. In this case, there was a distinction between extraordinary nursing services and usual domestic services that were viewed as part of a marital obligation.

Note that this case did not involve injury to a person providing domestic service, personal or physical assistance. The injured husband worked on an oil rig. As stated above, the issues in this case revolved around the central issue of the value of certain services provided to him by his wife.

Washington State

Linda J. Bromley, Docket Nos. 93 3892 & 93 5100; Claim No. N-071072; Washington State Board of Industrial Insurance Appeals (1995).

The injured worker in this case was providing home care service to a frail elder in her private home. The elder was a program participant in the Washington State Medicaid Community Options Entry System (COPES) Program. Under the COPES Program a program participant has the choice to either recruit and hire an individual home care provider or receive services provided by a contracted home agency. The choice of provider is entirely up to the program participant consistent with federal requirements that also require that payment be made directly to the provider. All COPES Program providers sign a written agreement that explicitly states that the contractor is NOT an employee of the Department of Social and Health Services (the “Department”) and will not file any claims as a civil service employee, including workers’ compensation claims. Nevertheless, the injured worker contended that she was hired and employed by the Department and that would allow her to avoid the domestic service exclusion that would otherwise apply if her employer were the elderly person. The Department contended that it lacked authority to be the injured worker’s employer and, alternatively, it did not exercise sufficient control over the injured worker for her to believe that she was an employee of the Department. The Judges found, based on their review of the facts, that the injured worker could not have reasonably believed that she was an employee of the Department. A strongly worded dissent agreed with the outcome, but argued that cases like this should not turn in the belief of the injured worker; rather, they should be decided solely on the basis that the Department lacks statutory authority to become an employer under these circumstances. The majority rejected the dissenting approach and ruled on the basis of the injured worker’s reasonable belief about who is the employer, a basis affirmed in the Odell B. Henderson case decided by the Board later that same year (see below).

Odell B. Henderson, Docket No. 93 4609; Claim No. N-390500, Washington State Board of Industrial Insurance Appeals (1995)

This administrative decision involved the exclusion from coverage under the Washington Workers’ Compensation Law for "any person employed as a domestic servant in a private home by an employer who has less than two employees regularly employed 40 or more hours a week in such employment." The injured worker contended that she was employed by the Washington Department of Social and Health Services that would allow her to avoid the domestic servant exclusion. The Judges found that the injured worker's reasonable belief that she was an employee of the state agency was a fact material to the existence of an employment relationship with the state agency. The Judges remanded the case to the hearing process for a factual determination of whether the injured worker's belief was reasonable.

Everist v. Department of Labor and Industries, 789 P. 2d 760, 57 Wn. App. 483 (Wash. Ct. of App. Div. Two 1990)

The injured worker in this case worked as an in-home helper for a husband and wife although her primary responsibility was caring for the wife who was disabled. The Court discusses two traditional reasons for excluding domestic servants. These included: 1) where a non-business entity is an employer, as is often the case with domestic service, the assumption that the costs of workers' compensation are passed on to the ultimate consumers of the employer's product fails, and 2) given the variety and number of different types of workers hired by household employers, it would unduly increase the systematic administrative costs and unduly increase the financial and administrative burdens on household employers. The Court cited decisions in other jurisdictions as holding that a person charged with performing domestic duties is a domestic servant even though a significant percentage of the person's activities involve care-taking for a particular individual in the household. The Court liberally applied the state's domestic servant exclusion to find that the injured worker was excluded as a domestic servant because she performed duties traditionally performed by a domestic servant. The Court noted that the holding comports with the reasons mentioned above underlying the domestic servant exclusion.

West Virginia

Weatherford v. Arter, 135 W. Va. 391, 63 S.E. 2d 572 (S. Ct. of Appeals 1951)

This case concerned a person injured while nursing and attending to a sick husband in a private home. The Supreme Court of Appeals focused on the provision in the West Virginia Act that defines employers as "All persons, firms, associations and corporations regularly employing other persons for the purpose of carrying on any form of industry or business in this State." It found that the terms "industry" and "business" as used in the quoted language relate to an occupation or employment engaged in for the purpose of obtaining a livelihood or for profit or gain, and that neither word embraces or applies to a residence occupied by a person as a home. Therefore, the defendant in the case was not required to provide coverage to the injured worker. The Court said that the purpose of the Workmen's Compensation Statute in West Virginia is to require industry to bear the burden of injury to employees and the conduct of a home is not industry or business within the meaning of the statute. Although the question of domestic service had been raised in earlier proceedings, it was not addressed in this case.

Wisconsin

Joyce Ambrose (Applicant) v Harley Vandeveer Family Trust (Employer) and Northwestern National Insurance Company (Insurer), WI Workers’ Compensation Decision, Claim No. 86-39393 (December 14, 1988)

The issue of this case is whether the applicant, Joyce Ambrose, was an “employee” of the respondents, Vandeveer Family Trust or Marine Trust Company within the meaning of section 102.07(4), Stats.

The applicant sustained injuries on December 10, 1983, when she slipped and fell in the home of her sister, who suffered from a disabling disease. In his last will and testament, the applicant’s father established the Vendeveer Family Trust, which provides for the continuing care of the applicant’s disabled sister. Marine Trust Company was the trustee on December 10, 1983. The applicant attempted to obtain workers’ compensation coverage for her fall through Marine Trust Company’s Insurance Carrier, Northwestern National Insurance Company.

Neither the statutes nor any Wisconsin case law provides a definition of domestic servant. The Commission concluded that a reasonable interpretation of the term “domestic servant” would not include an individual who is hired to provide primary care to a person with a disability. The Commission found this to be true even though the primary care giver may assist in the preparation and clean up of meals, because such activities would be incidental to the primary care duties. This interpretation is in accord with the holding of a California Court of Appeals care that addressed a similar issue, Mc Callister v. Worker’s Compensation Appeals Board, App., 132 Cal. Rptr,. 527 (1976). The Commission also believed it was in accord with a long-standing admonition of the WI Supreme Court that worker’s compensation statutes must be liberally construed in favor of including all services that can reasonably be said to come within the statute (See Grant County Service Bureau, Inc. v. Industrial Commission, 25 Wis. 2d 579, 52, 131 N.W. 2d 293 (1964). If the applicant had been hired for the specific purpose of performing regular cooking, cleaning or other duties commonly associated with the meaning of the term “domestic servant,” her employment would have come within the exclusion of section 102.07(4), Stats. The Commission believed she was employed exclusively as a primary care giver for her disabled sister, not as a cook, cleaning person or other form of domestic servant. However, it is believed that the Commission missed the fact that the state uses two classification codes (0908 and 0913) for domestic service that specifically include “ cook, housekeeper, laundry worker, butler, companion, nurse and babysitter. Companion and nurse services would certainly cover the tasks performed by the applicant but the Commission failed to recognize this.

The question remaining for the Commission was, who was the employer of the applicant, the Vandeveer Family Trust or the sister (e.g., what was the employer – employee relationship)? The primary test used by the Commission for determining the existence of an employer –employee relationship is whether the alleged employer has the right to control the details of the work, and among the secondary test to be considered are: (1) the direct evidence of the exercise of the right of control; (2) the method of payment compensation, (3) the furnishing of equipment or tools for the performance of work; and (4) the right to fire or terminate the relationship (See Kress Packing Company v. Kottwitz, 61 Wis. 2d 175, 182, 212 N. W. 2d 97 (1973). The Commission found that the sister administered her own affairs and at all time she reserved the right to control the details of the applicant’s employment. She hired the applicant, arranged for her payment by requesting and authorizing wages from the Trust, and retained the right to terminate the employment relationship. The Trust merely acted as conservator and manager of the trust funds. The Commission found that neither the Trust nor Marie Trust Company was the applicant’s employer. The Commission dismissed the case against Vandeveer Family Trust and Marine Trust Company. However, this would not preclude the applicant from filing an application naming her sister as the employer.

Shirley Nickell (Applicant) v. County Kewaunee Other, (Employer) and Firemans Fund Insurance of Wisconsin (Insurer), WI Workers’ Compensation Decision Claim No. 94064155.

The main legal issue in this case was whether the relationship of employee and employer exists and between which parties (e.g., the applicant and the county or the applicant and the program participant, Ms Kostichka. The domestic service exception would only apply if the applicant’s “employer’ was Ms Kostichka and not the county.

The record indicated that some eligible program participants under the Community Options Program choose their own personal care workers and then apply to the county for payment. In this case, Ms. Kostichka had chosen the applicant’s predecessor but when that worker left, she simply asked the county for a referral. In addition, the applicant herself went to the county to find placement as a personal care worker, and the county required her to be trained, and placed her in assignments with many different eligible program participants over a period of several years, and the county employs individuals to act as supervisor of personal care workers. In addition, the applicant’s rate of pay was established by the county, and she was paid, through a fiscal intermediary, from funds it received from the county. The Commission found that while it is true that the personal care workers are paid through a fiscal intermediary, they are paid by a single check with fund the fiscal intermediary receives from the county, regardless of the number of eligible program participants to who the worker provides services. Further the county itself selected the fiscal intermediary for Ms Kostichka and numerous other eligible individuals.

The applicant testified that the county instructed her to do whatever the eligible program participants wanted her to do. Moreover, the county’s witness testified that the county would not fire the personal care workers. In addition, the county did not provide equipment or tools to the applicant, though that would hardly be expected under this arrangement.

Finally, the legislature enacted changes to the state unemployment compensation law to establish a statutory scheme designed to exclude counties from the definition of “employer” under unemployment compensation law, while ensuring that unemployment taxes or contributions would be made by fiscal intermediaries on behalf of the eligible program participant (See sections 46.27(5)(I) and 108.02 (13)(k), Stats. Prior to the changes, the Commission consistently concluded that counties were the employers for unemployment purposes, of personal care workers or similar workers providing services to eligible program participants under the Community Options Program. No similar changes have been enacted into the workers’ compensation statutes.

This case considers the petition and positions of the parties, and it reviewed the evidence submitted by the Administrative Law Judge (ALJ). Based on its review, the Commission agreed with the ALJ decision that the county is the applicant’s employer under sec. 102.07(1), Stats., and that the domestic servant exclusion under sec. 102.07(4)(b), Stats., does not apply. Thus the county is liable for payment of workers’ compensation benefits and medical expense.

Winkler v. Smith, Claim No. 1998059089, Wis. Labor and Industry Review Commission, (2000).

This administrative decision involved a worker injured in the course of performing various "companion" services for an Alzheimer's patient in the patient's home. The dispositive issue in the Commission's decision was whether the injured worker was an employee as the term was used in the Wisconsin workers’ compensation law. Relying on typical employment standards (e.g. direction and control) articulated in Kress Packaging Co. v. Kottwitz, 61 Wis. 2d 175 (1973) the Commission found that the worker was an employee and would be covered unless one of two exceptions in the Wisconsin law applied; (1) domestic servant or (2) a person whose employment is not in the trade, business, profession or occupation of the employer, unless the employer opts to voluntarily cover them. Citing dicta in two of its other decisions but with little other discussion, the Commission found that a person providing personal care to a person with a functional disability is not a domestic servant. It went on, however, to find that an invalid or a relative arranging for health care has not developed or established a trade, business, occupation or profession, even if they frequently hired the same individuals to provide the health care. Therefore, the Commission concluded that the injured worker was not an employee and hence was not entitled to workers' compensation coverage.

This case, like the Florida case discussed earlier (Smith v. Ford), relies on an exclusion that recognizes the difficulty household employers face knowing when and to what extent they face potential liability if they hire persons to perform services for them in their private homes as opposed to their trades or businesses.

APPENDIX D. TABLES

TABLE 1. Worker's Compensatino Laws And Coverage Requirements For Domestic Service Employment By Jurisdiction
Jurisdiction	Workers' Compensation Law Citation	Type of LawCompulsory or Elective	Extent of Compulsory Coverage for Domestic Service Employers	If Exempt, Can Domestic Service Employer Voluntarily Provide Coverage?
AL	Code of Alabama 1975- Articles 1-13, Sections 25-5-1 – 25-5-340	Compulsory	Exempt	Yes
AK	Chapter 23.30- Alaska Labor and Workers’ Compensation	Compulsory	Any domestic worker except part-time babysitters, cleaning persons, harvest help, and similar part-time or transient help.	Yes
AZ	Arizona Revised Statutes-Title 23, Chapter 6, Article 1, Scope of WC Section 900	Compulsory	Exempt	Yes
AR	Title 11, Labor and Relations, Chapter 9	Compulsory	Exempt	Yes
CA	Division 4, Sections 3200-6208 of the California Labor Code	Compulsory	Any domestic workers, including one who cares for an supervises children, employed 52 hours or more, or who earned $100 or more, during 90 calendar days exposing such worker to the hazards of an occupational disease. Excludes workers employed by a parent, spouse or child.	Yes
CO	Title 8, Articles 14.5, 40-47 & 55 of the Colorado Revised Statutes	Compulsory	Any domestic worker employed 40 or more hours per week or five or more days per week by one employer.	Yes
CT	Chapter 568, Sections 31-275 through 31-355a- Connecticut General Statutes	Compulsory	Any domestic worker employed more than 26 hours per week by one employer.	Yes
DE	Title 19, Chapter 23- Delaware Code	Compulsory	Any household worker who earns $750 or more in any three-month period from a single private home or household.	Yes
DC	D.C. Law 3-77	Compulsory	Domestic workers employed by the same employer at least 240 hours during a calendar year.	Yes
FL	Title XXXI, Chapter 440- Florida Statutes	Compulsory	Exempt	Yes
GA	Title 34, Chapter 9 of the Unannotated Georgia Code	Compulsory	Any employer, including those that engage inside domestic service workers employing three (3) or more full or part-time workers.	Yes
HI	Chapter 386 of the Hawaii Revised Statutes, Workers’ Compensation Law	Compulsory	Any worker employed solely for personal, family or household purposes whose wages are $225 or more during the current calendar quarter and during each completed calendar quarter of the preceding 12-month period.	Yes
ID	Title 72, Chapters 1-8 of the Idaho Code	Compulsory	Exempt	Yes
IL	820 ILCS 305	Compulsory	Any worker or workers employed for a total of 40 or more hours per week for a period of 13 or more weeks during a calendar year by any household or residence.	Yes
IN	Title 22, Article 3 of the Indiana Code – Workers’ Compensation Act	Compulsory	Exempt	Yes
IA	Chapter 85 of the Iowa Code – Workers’ Compensation	Compulsory	Any employee working in or about a private dwelling (who is not a regular household member) whose earnings are $1,500 or more during the 12 consecutive months prior to an injury. Workers who are either a spouse of the employer or relatives of either the employer or spouse residing on the premises of the employer are exempt.	Yes
KS	Chapter 44, Article 5 of the Kansas Statutes	Compulsory	Any domestic worker if the employer had a total payroll for the preceding calendar year of more than $20,000 for all workers under his/her employ.	Yes
KY	Chapter 342 - Kentucky Revised Statutes	Compulsory	Two or more domestic workers regularly employed in a private home 40 or more hours a week. The law has no numerical exemption for general employment.	Yes
LA	Title 23, Chapter 10 - Louisiana Revised Statutes	Compulsory	Exempt	Yes
ME	Title 39A Enacted by PL 1991, c.885, PTA @ 8	Compulsory	Exempt	Yes
MD	Title 9, Article, Sec. 9-202 of the Annotated Code of Maryland	Compulsory	Any domestic worker whose earnings are $750 or more in any calendar quarter from a private household. Domestic servants and their employers jointly may elect for the employee to be covered, even if the individual does not meet the earnings requirement.	Yes
MA	Chapter 152 of the MA General Laws – Workers’ Compensation Act	Compulsory	Domestic workers employed 16 or more hours per week by an employer.	Yes
MI	Act 317 of 1969 – Workers’ Disability Compensation Act of 1969	Compulsory	Any household domestic worker who is employed 35 or more hours per week or longer for 13 weeks or longer during the preceding 52 weeks.	Yes
MN	Chapter 176A of the Minnesota Statutes	Compulsory	Any domestic worker who earns $1,000 or more in any three-month period or who has earned $1,000 or more in any three-month period of the previous year from the same single, private household.	Yes
MO	Chapter 287 of the Missouri Revised Statutes – Workers’ Compensation Law	Compulsory	Exempt	Yes
MS	Title 71, Chapter 3 of the MS Code – Workers’ Compensation	Compulsory	Exempt	Yes
MT	Title 39, Chapter 71 of the Montana Code Annotated 2001	Compulsory	Exempt	Yes
NE	Section 48-101 to Section 48-1, 118 of the Nebraska Revised Statutes	Compulsory	Exempt	Yes
NV	Title 53 Chapter 616A-D of the Nevada Statutes	Compulsory	Any person engaged in household domestic service including a cook, housekeeper, maid companion, babysitter, chauffeur or gardener is exempt.	N/A
NH	Title XXIII, Chapter 281-A of the New Hampshire Revised Statutes	Compulsory	All domestic service workers are covered under the law.	N/A
NJ	NJSA Title 34 – Labor and Workmen’s Compensation	Compulsory	All domestic service workers are covered under the law.	Yes
NM	Chapter 52 of the New Mexico Statutes	Compulsory	Exempt	Yes
NY	Chapter 67 of the Consolidated Laws of New York State – Workers’ Compensation Law	Compulsory	Any domestic worker employed (other than those on a farm) by the same employer for a minimum of 40 hours per week.	Yes
NC	Chapter 97 of the North Carolina Statutes	Compulsory	Domestic service workers if employer employs more than 10 full-time non-seasonal laborers.	Yes
ND	Title 65 of the North Dakota Century Code – Workers’ Compensation	Compulsory	Exempt	Yes
OH	Title 41, Chapter 4123 of the Ohio Revised Code Ann.	Compulsory	Any domestic worker who earns $160 or more in any calendar quarter from one employer.	Yes
OK	Title 85 of the Oklahoma Statutes – Workers’ Compensation Law	Compulsory	Any domestic worker if the employer had a gross annual payroll in the preceding calendar year of $10,000 or more for such workers.	Yes
OR	Chapter 656 of the Oregon Revised Statutes – Workers’ Compensation	Compulsory	Exempt	Yes
PA	Act of 1915, P.L. 736, no. 338, as amended – PA Workmen’s Compensation Act	Compulsory	Exempt	Yes
RI	Title 28, Chapter 28-29 of the Rhode Island Code, Workers’ Compensation	Compulsory	Exempt	Yes
SC	Title 42 of the 2002 South Carolina Code of Laws – Workers’ Compensation	Compulsory	Employers with four or more domestic workers whose annual payroll during the previous calendar year $3,000 or more.	Yes
SD	Title 62 of the South Dakota Codified Laws and Constitution – Workers’ Compensation	Compulsory	Any domestic service worker employed more than 20 hours in any calendar week and for more than 6 weeks in any 13-week period.	Yes
TN	Title 50, Chapter 6 of the Tennessee Code	Compulsory	Exempt	Yes
TX1	Chapter 401, Title 5 of TX Labor Code	Elective	Only state to allow employers to choose whether or not to provide coverage (§ 406.002-Coverage Generally Elective). However, public employers and employers that enter into a building or construction contract with a governmental entity must provide coverage. TX Compensation Commission Manual specifically exempts domestic or casual workers engaged in employment that is incidental to a personal residence from coverage.	Yes
UT	Utah Code, Title 34A, Chapter 02 – Worker’s Compensation Act	Compulsory	Any domestic worker regularly employed for 40 or more hours per week by the same employer.	Yes
VT	Title 21, Chapters 9 and 11 of the Vermont Statutes – Employer’s Liability and Workers’ Compensation	Compulsory	Exempt	Yes
VA	Title 65.2 of the Code of Virginia – Workers’ Compensation	Compulsory	Exempt	Yes
WA	Title 51, RCW Industrial Insurance	Compulsory	Employers with two or more domestic workers if regularly employed in a private home 40 or more hours per week. Law has no numerical exemption for general employment.	Yes
WV	Chapter 23 of the WV Code– Workers’ Compensation	Compulsory	Exempt	Yes
WI2	Chapter 102, Wis. Stats.– Workers’ Compensation Act of Wisconsin	Compulsory	Exempt	Yes
WY3	Title 27, Chapter 14 Sections 101-805	Compulsory	Exempt	No
AS	Title 32, Chapters 4-6 – Workers’ Compensation – General Provisions and Administration	Compulsory	Any employer, regardless of business or private home with three or more employees.	Yes
GU	Guam Workers’Compensation Law – PL 1-80	Compulsory	Exempt	Yes
NN4	Navajo Nation Law –15NNC Sections 1001-1048	Compulsory	N/A	N/A
NMI	PL 6-33/9-33 – Workers’ Compensation Law	Compulsory	Household maids, yard maintenance and residential farmers are exempt.	Yes
PR	Act No. 45 – Workers’ Accident Compensation Act	Compulsory	Any domestic worker regularly employed by the same employer.	N/A
VI	Title 24 Chapter 11 of the Virgin Islands Code – Workers’ Compensation Administration	Compulsory	Exempt	Yes
SOURCE: U.S. Dept of Labor Office of Workers' Compensation Programs and State and Territory Workers' Compensation Laws. Texas provides for mandatory workers' compensation coverage under Title 25 of the State statutes regarding rules and regulations for "Carriers" (Article 911-A, Sec. II, Motor Bus Transportation and Regulations by the Railroad Commission). WI Labor Review Commission (LIRC) does not consider home-care providers (description similar to personal care workers) as domestic service under the State's workers' compensation (WC) law. Although the law does not define home-care providers, LIRC considers them exempt from the WC law because they "do not provide services as a part of the trade, business, occupation or profession of the recipient of services." Employers of home-care providers may elect to provide WC coverage. Wyoming law is compulsory for all employers engaged in extra-hazardous occupations and elective for all other occupations. Navajo Nation Statute only provides workers' compensation insurance coverage to Navajo Nation Government and enterprises. It does not cover private employers such as household employers. They would have purchase workers' compensation insurance from a private carrier or through AZ insurer of last resort or Assigned Risk Plan.

TABLE 2. Workers' Compensation Insurance Requirement, Self-Insurance And Penalties For Failure To Insure By Jurisdiction
Jurisdiction	Workers' Compensation Insurance1	Self-Insurance	Penalties for Failure to Insure
AL	Required	Individual and Group	Fine not less than $100 or more than $1,000. Employers may be enjoined from doing business and liable to suit with defenses abrogated and double the amount of compensation.
AK	Required	Permitted	Class B or C felony (up to 1 year imprisonment, $10,000 fine or both). Board may enjoin use of labor. Employer liable to suit with defenses abrogated, and employer negligence presumed proximate cause of injury. Individuals in charge of corporation personally liable for compensation.
AZ	Required	Individual and Group	Employer liable to suit with defense abrogated. $500 civil penalty plus a 10% penalty on all claims expenses. Award paid by Special Fund. Injunction against doing business in the state.
AR	Required	Individual and Group2	Fine up to $10,000 or Class D Felony; employer liable to suit with defenses abrogated. Possibly enjoined from engaging in further employment.
CA	Required	Individual and Group	The failure to secure the payment of compensation, as required by one who knew, or because of his or her knowledge or experience should be reasonably expected to have known, of the obligation to secure the payment of compensation, is a misdemeanor punishable by imprisonment in the county jail for up to one year, or by a fine of up to ten thousand dollars ($10,000) or both imprisonment and fine. Employer may be enjoined from doing business. Mandatory penalty upon issuance of stop order is a misdemeanor; penalty is up to $10,000, imprisonment up to 60 days, or both. $500 penalty for failure to respond to Director’s inquiry. Upon final adjudication of a claim, the uninsured employer shall be assessed: (a) in non-compensable cases, $2,000 per employee employed at the same time of injury, or (b) in compensable cases, $10,000 per employee employed. The maximum shall be $100,000. Payments are credited to the Uninsured Employer Fund of the State Treasury.
CO	Required	Individual Company and Group	Compensation increase of 50% or employer liable to suit with defenses abrogated (at option of employee). Employer may also be enjoined from doing business or fined up to $500 per day for failing to insure, not to exceed the annual premium.
CT	Required	Permitted	Fine of not more than $50,000 for failure to insure. Employer may be enjoined from entering into any contracts of employment.
DE	Required	Individual and Group	Fine of $1 per day per employee (minimum of $25/day); if default, continues for 30 days employer may be enjoined from doing business. Employer liable to suit with defenses abrogated.
DC	Required	Permitted	Civil fine of not less than $1,000 and not more than $10,000.
FL	Required	Individual and Group3	Fine of $,1000 or twice the amount the employer would have paid during periods it illegally failed to secure coverage in the preceding 3-year period, whichever is greater. Failure to provide coverage is deemed an immediate and serious danger to public health, safety, or welfare sufficient to justify stop-work order issuance and $100 daily penalty until compliance is achieved. Subject to prosecution for third degree felony for knowingly failing to secure coverage if required.
GA	Required	Individual and Group	Misdemeanor. Compensation may be increased 10% plus attorneys fees. Penalty up to $5,000 per violation.
HI	Required	Individual and Group	$250 or $10 per employee per day during default, whichever is greater. Employer may be enjoined from doing business.
ID	Required	Permitted	Misdemeanor. Employer may be liable for penalty of $2 per day per employee or $25 per day, whichever is greater, for each day failure continues. May be enjoined from doing business. Additional penalties include $500 for the second violation and $1,000 for subsequent violations.
IL	Required	Individual and Group	Fine up to $500 for each day’s default. Minimum penalty $10,000. Employer liable to suit, also corporate officers, directors, partners, members of limited liability company upon finding of knowing and willful refusal or failure to comply, if employer does not pay penalty.
IN	Required	Permitted4	Class A infraction – maximum fine $10,000. Uninsured employer may be liable for medical and legal expenses, plus double compensation and may be enjoined from doing business.
IA	Required	Individual and Group	Employer liable to suit with defenses abrogated and presumption of negligence of employer. Employer is liable to penalty of up o $100 per day and may be enjoined for further noncompliance. A temporary or permanent writ of injunction may be ordered enjoining an employer from operating without insurance or self-insurance coverage.
KS	Required	Individual and Group	Employer liable to suit. Penalty may be double the amount the premium would have been or $25,000, whichever is greater.
KY	Required	Individual and Group	Failure to secure payment of compensation – claimant may claim compensation and bring action at law or in admiralty with employer’s common law defenses abrogated. Employer may be enjoined from doing business. With respect to employers who fail to maintain workers’ compensation insurance coverage on their employees, each employee of the employer and each day of noncompliance shall constitute a separate offense for purposes of determining the fine/penalty. Employer is subject to criminal penalty including a fine of $100 to $1,000 or imprisonment for 30 to 180 days or both.
LA	Required	Individual and Group	Compensation increased 50% and civil fine up to $10,000 ($250 for first offense and $500 for each additional employee). Employer may be enjoined from doing business. Willful failure to insure is a felony, and is subject to a criminal fine up to $10,000 and one year at hard labor. Willful misrepresentation is a felony subject to a criminal fine up to $10,000 and 10 years at hard labor.
ME	Required	Individual and Group	Employer liable for civil penalty of up to $10,000, or an amount equal to 108% of the premium, calculated using Maine Employers’ Mutual Insurance Company’s Standard Discounted Standard Premium, that should have been paid during the period the employer failed to secure coverage, whichever is larger, payable to Employment Rehabilitation Fund. Corporate employers subject to revocation or suspension or authority to do business. Class D crime. Employer liable to suit with defenses abrogated.
MD	Required	Individual and Group5	Assessment against uninsured employers of at least $150 but not exceeding $500 and 15% of any award made in the claim not to exceed $2,500. Non-Insured Employer guilty of misdemeanor and upon conviction subject to fine not to exceed $5,000 or one year imprisonment or both. Employer also liable to suit and with defenses abrogated. Other insurer assessed to pay unpaid claims of insolvent insurer payable into Uninsured Employers’ Fund.
MA	Required	Individual and Group	Fine of not more than $1,500 or imprisonment for not more than 1 year, or both; employer liable to suit with defenses abrogated. Civil penalties for failure to insure include: stop-work orders, debarred from state and municipal contracts, and a $100 per day fine for each day employer operates after stop-work order.
MI	Required	Individual and Group	Fine of not more than $1,000 per day or imprisonment for not more than 6 months, or both; employer liable for damages.
MN	Required	Individual and Group	Penalty of up to $1,000 per employee per week during which the employer was not in compliance. Employer may be enjoined from further employment. Intentional compliance is a gross misdemeanor. Employer liable to suit with some defenses abrogated. Additional penalty of $2,000 is assessed if information reported to obtain business license or permit is false.
MS	Required	Individual and Group6	Fine of up to $1,000 or 1 year imprisonment or both, civil penalty up to $10,000. Employer also liable to suit with defenses abrogated.
MO	Required7	Individual and Group	Employer liable to suit with defenses abrogated. Worker may receive medical and/or death benefits out of Second Injury Fund and employer is liable for an amount equal to twice the annual estimated premium of employer or $25,000, whichever is greater. Failure to insure is a Class A misdemeanor, prosecution by the Attorney General. Policy is required to obtain a business license.
MT	Required	Individual and Group8	Employer enjoined from doing business. Double amount of unpaid premiums assessed as penalty (minimum $200). Employer liable for all benefits paid, or to be paid to injured worker. Employer automatically negligent if no coverage obtained. Penalties payable to Uninsured Employers’ Fund.
NE	Required	Permitted9	Employer liable to suit with defenses abrogated and may be subject to any one or more of the following: enjoinder from doing business in NE until compliance is secured; imprisonment for not more than 1 year; penalty of not more than $1,000 for each violation. Each day of continued failure to secure payment of compensation constitutes a separate violation.
NV	Required	Individual and Group	An employer who fails to obtain or maintain coverage is liable to suit by the injured employee or his dependents; if the injured employee elects to be covered by the Uninsured Employers’ Claim Fund, the employer is liable for claim costs, administrative fees, interest, attorney’s fees and costs, and an ‘administrative fine of not more than $10,000.’ The employer’s business may be closed; employer is liable for a penalty equal to the premiums that would have been owed for the period of non-insurance but not to exceed 6 years and interest. A first offense is generally a misdemeanor; however, if an employee in the course and scope of employment suffers ‘substantial bodily harm’ or is killed during the period of non-coverage, it is a category C felony, punishable by imprisonment between 1 and 5 years and a fine between $1,000 and $50,000. A second failure to provide or maintain insurance coverage is a category C felony.
NH	Required	Individual and Group	Penalty of $2,500 plus $100 per employee per day. Employer may be enjoined from doing business and injured worker may sue for damages. Employer shall be guilty of a misdemeanor.
NJ	Required10	Permitted	Uninsured employers are subject t a disorderly person’s offense, an initial penalty of $1,000 as well as an assessment of 15% of any award, of which the amount of the assessment is not to exceed $5,000. Willful failure to provide insurance is a crime of the fourth-degree. An assessment of $1,000 may be imposed for every 10-day period that insurance is not provided.
NM	Required	Individual, Group and Pools11	Employer may be enjoined from doing business and fined up to $1,000 for each instance of non-compliance.
NY	Required	Individual and Group	Fine of $500 to $2,500 or imprisonment for up to 1 year, or both, with fines to $7,500 for repeated offenses. Employer liable to suit with certain special defenses abrogated. Additional fine of $250 for each 10-day period of no coverage, or a sum not to exceed 2% of payroll for period of no coverage.12
NC	Required	Individual and Group13	Misdemeanor punishable by penalty of $1.00 per day per employee (maximum $100, minimum $50 per day), imprisonment, or both. Employer liable to suit with common law defenses abrogated.
ND	Required in State Fund	No permitted	Class A Misdemeanor. If the difference is more than $500 it is a class C felony. $2,000 fine plus 3 times the difference between premium paid & amount that should have been paid. Uninsured employer liable for damages for injuries or death and cannot avail himself/herself of common law defense. Employer may be enjoined fro employing uninsured workers.
OH	Required in State Fund	Permitted	Minor misdemeanor – fine up to $100. If willful, second-degree misdemeanor – fine up to $750, imprisonment up to 90 days, or both. Employer may be enjoined from doing business. Employer is also liable to suit with defenses abrogated.
OK	Required	Individual and Group	Civil penalties are a fine up to $250 per employee for first offense, up to $1,000 per employer for second offense, with the maximum fine for all violations being $10,000. Criminal penalty is conviction of misdemeanor subject to a fine of not more than $1,000 or up to 6 months in jail, or both. The Commissioner of Labor can issue a cease-and-desist order against an employer who is cited for 2 offenses of failing to obtain workers’ compensation insurance.
OR	Required	Individual and Group	Employer is liable to suit with defenses abrogated. Enjoined from hiring workers. Liable for payment of all claims plus administrative costs. Minimum fine of $1,000 for first violation or twice the amount of premium evaded, whichever is greater, to $250 per day for subsequent violations; additional fines to $5,000 based on extent of injury.
PA	Required	Permitted	It is a third-degree misdemeanor offense for an employer not to carry workers’ compensation insurance. Fines of up to $2,500 and/or one year in prison for each day of non-coverage can be imposed for noncompliance with the law. If the failure to insure is intentional, the offense is considered a third degree felony with fines of up to $15,000 and 7 years in prison per day of non-coverage. Any party may file a criminal complaint against an uninsured party with the county district attorney’s office.
RI	Required	Individual and Group	Misdemeanor. Fine of $500 to $1,000 per day of noncompliance and/or imprisonment for one year. Corporate officers liable personally.
SC	Required	Individual and Group	If employer fails to insure, fine of 10 cents a day per employee (maximum $50, minimum $1 per day). Employer liable to suit with defenses abrogated. Willful failure to insure is misdemeanor punishable y fine of $100 to $1,000, or imprisonment of 30 days to 6 months, or both.
SD	Required	Individual	Employer liable to suit for damages or double compensation and medical care as benefits.
TN	Required	Individual and Group	Administrative fine of $5,000 for every 30 days of willful refusal and noncompliance. Employers may be penalized 25% of medical costs in cases of bad faith failure or late payments.
TX	Required14	Permitted15	Employer liable to suit with defenses abrogated.
UT	Required	Permitted	Minimum fine of $1,000 but not more than 3 times the premium employer would have paid during period of noncompliance. Employer liable to suit with defenses abrogated. Costs and attorney’s fees in civil suit. Employers and officers guilty of a misdemeanor. Employer liable for all compensation paid from Uninsured Employers’ Fund plus interest, costs, and attorney’s fees.
VT	Required	Permitted	Failure to secure compensation – fine up to $50 per day, up to maximum of $5,000. Fine increases to $150 per day 5 days after notice by Commissioner.
VA	Required	Individual and Group	Civil Penalties of $500 to $5,000. Employer liable to suit with certain defenses abrogated and may be enjoined from doing business. Intentionally uninsured employer commits Class 2 misdemeanor.
WA	Required in State Fund	Permitted16	Claim cost penalty equals 50% to 100% of the cost of the injury; unregistered penalty = $500 or twice the unpaid premium, whichever is greater.
WV	Required	Permitted Through State Fund Approval	Employer liable to suit with defenses abrogated; all past premium taxes, interest and penalties may be enjoined from doing business in the state; Willing failure or false reporting is a felony with imprisonment up to 10 years and fine of $2,500 to $10,000.
WI	Required	Permitted	Fine of twice the amount of premium not paid during an uninsured time period or $750, whichever is greater. Under certain circumstances, an employer can be subject to a penalty of $100 for each day that he/she is uninsured up to 7 days. Employer may be restrained from doing business pending compliance. Employer is liable for all benefits awarded on uninsured claims.
WY	Required	Permitted if Work is Determined Not to be Extra- Hazardous17	Fine of not more than $750 for first conviction; fine of not more than $10,000 for second conviction or subsequent convictions, plus 0.02% interest per month or $50 per month, whichever is greater, on unpaid balance. Employer may be enjoined from doing business and liable to suit with defenses abrogated.
AS	Required	N/A
GU	Required	Not Permitted	Uninsured employers may be sued at law or in admiralty. Insured employer liability is exclusive for contribution among joint tort feasors against the employer.
NN	Required	N/A
NMI	Required	N/A
PR18	Required in Territorial Fund	Not Permitted	Misdemeanor, fine of $1,000 maximum, or imprisonment for not more than 6 months, or both. Employer liable to suit with defenses abrogated. Penalty 30% of compensation (minimum $10.00). Detention of construction work.
VI	Required in Territorial Fund	Not Permitted	Employer liable for compensation and expenses plus penalty equal to 30% of compensation and expenses. Employer liable to suit with defenses abrogated. Fine up to $500 or imprisonment up to 6 months, or both. Interest on premiums in default. Employer may be enjoined from doing business
SOURCE: U.S. Chamber of Commerce Statistical Research Center, 2002 Analysis of Workers' Compensation Laws Requirement for employers considered to be "covered employers" in accordance with the jurisdiction's workers' compensation law. Arkansas- Municipalities with populations of more than 7,000 may self-insure on individual or group basis. Florida - Application for workers' compensation coverage under a group self-insurance fund must contain the following statement: "This is a fully assessable policy. If the fund is unable to pay its obligations, policyholders must contribute on a pro rata earned premium basis the money necessary to meet any unfilled obligations." Indiana - Except as to state and political subdivisions, banks, trust companies, and savings and loan associations. These entities are self-insured by statute. Maryland - Eligibility for group self-insurance is limited to countries, municipalities, Board of Education, Community Colleges, and certain private employers. Mississippi - All self-insurers must be members of the MS Workers' Compensation Self-Insurer Guaranty Association. Missouri - Employers engaged in mining must insure only to the extent of the maximum liability for 10 deaths in one accident. Montana - Private employers and public entities, other than state agencies, may establish individual or group self-insurance funds. Nebraska - Group self-insurance permitted for any two or more public agencies New Jersey - Statutory presumption of compulsory inclusion in every contract of hire since July 4, 1911. Coverage may be terminated by either party upon notice in writing prior to any accident. Permits ten (10) or more employers licensed y the State as hospitals to group self-insure. New Mexico - Group means a not-for-profit unincorporated association consisting of two or more public hospital employers or private employers, which are engaged in the same or similar type of business. New York - President, secretary and treasurer of a corporation are criminally liable for their failure to obtain coverage and are personally liable for penalties. Corporate officer who failed to obtain insurance is ineligible for benefits out of Uninsured Employers' Fund for self, surviving spouse, or dependents. North Carolina - All individual and group self-insurers must be members of North Carolina Self-Insurance Guaranty Association as a condition of authority to self-insure. Texas - If the employer accepts. Texas - Except for state and political subdivisions. Self-Insurance is permitted upon Commission's approval of each inquiry. Washington State - Group self-insurance permitted for school districts and hospitals. Wyoming - Coverage is compulsory for 'extra hazardous' industries and occupations only. Private insurers are allowed to write coverage for industries and occupations not considered extra hazardous, however, only the state fund is allowed to provide immunity to lawsuit by injured workers. Puerto Rico - Figures for Puerto Rico could not be verified at the time of publication; Information taken from the 2001 Analysis.

TABLE 3. Voluntary Workers' Compensation Insurance Market By Jurisdiction
Jurisdiction	Estimated Number of Private WC Insurance Carriers1	Level of Access to Voluntary Market for Domestic Service Employers2	Is an Agent/Producer Required For a Domestic Service Employer to Access Voluntary Market?3	Competitive Pricing	Administered Pricing
AL	202	Low	Recommended	X
AK	195	Low	Recommended	X
AZ	283	Moderate	No	X	X
AR	420	"Nonexistent"	No	X
CA	300+	Domestic service policies are not written in the voluntary market.	Recommended	X
CO	758	Low	Recommended	X
CT	337	Low	Recommended	X
DC	80+	Low	No	X
DE	297	Low	Recommended	X
FL	583	"Nonexistent"	Yes		X
GA	353	Low	No	X
HA	216	Low	Recommended	X
ID	270+	Moderate	No		X
IL3	385	Low	No	X	X
IN4	666	Low	Recommended	X	X
IA	240+	Low	Recommended		X
KS	349	Low	Yes	X
KY	562	Low	Yes	X
LA	N/A5	Moderate	Recommended	X
ME	208	Moderate	No	X
MD	534	Low	No6	X
MA	13	Low	Yes		X
MI	220	Low	Recommended	X
MN	1,000+	Low	Recommended	X
MS	278	Low	No	X
MO	260+	Low	Recommended	X
MT	247	Not Reported	No	X
NE	335	Low	Recommended	X
NV3	240+	Low	Recommended	X	X
NH	200+	"Nonexistent"	Recommended	X
NJ	4507	Low	Recommended		X
NM	220	"Nonexistent"	No	X
NY	800	Low	Recommended		X
NC	N/A	"Nonexistent"	Recommended	X
ND	No private market
OH	No private market
OK	239	Low	Recommended	X
OR	423	Low	Requirement varies by private carrier. The SAIF does not require the use of an agent.	X
PA	368	Low	Recommended	X
RI	20	Low	Recommended	X
SC	240	Low	Recommended	X
SD	567	Low	No	X
TN	300+	Low	Recommended	X
TX	350+	"Not Reported"	Yes	X
UT	150+	Low	Recommended	X
VT	206	Low	No	X
VA	523	Low	Recommended	X
WA	No private market
WV	No private market
WI	300	Low	Recommended		X
WY	No private market
AS	2	Low	No	X
GU8	10	Low	No	X
NMI8	34	Moderate	No	X
NN	N/A9
PR	No private market
VI	No private market
Estimated number of insurance companies authorized to write workers' compensation policies as reported by state agency staff or agency web site. As reported by state agency staff. As reported by state agency staff. The requirement often can vary by insurance carrier within a state's voluntary market. NCCI reported that IN, IL and NV use both administered pricing and competitive pricing methods. State reported 1,355 insurance companies authorized to write casualty insurance policies but could not break out those that wrote workers compensation. MD Injured Workers' Insurance Fund staff reported that agents could act as a barrier to residual market it he/she process a household employer's policy with a voluntary carrier because the fee they receive (e.g., often $15-20/policy) too low to cover the paperwork burden and related expense. Approximately 350 are insurance carriers authorized to write standard workers' compensation insurance policies and approximately 100 are household insurance carriers who write the workers' compensation homeowner's endorsement for domestic service workers. State agency staff reported that they did not know of any case where a household employer has purchased a workers' compensation insurance policy. Individual household employers can not access workers' compensation insurance through the Nation. They must obtain workers' compensation insurance through the AR voluntary or residual markets.

TABLE 4. Residual Market Minimum Premiums For Domestic Service Classification Codes By Jurisdiction
Jurisdiction	Residual Market Administrator	Rate Type	Premium Type	Effective Date	WC Code 0908	WC Code 0909	WC Code 0912	WC Code 0913	WC Code Other
AL	NCCI1	Per capita	Per capita	3/01/03	$492.00	$469.00	$750.00	$750.00
AK	NCCI	Per capita	Per capita	1/01/03	$172.0	$155.00	$500.00	$482.00
AR	NCCI	Per capita	Per capita	7/01/03	$348.00	$325.00	$610.00	$509.00
AZ	NCCI	Per capita	Per capita	10/01/02	$170.00	$125.00	$328.00	$517.00
CA	California State Compensation Insurance Fund	Per $100 payroll	0910(A)- Per household policy; 0913(A)- Per capita	7/01/03	Not used	Not used	Not used	Not used	0910(A)-$200 (Occasional); 0913(A)-$200 (Full-time)
CO	Pinnacol Insurance Company	Per capita	Per capita	12/01/03	$419.00	$466.00	$710.00	$514.00
CT	NCCI	Per capita	Per capita	1/01/03	$439.00	$324.00	$722.00	$669.00
DE	Delaware Compensation Rating Bureau	Per capita	Per capita	6/01/03	$328.00	$333.00	$515.00	$591.00
DC	NCCI	Per capita	Per capita	11/01/02	$407.00	$409.00	$750.00	$676.00
FL	Florida Workers’ Compensation Joint Underwriting	Per capita	Per capita	4/01/03	$664.00	$584.00	$1,650.00	$1,542.00
GA	NCCI	Per capita	Per capita	4/01/01	$265.00	$287.00	$510.00	$472.00
HI	Hawaii Employers Mutual Insurance Company	Per capita	Per capita	7/03/03	$650.00	$650.00	$650.00	$650.00
ID	NCCI	Per capita	Per capita	1/01/03	$206.00	$150.00	$300.00	$227.00
IL	NCCI	Per capita	Per capita	1/01/03	$458.00	$368.00	$750.00	$644.00
IN	NCCI	Per capita	Per capita	1/01/03	$347.00	$309.00	$487.00	$381.00
IA	NCCI	Per capita	Per capita	1/01/03	$352.00	$324.00	$550.00	$550.00
KS	NCCI	Per capita	Per capita	1/01/03	$301.00	$283.00	$578.00	$433.00
KY	Kentucky Employers' Mutual Insurance Company	Per capita	Per capita	1/01/03	$326.00	$353.00	$853.00	$656.00
LA	Louisiana Workers’ Compensation Corporation	Per capita	Per capita	6/30/03	$188.45	Not used	Not used	$770.57
ME2	Maine Employers Mutual Insurance Company	Per capita	Per capita	3/17/03	$391.00	$342.00	$623.00	$542.00
MD	Injured Workers' Insurance Fund	Per $100 of payroll	Per household policy	1/01/03	Not used	Not used	$175.00	$175.00
MA	Workers' Compensation Rating and Inspection Bureau of Massachusetts	Per $100 of payroll	Per household policy	7/1/01	Not used	Not used	Not used	Not used	0918-$170
MI	Compensation Advisory Organization of Michigan	Per capita	Per capita	1/01/03	$418.00	$430.00	$734.00	$735.00
MN	Minnesota Workers' Compensation Insurance Association	Per capita	Per capita	4/01/03	$419.00	$251.00	$2,480.00	$745.00
MS	NCCI	Per capita	Per capita	3/01/03	$434.00	$426.00	$750.00	$750.00
MO	Travelers Insurance Company	Per capita	Per capita	7/01/03	$401.00	$356.00	$750.00	$602.00
MT	State Compensation Insurance Fund	Per $100 of payroll	Per household policy	7/01/03	Not used	Not used	Not used	Not used	9015-$304.12
NE	Travelers Insurance Company	Per capita	Per capita	2/01/03	$410.00	$363.00	$750.00	$600.00
NV	NCCI	Per capita	Per capita	7/01/00	Not used	Not used	Not used	Not used	0001-$750; 0002-$432
NH	NCCI	Per capita	Per capita	1/01/03	$553.00	$378.00	$709.00	$750.00	$3.00/policy/year - Homeowner’s / Tenant’s Endorsement for Domestic Service3
NJ4	New Jersey Compensation Rating & Inspection Bureau	Per household for part-time help (standard WC & homeownerpolicy; Per capita for full-time help std & homeowner policies	Per household for part-time help (standard WC & homeownerpolicy; Per capita for full-time help std & homeowner policies	01/01/03			State-specific code: $76.00- Std WC Policy for 1st worker, $60 for each additional worker; $61.00 -Home- Owner’s Policy 1st worker, $60 for additional worker.	State-specific code: $76.00- Std WC Policy for 1st worker, $60 for each additional worker; $61.00 -Home-Owner’s Policy 1st worker, $60 for additional worker.	0910 – (Occasional) State-specific code- $16.00 for standard WC policy; $1.00 for homeowner’s policy.
NM	NCCI	Per capita	Per capita	7/01/03	$395.00	$395.00	$750.00	$468.00
NY5	New York State Insurance Fund	Per capita	Per capita	2/24/03	$130.88	$160.26	$700.40	$494.74
NC	North Carolina Rating Bureau	Per capita	Per capita	4/01/03	$368.00	$350.00	$850.00	$600.00
OK	CompSource Oklahoma	Per capita	Per capita	2/01/02	$258.00	$252.00	$350.00	$350.00
OR	NCCI	Per $100 payroll	Per household policy	1/01/03					8989-$500.00
PA	State Workmen's Insurance Fund	Per capita	Per capita	4/01/03	$253.00	$266.00	$405.00	$505.00
RI	The Beacon Mutual Insurance Company	Per capita	Per capita	11/01/98	$243.00	$234.00	$367.00	$358.00
SC	NCCI	Per capita	Per capita	12/01/01	$301.00	$292.00	$495.00	$432.00
SD	NCCI	Per capita	Per capita	7/01/03	$290.00	$279.00	$759.00	$496.00
TN	Aon Risk Services	Per capita	Per capita	3/01/03	$328.00	$321.00	$610.00	$733.00
TX	Texas Workers’ Compensation Insurance Fund	Per capita/Per $100 Payroll	Per capita/Per $100 Payroll	1/01/03	Not used	Not used	Not used	No rate available	0923 – TX specific – per $100 payroll 0913 – TX specific - per capita
UT6	Workers’ Compensation Fund of Utah	Per capita	Per capita	12/01/02	$400.00	$400.00	$400.00	$400.00
VT	NCCI	Per capita	Per capita	4/01/03	$349.00	$363.00	$750.00	$644.00
VA	NCCI	Per capita	Per capita	4/01/03	$290.00	$320.00	$535.00	$450.00
WI	Wisconsin Compensation Rating Board	Per capita	Per capita	7/01/02	$405.00	$325.00	$658.00	$672.00
AS78	National Pacific Insurance Company	No involuntary market
GU7,89	Guam Insurance Commission, Division of Tax and Revenue	No involuntary market
NN	Navajo Nation	No access to WCI for domestic service employers in Nation
NMI7,8	Northern Mariana Islands Retirement Fund, Workers’ Compensation Division	No involuntary market
SOURCE: NCCI and State Residual Market Administrative Organizations. NCCI stands for National Council on Compensation Insurance Maine allows tier rating (e.g., deviations from standard rates). State agency and insurers reported that the homeowner's/tenant's endorsement should only apply to occasional (not full-time) domestic service workers. However, the statute is silent on this. Persons with disabilities that hire a personal assistance worker can not consider their worker under the domestic service (Title XXIII, Section 281-A:6) and can not take advantage of the homeowner's/tenant's endorsement for workers' compensation coverage option. Domestic service employers may also access WCI for occasional workers through a mandatory homeowners/renters insurance endorsement. Premium is $1.00/policy/year. Occasional workers may also be covered through a standard policy under code 9010 for $16.00/year. The minimum premium includes the terrorism assessment charge. Utah allows tier rating and the State Insurance Fund uses three tiers, Nonstandard, Standard and Preferred. A household employer would fall into the nonstandard tier if he/she was a new employer or had a 100% loss ratio. The only way a household employer can get into the preferred tier is if he/she has a loss ratio of 50% or less. American Samoa, Guam, and the Commonwealth of Northern Mariana Islands all use the per $100 payroll method to establish rates and the per household method to establish premiums. No rate information was available, however, in American Samoa it was estimated that a premiums in the voluntary market would be approximately ½% of inside workers' and 1% of outside workers' annual wages. American Samoa and the Commonwealth of Northern Mariana Islands do not use classification codes of any kind. They determine employer status for rating purposes on a case-by-case basis. Effective 8/03 Guam has adopted the NCCI codes 0909, 0912 and 0913. Minimum voluntary market premiums are #36.00, $36.00, and $28.00, respectively and these minimum are the premiums when the employer has no payroll.

TABLE 5. Administered Pricing Minimum Premiums For Domestic Service Classification Codes By Jurisdictions1
Jurisdiction	Rate Type	Premium Type	Effective Date	WC Code 0908	WC Code 0909	WC Code 0912	WC Code 0913	WC Code Other
AZ1	Per capita	Per capita	10/1/02	$131.00	$96.00	$252.00	$398.00
FL	Per capita	Per capita	4/1/03	$427.00	$371.00	$750.00	$750.00
ID	Per capita	Per capita	1/1/03	$193.00	$150.00	$300.00	$211.00
IL2	Per capita	Per capita	1/1/03	$421.00	$343.00	$750.00	$555.00
IN2	Per capita	Per capita	1/1/03	$347.00	$309.00	$487.00	$381.00
IA	Per capita	Per capita	1/1/03	$330.00	$307.00	$515.00	$513.00
MA3	Per capitaPer $100 payroll	Per capitaPer household policy	7/1/01	$134.00	$141.00	$233.00	$668.00	0918 - $170.00
NJ4	Per household policy (Part-time help std and homeowner’s policies); Per capita (Full-time help std and homeowner’s policies).	Per household policy (Part-time help std and homeowner’s policies); Per capita (Full-time help std and homeowner’s policies).	1/1/03	Not used	Not used	State-specific code: $76.00- Std WC Policy for 1st worker, $60 for each additional worker; $61.00 -Home-Owner’s Policy 1st worker, $60 for add worker.	State-specific code: $76.00- Std WC Policy for 1st worker, $60 for each additional worker; $61.00 -Home-Owner’s Policy 1st worker, $60 for add worker.	0910 – (Occasional) State-specific code- $16.00 for standard WC policy; $1.00 for homeowner’s policy.
NY5	Per capita	Per capita	2/24/03	$130.88	$160.26	$700.40	$494.74
NV2	Per capita	Per capita	7/1/00	Not used	Not used	Not used	Not used	0001-(Full-time)$693.00; 0002(Occasional)-$340.00
WI	Per capita	Per capita	7/1/02	$405.00	$325.00	$658.00	$672.00
SOURCE: NCCI and State Insurance/Rating Agencies. States that use administered pricing typically have one rate per classification code that all carriers must use. NCCI reported that Illinois, Indiana, and Nevada use both competitive and administered pricing mechanism for establishing rates for the voluntary WC markets. MA uses the per capita approach to establish rates for classifications 0908, 0909, 0912 and 0913 and uses a per $100/payroll approach to establish rates for classification 0918. NJ does not have minimum premiums, the information reported is actual premiums. The minimum premiums include the terrorism assessment charge.

TABLE 6. State Insurance Fund Minimum Premiums For Domestic Service Classification Codes By Jurisdiction
Jurisdiction	State Insurance Fund	Rate Type	Premium Type	Effective Date	WC Code 0908	WC Code 0909	WC Code 0912	WC Code 0913	WC Code Other
AZ1	AZ State Compensation Fund	Per capita	Per capita	10/01/02	$131.00	$96.00	$252.00	$398.00
CA	CA State Compensation Insurance Fund	Per $100 payroll	0910(A)- Per household policy; 0913(A)- Per capita	7/01/03	Not used	Not used	Not used	Not used	0910(A) (Occasional) -$200; 0913(A) (Full-time) - $200
ID1	Idaho State Insurance Fund	Per capita	Per capita	1/01/03	$193.00	$150.00	$300.00	$211.00
MD	MD Injured Workers’ Insurance Fund	Per $100 of payroll	Per household policy	1/01/03	Not used	Not used	$175.00	$175.00
MT	Montana State Fund	Per $100 of payroll	Per capita	7/01/03	Not used	Not used	Not used	Not used	9015-$304.12
NY2	NY State Insurance Fund	Per capita	Per capita	2/24/03	$130.88	$160.26	$700.40	$494.74
ND	ND Workers’ Compensation Bureau	Per $100 of payroll	Per household policy	7/01/03	Not used	Not used	Not used	Not used	9002 - $327.00
OH	OH Bureau of Workers’ Compensation	Per $100 of payroll	Per household policy	7/01/03	Not used	Not used	Not used	Not used	8989-$10.003
OK	OK State Insurance Fund	Per capita	Per capita	2/01/02	$258.00	$252.00	$350.00	$350.00
PA	PA State Workmen’s Insurance Fund	Per capita	Per capita	4/01/03	$253.00	$266.00	$405.00	$505.00
UT4	Workers’ Compensation Fund of Utah	Per capita	Per capita	12/01/02	$400.00	$400.00	$400.00	$400.00
WA	WA Industrial Insurance State Fund	Per hour worked	Per household policy	01/01/03	Not used	Not used	Not used	Not used	6510 – no minimum premium, hourly comp rate of $0.7744/hr
WV	WV Workers’ Compensation Fund	Per $100 payroll	Per household policy	7/01/03	Not used	Not used	Not used	Not used	8828 - $25.005
WY	WY Workers’ Compensation Fund	N/A6
PR	Puerto Rico State Insurance Fund	Per $100 of payroll	Per household policy	7/01/02	Not used	Not used	Not used	Not used	0912-011 PR specific - $65.007
VI	Virgin Islands Division of Government Insurance	Per $100 of payroll	Per household policy	1/1/97	Not used	Not used	Not used	Not used	0405 VI-specific - $25.008
The minimum premiums are the administrative pricing minimum premiums quoted by State. The minimum premiums include the terrorism assessment charge. This is the minimum premium administrative cost in the absence of a premium. No other minimum premium applied. The blended rate for class 8989 is $4.4457/$100. Utah allows tier rating and the State Insurance Fund uses three tiers, Nonstandard, Standard and Preferred. A household employer would fall into the nonstandard tier if he/or she was a new employer or if he/she had a 100% loss ratio. The only way a household employer can get into the preferred tier is if he/she has a loss ratio of 50% or less. This represents the minimum premium for an employer who has not payroll. WY does not write workers' compensation policies for domestic service workers. Premium would be the $65/minimum premium or $3.75/$100 of payroll, whichever is greater. The minimum premium reflects an employer with no payroll. VI has a maximum premium that can not exceed $8,424 per employee per year and the minimum premium is $25 (for employer with no payroll) for classification 0405, effective 1/1/97.

TABLE 7. Inclusion of Domestic and Personal Assistance Service Workers And The Treatment of Family Members As Covered Workers In Workers' Compensation Laws By Jurisdiction
Jurisdiction	Is Domestic Service Defined in Law?	Is Domestic Service Defined by Classification Code(s) (List Codes)?	Are Personal Assistance Workers Included in Definition of Domestic Service?	If Not, How are Personal Assistance Workers Classified?	Are Family Members Considered “Covered” Workers?
AL	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported they “appear to.” No specific cite in law or classification codes. Final determination would be based on result of a WC claim appeal decision.	N/A	Yes1
AK	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a WC claim appeal decision.	N/A	Yes1
AZ	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “could not say.” No specific cite in law or classification codes. Final determination would be based on result of a WC claim appeal decision.	N/A	Yes1
AR	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation staff reported “yes,” as long as they are hired by the household employer and perform their work in and around the private home. No specific cite in law or classification codes. Final determination based on result of a workers’ compensation claims appeal.	N/A	Yes1
CA	No	State-specific codes: 0910(A), 0913(A)	Workers’ compensation staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	No. Employers are specifically exempted from covering employees if they are a parent, spouse or child.
CO	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation staff reported they were unsure. No specific cite in law or classification code. Final determination would be based on result of a workers compensation claim appeal decision.	N/A	Yes1
CT	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation staff reported it appears to. No specific cite in law or classification code. Final determination would be based on result of a workers compensation claim appeal decision.	N/A	§31-275(9)(b)(iii) (exempt employees) if, in any contract of insurance, the wages or salary of a member of the employers family dwelling in his house is included in the payroll on which the premium is based, then that person shall, if he sustains an injury arising out of and in the course of his employment, be deemed an employee and compensated in accordance with the provisions of this chapter.
DE	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation staff reported, “yes” as long as the services are being provided for a household employer and not provided by an agency or vendor. No specific cite in law or classification code. Final determination based on result of a workers’ compensation appeal decision.	N/A	Yes1
DC	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation staff reported “it appears to.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
FL	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a WC claim appeal decision.	N/A	Yes1
GA	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a WC claim appeal decision.	N/A	Yes1
HI	No	NCCI codes: 0908, 0909, 0912, 0913	Yes, Hawaii workers’ compensation law §381-6 specifically includes attendant care and day care services under the domestic service definition.2	N/A	Exempt from coverage but employers may elect to cover.
ID	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a WC claim appeal decision.	N/A	Exempt from coverage but employer may elect to cover.
IL	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “it appears to.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
IN	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes,” No specific cite in law or classification code(s). Final determination would be based on result of a workers claim appeal decision.	N/A	Yes1
IA	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “we believe so.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Not when the relative is a member of the household (Code 2003 §85.1. “Member of the household” is defined to be the spouse of the employer or relative of either the employer or spouse residing on the premises of the employer (e.g., parents, brother, sister, child, and stepchild). Staff was not sure if the employer could elect to provide coverage.
KS	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes, but K.S.A. §44-404(a)(2) states that any employment, other than those employments stated in statute, wherein the employer had a total gross payroll for the preceding calendar year of not more than $20,000 for all employees and wherein the employer reasonably estimates that such employer will not have a total gross annual payroll for the current calendar year of more than $20,00 for all employees, except that no wages paid to an employee who is a member of the employer’s family by marriage or consanguinity shall be included in total gross annual payroll of such employer for workers’ compensation purposes.
KY	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
LA	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification code(s). Final determination would be based on result of a WC claim appeal decision.	N/A	Yes1
ME	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes, activities of daily living would be included under the nurse category.”4 No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes, but Title 39-A§102(1)(4) states that the parent, spouse, or child of a sole proprietor, partner, or bona fide owner of 20% of the voting stock may waive in writing all the benefits provided by workers’ compensation.
MD	No	NCCI codes: 0912, 0913	Workers’ compensation staff reported “yes, under code 0913. This includes occasional driving but not medication administration.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
MA	No	NCCI codes: 0908, 0909, 0912, 0913State specific code 09185	Not defined in law but clearly defined in employment classification code 0918.	N/A	Yes1
MI	Yes6	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation staff reported “it appears to.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	No7
MN	Yes8(Household worker)	NCCI codes: 0908, 0909, 0912, 0913	No, MN Statutes 2002 § 176 subd. 9(17) states that a worker who provides in-home attendant care services to a physically disabled person and who is paid by the Department of Human Services for services renders is considered an employees of State and not the person with the disability.9	N/A	Yes1
MS	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
MO	No	NCCI codes: 0908, 0913	Workers’ compensation agency staff reported “yes under nurse category.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Domestic service workers are exempt, including paid family members, but employers may elect coverage10
MT	No	State-specific codes: 0915	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
NE	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported they believe it does regardless of occasional driving. No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
NV	Yes11	State specific codes: 0001, 0002	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
NH	Yes12	NCCI codes: 0908, 0909, 0912, 091313	No14	N/A	Yes1
NJ	No	NCCI codes: 0912, 0913	Workers’ compensation agency staff reported “yes but a worker who does occasional driving should be considered as an “out-servant.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
NM	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “it appears to.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
NY	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
NC	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	Yes	Yes1
ND	No	State specific codes: 9002	Yes, personal assistance workers are specifically cited in classification code 9002.15	N/A	No. A spouse or child under the age of 22 of an employer are not considered to be an employee.16
OH	No	State specific codes: 8989	Workers’ compensation agency staff reported “it appears to.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
OK	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes if working for a household employer in and around a residence.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	An employer with five or less employees, all of whom are related by blood or marriage to the employer, will be exempt from the Workers’ Compensation Act.3
OR	Yes17	State specific codes: 8989	Workers’ compensation agency staff reported “it appears to.” No specific cite in classification code 8989 to home health workers.” Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
PA	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes but not sure how to handle occasional driving.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.18	N/A	Yes1
RI	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
SC	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
SD	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
TN	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation staff reported “yes, as long as the worker is not professionally trained.” No specific cite in law or classification codes. Final determination would be based on result of a WC claim appeal decision.	N/A	Yes1
TX	No	State specific codes: 0913, 0923	Workers’ compensation agency staff reported “yes as long as working for household employer.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.19	N/A	Yes1
UT	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported, “yes,” but, when there is driving involved, the worker would have to be classified in the highest rating class.(0909 or 0912). No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
VT	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes,” but, if the PCA drives at any time, then the employer is required to provide coverage. No specific cite in law or classification codes. Final determination would be based on result of a WC claim appeal decision.	N/A	Members of the employer’s family dwelling in his house are not considered to be employees. However, if their wages or salaries are included in the payroll upon which the WC premium is based then such persons are deemed employees and compensated accordingly. .20
VA	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
WA	No	State-specific codes: 6510-00	Workers’ compensation agency staff reported “yes,” however unclear. There is a classification code 651-00 Chore Services, that includes many of the tasks performed by personal care workers. However, the code states its for “establishments” that provide these services and not household employers hiring their workers directly. Final determination would be based on result of a WC claim appeal decision.	6511-00 (Chore Services – the definition reflects many of the tasks performed by a personal care worker, however, the employer is an establishment rather than a household employer.	Yes1
WV	No	State specific codes: 8828	Workers’ compensation agency staff reported “yes.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
WI	No	NCCI codes: 0908, 0909, 0912, 0913	Workers’ Compensation Division has developed a policy that separates personal assistance workers from general “domestics” called “home care provider.” Household employers hiring their own home care providers would fall into the domestic service code for rating purposes. They have not created a separate rating code because they don’t believe the group is large enough to generate reliable loss information.21 Home care providers hired by household employers are exempt from the State’s WC law because the worker’s employment is not in a trade, business, profession or occupation of the employer.	See footnote 18	Yes1
WY	State has mandatory exemption for domestic service.	N/A	N/A	N/A	N/A
AS	No	Do not use classification codes per se; develop classification per employer group based on employer-specific information.	No	Determined on an employer-specific basis.	Yes1
GU	No	NCCI codes: 0909, 0912, 0913	Workers’ compensation agency staff reported “it appears to.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes22
NMI	No	NMI does not use codes. Determine on case by case basis.	Workers’ compensation staff reported they would compute a premium for a personal assistance worker on a case-by-case basis.		Yes1
NN	N/A	N/A	N/A	N/A	N/A
PR	No	PR specific code: 0912-011	Yes23	N/A	Yes1
VI	No	VI specific code: 0405	Workers’ compensation agency staff reported “possibly under nurse category.” No specific cite in law or classification codes. Final determination would be based on result of a workers’ compensation claim appeal decision.	N/A	Yes1
The WC law is silent regarding the status of family members as covered employees. For the purpose of this report, they may be covered at the discretion of the employer. Hawaii Workers Compensation Law §381-1 (6) Domestic, which includes attendant care, and day care services authorized by the department of human services under the Social Security Act, as amended, performed by an individual in the employ of a recipient of social service payments. Both OWCA and LA WC Corp staff though that they might represent more risk than what is traditionally considered under 0908-0913 Staff reported that occasional driving would require a driver standard exception code added to policy. If worker administers medications, he/she is not a domestic servant. MA implemented a new domestic service classification code for personal assistance workers - 0918 (See Appendix A). Michigan Workers Compensation Act §418.118 (3) A household servant or domestic as used in this act means a person who engages in work or activity relating to the operation of a household and its surroundings whether or not he resides therein. Michigan WC Act §118 (1) No household domestic servant shall be considered an employee if the person is a wife, child, or other member of the employer's family residing in the home, and no household employer shall be deemed a statutory principal within the meaning of section 171 for the purposes of this section. Minnesota Statutes 2002 §176 subd. 21 "Household worker" means one who is a domestic, repairer, groundskeeper, or maintenance in, for, or about a private home for, or about a private home or household, but the term shall not include independent contractors nor shall it include persons performing labor for which they may elect workers' compensation under §176.041, subdivision 1a. Minnesota Statutes 2002 §176 subd. 9 (17) a worker who renders in-home attendant care services to a physically handicapped person, and who is paid directly by the commissioner of human services for these services, shall be an employee of the state within the meaning of this subdivision, but for no other purpose. The workers' compensation language is reflective of the MN Unemployment Insurance Law Section 268.035 Definitions subd. 14(5) that states: "Employer means any of the following ..any nonprofit organization or government agency providing or authorizing the hiring of home workers, personal care attendants, or similar worker whether the organization or agency pays the employee directly or provides funds to the recipient of the service to pay for the services." Missouri Revised Statutes §287.030 Employer Defined: (3) Any of the above-defined employers must have five or more employees to be deemed an employer for the purposes of this chapter unless election is made to become subject to the provisions of this chapter as provided in subsection 2 of section 287.090 An employee who is a member of the employer's family within the third degree of affinity or co-sanguinity shall be counted in determining the total number of employees of such employer. Domestic service workers, including paid family members, are exempt. But household employers may elect workers' compensation insurance coverage for these workers. NRS §616B.032 For purposes of determining a homeowner's insurance policy, "Domestic worker" is a person who is engaged exclusively in household or domestic service performed inside or outside of a person's residence. The term includes, without limitation, a cook, housekeeper, maid, companion, babysitter, chauffeur or gardener. RSA §281-A:2 Definitions, V-a "Domestic", "Domestic employee", or "domestic worker" means a person performing domestic services in a private residence of the employer, where the employer is an individual, family, local college club, or local chapter of a college fraternity or sorority and not an agency or other entity engaged in the business of providing domestic workers to the public and the person is not defined as an independent contractor under RSA 281-A:2, V-b (a) "Domestic labor" or "domestic services" means the performances of such duties as housekeeping, childcare, gardening, handy person work, and serving as a companion or caregiver for children or others who are not physically or mentally infirm. (b) "Domestic labor" or "domestic services" shall also include the services rendered by paid roommates or live-in companions who provide fellowship, care, and protection for persons who because of advanced age, or physical or mental infirmity cannot care for their own needs, regardless of whether the paid roommate or companion is employed by an agency or entity other than the person using such services The state uses NCCI classification codes for domestic service but they do not match the statutory definition of domestic service. A person with a disability can not classify their personal assistance worker under domestic service but state insurance department staff could not say what classification the personal assistance worker would fall under. Domestic service classification includes "those individuals performing home help services or providing personal assistance or home care for persons who are convalescent, aged, or acutely or chronically ill or disabled. North Dakota Century Code 65-01-02. Definitions (17)(b)(3) For purposes of this paragraph and section 65-07-01, "child" means any legitimate child, stepchild, adopted child, foster child, or acknowledged illegitimate child. But employers may elect coverage by obtaining an optional policy, standard policy not available. Premium for optional policy is the maximum rate for the rate class. ORS 656.026(1) A worker employed in or about a private home. For the purposes of this subsection, "domestic servant means any worker engaged in household domestic service by private employment contract, including, but not limited to, home health workers." Pennsylvania State Workers' Insurance Fund reported that domestic service is not just "maids." It also includes "a person hired by another person to work inside the home." Representative from SWIF stated that this includes working for a disabled person in their home, doing their laundry, helping them with personal needs, making them meals, etc." In Viola v. Workmen's Compensation Appeals Board, 549A. 2d 1367, 121 Pa. Commw. 47 (1988) the court found that the worker's duties were related solely to the unique needs of the disabled individual rather than the needs of the household and the duties were similar to a nurse aide and did not include household duties and held that the worker was not an exempt domestic servant. Department of Insurance staff reported that as long as they were working for a household employer, personal care workers would fall under the domestic service classification. Vermont Statutes §601(4)(D). Home care provider tasks include providing primary-care to an individual such as helping walking, bathing, preparing meals and special diets, supervising use of medications and exercise therapy, and other duties commonly associated with the meaning of primary-care gives. Housekeeping duties should be incidental to primary-care duties. Family members are "covered" if they are hired as a domestic service workers to work in the house of the employer and the worker does not reside in the same household as the employer. Definition includes "attendants."

TABLE 8. Workers' Compensation Administrative, Rating And Claims Appeal Agencies By Jurisdiction
Jurisdiction	Workers' Compensation Administrative Agency	Worker's Compensation Rating Agency	Workers' Compensation Claims Appeal Agency
AL	Workers’ Compensation DivisionAL Department of Industrial RelationsIndustrial Relations Building649 Monroe StreetMontgomery, AL 36131(334) 242-2868Fax: (334) 261-3143http://www.dir.state.al.us/wc.htm	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	Courts1
		AL Department of Insurance201 Monroe StreetSuite 1700Montgomery, AL 36130http://www.aldoi.org
AK	Division of Workers’ CompensationAK Department of Labor & Workforce DevelopmentP.O. Box 25512Juneau, AK 99802-5512(907) 465-2790Fax: (907) 465-2797http://www.labor.state.ak.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	Workers’ Compensation BoardAK Department of Labor & Workforce DevelopmentP.O. Box 25512Juneau, AK 99802-5512(907) 465-2790Fax: (907) 465-2797http://www.labor.state.ak.us/boards
		Workers’ Compensation BoardAK Department of LaborP.O.Box 25512M/S 0700Juneau, Alaska 99802-5512(907) 465-2790Fax: (907) 465-2797http://www.gov.state.ak.us/boards
AZ	Industrial Commission of Arizona90 West WashingtonP.O. Box 19070Phoenix, AZ 85005-9070 (602) 542-4411http://www.ica.state.az.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	Industrial Commission of Arizona90 West WashingtonP.O. Box 19070Phoenix, AZ 85005-9070 (602) 542-4411
		AZ Department of Insurance2910 North 44thStreetSuite 210Phoenix, AZ 85018 (602) 912-8444http://www.id.state.az.us
AR	AR Workers’ Compensation Commission324 Spring StreetP.O. Box 950Little Rock, AR 72203-0950 (800) 622-4472, (501) 682-3930Fax: (501) 682-2777http://www.awcc.state.ar.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	AR Workers’ Compensation Commission324 Spring StreetP.O. Box 950Little Rock, AR 72203-0950 (800) 622-4472, (501) 682-3930
		AR Insurance Department1200 W. Third StreetLittle Rock, AR 77201 (501) 371-2600(800) 282-9134http://www.state.ar.us/insurance
CA	State of California Division of Workers’ Compensation455 Golden Gate Ave., 9thFloorSan Francisco, CA 94102-3660 (415) 703-4600http://www.dir.ca.gov/dwc	Workers’ Compensation Insurance Rating Board525 Market StreetSuite 800San Francisco, CA 94105	Workers’ Compensation Appeals Board455 Golden Gate Ave., Suite 9328San Francisco, CA 94102-3660 (415) 703-4600 http://www.dirca.gov/WCAB/wcab.htm
	Department of Industrial Relations, Commission on Health and Safety and Workers’ Compensation455 Golden Gate Ave., 10thFloorSan Francisco, CA 94102 (415) 703-4220
CO	Division of Workers’ Compensation1515 Arapahoe StreetTower 2, Suite 500Denver, CO 80202-2117 (800) 390-7936, (303) 318-8700 http://www.coworkforce.com/dwc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	Industrial Claims Appeals OfficeWorkers’ Compensation1515 Arapahoe StreetTower 2, Suite 350Denver, CO 80202 (303) 894-2378
		Department of Regulatory Agencies, Colorado Division of Insurance1560 Broadway, Suite 850Denver, CO 80202 (800) 930-3745, (303) 894-7499 http://www.dora.state.co.us/insurance
CT	CT Workers’ Compensation Commission 21 Oak StreetHartford, CT 06106 (860) 493-1500Fax: (860) 247-1361 http://www.wcc.state.ct.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	CT Workers’ Compensation CommissionCompensation Review Board21 Oak StreetHartford, CT 06106 (860) 493-1500
		CT Department of InsuranceProperty and Casualty DivisionP.O. Box 816Hartford, CT 06142-0816 (860) 297-3800Fax: (860) 566-7410 http://www.ct.gov/cid
DE	DE Department of LaborDivision of Industrial AffairsOffice of Workers’ Compensation4425 North Market StreetWilmington, DE 19802 (302) 761-8200http://www.delawareworks.com/division/industaffairs	DE Compensation Rating BoardOne South Penn Square Widener Building; 6thFloorPhiladelphia, PA 19107 (302) 654-1435Fax: (215) 564-4328http://www.dcrb.com	DE Department of LaborDivision of Industrial AffairsIndustrial Accident Board4425 North Market StreetWilmington, DE 19802 Accident Board
DC	DC Department of Employment ServicesOffice of Workers’ Compensation77 P Street, NE, 2ndFloorWashington, DC 20002 (202) 671-1000http://www.does.ci.washington	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	DC Department of Employment ServicesOffice of Workers’ Compensation77 P Street, NE, 2ndFloorWashington, DC 20002 (202) 671-1000
		DC Department of Insurance and Securities Regulation810 First Street, NE, Suite 701Washington, DC 20002 (202) 727-8000http://www.disr.dc.gov
FL	FL Department of Financial ServicesDivision of Workers’ Compensation301 Forrest Building2728 Centerview DriveTallahassee, FL 32399-0680 (850) 488-2514 Fax: (850) 922-6779http://www.flfs.com/wc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	FL Department of Financial ServicesDivision of Administrative HearingsOffice of Judges of Compensation ClaimsP.O. Box 8000Tallahassee, FL 32314-8000 (850) 487-1911http://www.doah.state.fl.us/internet/http://www.jcc.state.fl.us/jcc/default.cfm
		FL Financial Services CommissionOffice of Insurance Regulation2000 East Gaines StreetTallahassee, FL 32399-0326 (850) 413-3140 http://www.fldfs.com
GA	GA State Board of Workers’ Compensation270 Peachtree St, NWAtlanta, GA 30303-1299 (800) 533-0682, (404) 656-3875Fax: (404) 656-7768 http://www.ganet.org/sbwc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	GA State Board of Workers’ CompensationAppellate Division270 Peachtree St, NWAtlanta, GA 30303-1299 (800) 533-0682, (404) 656-3875Fax: (404) 656-7768
		Office of the Commissioner of InsuranceGA Rating BureauProperty and Casualty Unit904 West Tower; Floyd BuildingTwo Martin Luther King, Jr. DriveAtlanta, GA 30334 (404) 656-4449http://www.gainsurance.org
HI	HI Disability Compensation Division830 Punchbowl Street, Room 209Honolulu, HI 96813 (808) 586-9174 Fax: (808) 586-9219 http://dlir.state.hi.us	HI Insurance Bureau2715 So King StreetSuite 320Honolulu, HI (808) 531-2771 (F) (808) 536-3516	HI Labor & Industrial Relations Appeals Board888 Mililani Street, Room 400Honolulu, HI 96813 (808) 586-8600Fax: (808) 586-8613
		HI Office of Commerce and Community AffairsDivision of InsuranceP.O. Box 3614Honolulu, HI 96811http://www.state.hi.us/dcca/ins
ID	ID Industrial CommissionP.O. Box 83720Boise, ID 83720-0041 (208) 334-6000 http://www.state.id.us/iic	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	ID Industrial CommissionP.O. Box 83720Boise, ID 83720-0041 (208) 334-6000
		ID Department of Insurance700 West State StreetP.O. Box 83720Boise, ID 83720-0043 (208) 334-4250http://www.doi.state.id.us
IL	IL Industrial Commission100 W. Randolph, Suite 8-200Chicago, IL 60601 (312) 814-6500http://www.state.il.us/agency/iic	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	IL Industrial Commission100 W. Randolph, Suite 8-200Chicago, IL 60601 (312) 814-6500
		IL Department of Insurance320 W. Washington StreetJames R. Thompson CenterSpringfield, IL 62767-0001 (217) 782-4515http://www.ins.state.il.us
IN	Workers’ Compensation Board of IndianaGovernment Center South402 W Washington Street, W-196Indianapolis, IN 46204 (317) 232-3808http://www.state.in.us/workcomp	ID Compensation Rating Burea (ICRB)35920 Castleway West DriveIndianapolis, IN 50400 (800) 622-4208(317) 842-2800(F) (317) 842-3717	Workers’ Compensation Board of IndianaGovernment Center South402 W Washington Street, W-196Indianapolis, IN 46204 (317) 232-3808
		IN Department of Insurance311 W. Washington Street, Suite 300Indianapolis, IN 46204-2787 (317) 232-2385
IA	Iowa Workforce DevelopmentDivision of Workers’ Compensation1000 East Grand AvenueDes Moines, IA 50319-0209 (515) 281-5387 http://www.iowaworkforce.org/wc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	Iowa Workforce DevelopmentDivision of Workers’ Compensation1000 East Grand AvenueDes Moines, IA 50319-0209 (515) 281-5387
		Iowa Insurance Division330 Maple StreetDes Moines, IA 50319-0065 (877) 955-1212
KS	KS Department of Human ResourcesDivision of Workers Compensation800 SW Jackson St., Suite 600Topeka, KS 66612-1227 (785) 206-1227 http://www.hr.state.ks.us/wc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	KS Workers’ Compensation Appeals Board800 SW Jackson; 14thFloorTopeka, KS 66612-1227 (785) 296-8484
		The KS Department of Insurance420 SW 9thStreetTopeka, KS 66612-1678 (785) 296-3071
KY	Commonwealth of Kentucky Department of Workers’ Claims657 To Be Announced AvenueFrankfort, KY 40601 (800) 554-8601, (502) 564-5550 http://www.labor.ky.gov/dwc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	Commonwealth of Kentucky Department of Workers’ ClaimsWorkers’ Compensation Board1047 U.S. 127 South, Suite 4Frankfurt, KY 40601 (502) 564-3070 ex 391
		Commonwealth of Kentucky Department of Insurance420 SW 9thStreetTopeka, KS 66612-1678 (785) 296-3071http://www.doi.state.ky.us
LA	LA Office of Workers Compensation Administration (OWCA)P.O. Box 94040Baton Rouge, LA 70804-9040 (225) 342-7555 http://www.laworks.net	LA Bureau of Insurance1702 N 3rdStreetBaton Rouge, LA 70802 (225) 342-5203	LA Office of Workers Compensation Administration (OWCA)P.O. Box 94040Baton Rouge, LA 70804-9040 (225) 342-7555
ME	ME Workers’ Compensation Board27 State House StationAugusta, ME 04333-0027 (207) 287-3751http://www.state.me.us/wcb	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	ME Workers’ Compensation Board27 State House StationAugusta, ME 04333-0027 (207) 287-3751http://www.state.me.us/wcb
		ME Department of Professional and Financial RegulationBureau of Insurance#34 State House StationAugusta, ME 04333-0034 (800) 300-5000, (207) 624-8475 http://www.state.me.us/pfr/ins
MD	MD Workers’ Compensation Commission10 East Baltimore StreetBaltimore, MD 21202-1641 (410) 864-5100http://www.wcc.state.md.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	MD Workers’ Compensation Commission10 East Baltimore StreetBaltimore, MD 21202-1641 (410) 864-5100
		MD Insurance Administration525 St. Paul PlaceBaltimore, MD 21202 (410) 468-2000http://www.mdinsurance.state.md.us
MA	Commonwealth of Massachusetts Department of Industrial Accidents600 Washington Street, 7thFloorBoston, MA 02111 http://www.mass.gov/dia	The Workers’ Compensation Rating and Inspection Bureau (WCRIB) of MA101 Arch StreetBoston, MA 02110 (617) 439-9030Fax: (617) 439-6055http://www.wcribma.org	Commonwealth of Massachusetts Department of Industrial Accidents600 Washington Street, 7thFloorBoston, MA 02111 http://www.mass.gov/dia
MI	Bureau of Workers’ & Unemployment Compensation7150 Harris DriveP.O. Box 30016Lansing, MI 48909 (888) 396-5041http://www.michigan.gov/bwuc	Compensation Advisory Organization of MichiganP.O. Box 3337Livonia, MI 48151-3337 (734) 462-9600http://www.caom.com	MI Department of Consumer & Industry ServicesWorkers’ Compensation Appellate Commission201 No. Washington SquareP.O. Box 30468Lansing, MI 48909-7968 (517) 334-9719 http://www.cis.state.mi.us/wkrcomp/wcac
MN	MN Department of Labor and IndustryWorkers’ Compensation Division443 Lafayette Road, St. PaulMN 55155 (651) 284-5018 or (800) 342-5354 http://www.doli.state.mn.us	MN Workers’ Compensation Insurers Association, Inc. (MWCIA)7701 France Ave, South; Suite 450 Minneapolis, MN 55435-3200 (952) 897-1737(F) 952-987-6495http://www.mwcia.org	MN Workers’ Compensation Court of Appeals405 Minnesota Judicial Center25 Constitution AvenueSt. Paul, MN 55155 (651) 296-6526 http://www.workerscomp.state.mn.us
		MN Department of Commerce Insurance85 7thPlace East, Suite 500St. Paul, MN 55101 (651) 297-7161
MS	MS Workers’ Compensation Commission1428 Lakeland DriveJackson, MS 39216 (601) 987-4200http://www.mwcc.state.ms.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	MS Workers’ Compensation Commission1428 Lakeland DriveJackson, MS 39216 (601) 987-4200
		MS Insurance Department1001 Woolfolk State Office BldgJackson, MS 39201 (601) 359-3569http://www.doi.state.ms.us
MO	MO Department of Labor and Industrial RelationsDivision of Workers’ Compensation3315 West Truman BlvdP.O. Box 58Jefferson City, MO 65102-0058 (573) 751-4231, (888) 837-6069 http://www.dolir.state.mo.us/wc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	MO Workers’ CompensationDeterminations Review BoardP.O. Box 690Jefferson City, MO 65102-0690 (573) 751-3365(F) (573) 526-4839
		MO Department of Insurance301 West High StreetP.O. Box 690Jefferson City, MO 65102 (573) 751-4126http://insurance.mo.gov
MT	MT Department of Labor and IndustryWorkers’ Compensation Regulation Bureau1805 Prospect AvenueP.O. Box 8011Helena, MT 59624-8011 (406) 444-2840http://erd.dli.state.mt.us/workcompregs	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	MT Workers’ Compensation Court1625 11thAvenueHelena, MT 59624-0537 (406) 444-7794http://wcc.dli.state.mt.us
		MT Insurance Department8400 Helena Ave.Helena, MT 59601 (800) 332-6148
NE	NE Workers’ Compensation CourtP.O. Box 98908Lincoln, NE 68509-8908 (402) 471-6468, (800) 599-5155http://www.nol.org/home/wc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	NE Workers’ Compensation CourtP.O. Box 98908Lincoln, NE 68509-8908 (402) 471-6468, (800) 599-5155http://www.nol.org/home/wc
		NE Department of InsuranceTerminal Building941 “O” Street, Suite 400Lincoln, NE 68508-3639 (402) 471-2201 http://www.state.ne.us/home/ndoi
NV	NV Division of Industrial Relations400 West King Street, Suite 400Carson City, NV 89703 (775) 684-7260 http://www.state.nv.us/b&i/aiw	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	NV Division of Industrial RelationsDepartment of Administrative Appeals Officer400 West King Street, Suite 400Carson City, NV 89703 (775) 684-7260http://www.state.nv.us/b&i/aiw
		NV Division of Insurance788 Fairview Drive, Suite 300Carson City, NV 89701 (775) 687-4270
NH	NH Department of LaborWorkers’ Compensation Division95 Pleasant StreetConcord, NH 03301 (603) 271-3176 http://www.state.nh.us/dol/wc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	NH Department of LaborWorkers’ Compensation DivisionClaims Division95 Pleasant StreetConcord, NH 03301 (603) 271-8318 http://www.state.nh.us/dol/wc
		NH Department of Insurance56 Old Suncock RoadConcord, NH 03301 (603) 271-7973 http://www.state.nh.us/insurance
NJ	NJ Department of LaborDivision of Workers’ CompensationP.O. Box 381Trenton, NJ 08625-0381 (609) 292-2414Fax: (609) 984-2515 http://www.nj.us/labor/wc	NJ Compensation Rating and Inspection Bureau60 Park PlaceNewark, NJ 07102 (973) 622-6014Fax: (973) 622-6110 http://www.njcrib.com	NJ Department of LaborDivision of Workers’ CompensationP.O. Box 381Trenton, NJ 08625-0381 (609) 292-2414Fax: (609) 984-2515
NM	NM Workers’ Compensation AdministrationP.O. Box 27198Albuquerque, NM 87125-7198 (505) 841-6000Fax: (505) 841-6009 http://www.state.nm.us/wca	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	NM Workers’ Compensation AdministrationDispute Resolution BureauP.O. Box 27198Albuquerque, NM 87125-7198 (505) 841-6000Fax: (505) 841-6009
		NM Public Regulation CommissionInsurance DivisionWorkers’ Compensation Bureau1120 Paseo De PeraltaP.O. Drawer 1269Santa Fe, NM 87501 (505) 827-3978 http://www.nmprc.state.nm.us	NM Court of Appeals
NY	NYS Workers’ Compensation Board100 Broadway-MenandsAlbany, NY 12241 (518) 474-6670Fax: (518) 473-1415 http://www.wcb.state.ny.us	NYS Compensation Insurance Rating Board (NCIRB)200 E. 42 St.New York, NY 10017 (212) 697-3535Fax: (212) 972-1393 http://www.nycirb.org	NYS Workers’ Compensation Board, 100 Broadway-MenandsAlbany, NY 12241 (518) 474-6670Fax: (518) 473-1415
NC	NC Industrial Commission4319 Mail Service CenterRaleigh, NC 27699-4319 (919) 807-2500http://www.comp.state.nc.us/ncic	NC Rating Bureau5401 Six Forks RoadRaleigh, NC 27609-4435 (919) 783-9790Fax: (919) 783-7467http://www.ncrb.org	NC Industrial Commission4319 Mail Service CenterRaleigh, NC 27699-4319 (919) 807-2500
ND	ND Workers’ Compensation500 Front AvenueBismark, ND 58504-5685 (800) 777-5033(701) 328-3800(Fax) (701) 328-3820 http://www.ndworkerscomp.com	ND Workers’ Compensation500 Front AvenueBismark, ND 58504-5685 (800) 777-5033(701) 328-3800(Fax) (701) 328-3820 http://www.ndworkerscomp.com	ND Workers’ Compensation500 Front AvenueBismark, ND 58504-5685 (800) 777-5033(701) 328-3800(Fax) (701) 328-3820 http://www.ndworkerscomp.com
OH	OH Bureau of Workers’ Compensation30 West Spring StreetColumbus, OH 43125-2256 (614) 644-6292, (800) 644-6292 http://www.ohiobwc.com	OH Bureau of Workers’ Compensation30 West Spring StreetColumbus, OH 43125-2256 (614) 644-6292, (800) 644-6292 http://www.ohiobwc.com	Industrial Commission of Ohio30 West Spring StreetColumbus, OH 43215-2256 (614) 466-6136, (800) 521-2691http://www.ohioic.com
OK	OK Department of LaborWorkers’ Compensation Enforcement Division4001 N Lincoln BlvdOklahoma City, OK 73105 (405) 528-1500 http://www.okdol.state.ok.us/workcomp	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	OK Workers’ Compensation Court1915 North Stiles AveOklahoma City, OK 73105 (405) 522-8600http://www.owcc.state.ok.us
		OK Insurance DepartmentProperty & Casualty Rates Division2401 NW 23rd, Suite 28Oklahoma City, OK 73107 (405) 521-3681 http://www.oid.state.ok.us
OR	OR Department of Consumer & Business ServicesWorkers’ Compensation Division250 Winter Street, NE, Room 27Salem, OR 97391-3879 (503) 947-7810, (800) 452-0288Fax: (503) 947-7514 http://www.cbs.state.or.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	OR Workers’ Compensation Board2601 25thStreet, SESalem, OR 97302-1282 (503) 378-3308http://www.cbs.state.or.us/wcb
		OR Insurance Division30 Winter Street, NESalem, OR 97301 (503) 378-4100 http://www.cs.state.or.us/external/ins
PA	PA Department of Labor and IndustryBureau of Workers’ Compensation1171 South Cameron Street, Room 324Harrisburg, PA 17104-4447 (717) 772-4447	PA Compensation Rating BureauWidener Building, 6th FloorOne So Penn SquarePhiladelphia, PA 19107-3577 (215) 568-2371 http://www.pcrb.com	PA Workmen’s Compensation Appeals Board1171 South Cameron StreetRoom 305Harrisburg, PA 17104-2511 (717) 783-7878
RI	RI Department of Labor and TrainingDivision of Workers’ Compensation1511 Pontiac AvenueBuilding 69, 2ndFloorCranston, RI 02920-0942 (401) 462-8100http://www.dlt.state.ri.gov/wc	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	RI Workers’ Compensation CourtOne Dorrance PlazaProvidence, RI 02903 (401) 458-5000
		RI Department of Business Regulation, Division of Insurance233 Richmond StreetProvidence, RI 02903 (401) 222-2223
SC	SC Workers’ Compensation Commission1612 Marion StreetColumbia, SC 29201 (803) 896-5800http://www.wcc.state.sc.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	SC Workers’ Compensation CommissionJudicial Division1612 Marion StreetColumbia, SC 29201 (803) 896-5800
		SC Department of Insurance300 Arbor Lake DriveSuite 1200Columbia, SC 29223 (803) 737-6160http://www.doi.state.sc.us
SD	SD Department of LaborDivision of Labor and ManagementKneip Building, 3rdFloor700 Governors DrivePierre, SD 57501-2291 (605) 773-2291Fax: (605) 773-4211http://www.state.sd.us/dol/dlm	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	SD Department of LaborDivision of Labor and ManagementKneip Building, 3rdFloor700 Governors DrivePierre, SD 57501-2291 (605) 773-2291Fax: (605) 773-4211http://www.state.sd.us/dol/dlm
		SD Department of RevenueDivision of Insurance118 W CapitolPierre, SD 57501 (605) 773-3563http://www.state.sd.us/drr
TN	TN Department of Labor and Workforce DevelopmentWorkers’ Compensation Division710 James Robertson ParkwayGateway Plaza, 2nd FloorNashville, TN 37243-0665 (615) 532-4812 http://www.state.tn.us/labor-wfd	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	Courts1
		TN Department of Commerce and InsuranceDivision of InsuranceDavy Crockett Tower, Suite 500Nashville, TN 37243-0565 (615) 741-6997http://www.state.tn.us/commerce
TX	TX Workers Compensation CommissionSouthfield Building4000 S IH-35Austin, TX 78704-7491 (512) 804-4000 http://www.twcc.state.tx.us	TX Department of InsuranceP.O. Box 149104Austin, TX 78714-9104 (512) 322-3490, (800) 578-4677http://www.tdi.state.tx.us	TX Workers Compensation CommissionSouthfield Building4000 S IH-35Austin, TX 78704-7491 (512) 804-4000
UT	UT Labor Commission160 East 300 Street South, 3rd FloorSalt Lake City, UT 84111 (801) 530-6800 http://www.laborcommission.utah.gov	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	UT Labor CommissionWorkers’ Compensation Appeals Board160 East 300 Street South, 3rdFloorSalt Lake City, UT 84111 (801) 530-6800
		UT Insurance DepartmentState Office BuildingRoom 3110Salt Lake City, UT 84114-6901 (801) 538-3805http://www.insurance.utah.gov
VT	VT Department of Labor and IndustryWorkers’ Compensation DivisionNational Life BuildingDrawer 20Montpelier, VT 05620-3401 (802) 828-2286http://www.state.vt.us/labind	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	VT Department of Labor and IndustryWorkers’ Compensation DivisionNational Life BuildingDrawer 20Montpelier, VT 05620-3401 (802) 828-2286http://www.state.vt.us/labind
		VT Department of Banking and Industry89 Main Street, Drawer 20Montpelier, VT 05620-3101 (802) 828-3301http://www.bishca.state.vt.us
VA	VA Workers’ Compensation Commission1000 DMV DriveRichmond, VA 23220 (804) 367-8600, Fax: (804) 367-9740 http://www.vwc.state.va.us	NCCI1901 Pennisula Corp CircleBoca Raton, FL 33487(800) 622-4123http://www.ncci.com	VA Workers’ Compensation Commission1000 DMV DriveRichmond, VA 23220 (804) 367-8600Fax: (804) 367-9740 http://www.vwc.state.va.us
		Commonwealth of Virginia StateCorporation CommissionBureau of InsuranceTyler Building1300 E. Main StreetRichmond, VA 23219 (804) 371-9185, (800) 552-7945 http://www.wcc.state.va.us
WA	Washington State Department of Labor and IndustryInsurances Services Division7273 Linderson Way, SWTumwater, WA 98501-5414 (360) 902-5800, (800) 831-5227http://www.lni.wa.gov	Washington State Office of the Insurance Commissioner5000 Capitol BoulevardTumwater, WA 98501 (360) 725-7080 http://www.insurance.wa.gov/oic	Board of Industrial Insurance Appeals, 2430 Chandler Court, SWP.O. Box 42401Olympia, WA 98504-2401(360) 753-9646, (800) 442-0447(F) (360) 586-5611http://www.wa.gov/biia
WV	West Virginia Bureau of Employment ProgramsWorkers’ Compensation DivisionP.O. Box 3824Charleston, WV 25338-3824(304) 926-5048, (800) 628-4265http://www.state.wv.us/bep/wc	West Virginia WC Fund4700 MacCorkle AveSECharleston, WV 25304 (800) 628-4265 or (304) 926-5000http://www.state.wv.us/bep	Bureau of Employment ProgramsWorkers’ Compensation Appeal BoardP.O. Box 2628Charleston, WV 25329-2628 (304) 558-3375(F) (304) 558-1322 http://www.state.wv.us./bep/AppBd/default.htm
			Office of JudgesP.O. Box 2233Charleston, WV 25328-2233 (304) 558-1686 http://www.state.wv.us/bep/ooj
WI	WI Department of Workforce DevelopmentWorker’s Compensation DivisionRoom C100201 E. Washington AveMadison, WI 53703 (608) 266-1340 http://www.dwd.state.wi.us/wc	WI Compensation Rating BureauP.O. Box 3080Milwaukee, WI 53201-3080 (262) 796-4540Fax:(262) 796-4400http://www.wcrb.org	WI Labor & Industry Review Commission (LIRC)P.O. Box 8126Madison, WI 53708-81263319 West Beltline HighwayMadison, WI 53708-8126 (608) 266-9850(F) (608) 267-4409http://www.dwd.state.wi.us/lirc
		State of WI Office of the Commissioner of Insurance125 South Webster StreetMadison, WI 53702 (608) 266-3585(800) 236-8517
WY	Wyoming Workers’ Safety and Compensation Division1510 E. Pershing BlvdCheyenne, WY 82002 (307) 777-7441 http://wydoe.state.wy.us		State Hearing Examiners or Medical Commission
AS	Workmen’s Compensation Commission, Office of the GovernorPago Pago, AS 96799 011-684-633-4485		Workmen’s Compensation Commission, Office of the GovernorPago Pago, AS 96799 011-684-633-4485
GU	Department of LaborWorkers’ Compensation Commission108 “E” StreetTiyan, Guam 96913 (671) 647-0150	Guam Insurance CommissionDivision of Tax and RevenueP.O. Box 2307GMF, Guam 96921 (671) 475-1816	Department of LaborWorkers’ Compensation Commission108 “E” StreetTiyan, Guam 96913 (671) 647-0150
NN	Workers’ Compensation ProgramP.O. Box 2489Window Rock, AZ 86515 (928) 871-6389
NMI	Commonwealth of the Northern Mariana IslandsWorkers’ Compensation CommissionP.O. Box 501247Saipan, MP 96950 (670) 664-8026	Commonwealth of the Northern Mariana IslandsBanking and Insurance OfficeCaller Box 1007Saipan, MP 96950 (670) 664-3000	Commonwealth of the Northern Mariana IslandsWorkers’ Compensation CommissionP.O. Box 501247Saipan, MP 96950 (670) 664-8026
PR	Industrial Commissioner’s OfficeG.P.O Box 364466San Juan, PR 00936 (787) 783-3808	PR State Insurance FundG.P.O. Box 5028San Juan, Puerto Rico 00936 (787) 767-4681	Industrial Commissioner’s Office, G.P.O Box 364466San Juan, PR 00936 (787) 783-3808
VI	Department of LaborWorkers’ Compensation Division3012 Vitraco Mall, Golden Rock ChristianstedSt. Croix, VI 00820-4666 (809) 692-9390	VI Department of FinanceDivision of Insurance2314 Kronprindsens GadeSt Thomas,VI 00802 (340) 774-450-Sec 9	VI Department of LaborDivision of Hearings and Appeals3012 Vitraco Mall, Golden Rock ChristianstedSt. Croix, VI 00820-4666 (809) 692-9390
Al and TN use the State Courts to hear workers' compensation appeals. NCCI reports that HI is an NCCI state. However, they have a rating bureau that uses NCCI information to develop rate filings that are reviewed and approved by the HI Division of Insurance. NCCI reports that IN is an NCCI state, however, the state has a rating bureau that uses NCCI information to develop rate filings that are reviewed and approved by the IN Department of Insurance.

TABLE 9. Top Twenty Five Commercial Workers' Compensation Insurers (2002)
Insurer Group	2002 Workers' Compensation  Insurance Premiums	Percent of  Total Premiums
State Compensation Fund of California	$5,492,547	18.5%
Liberty Mutual Insurance Companies	3,807,507	12.3
American International Group	3,135,134	10.6
Zurich/Farmers Group	2,107,534	7.1
Travelers PC Group	1,533,078	5.1
Hartford Insurance Group	1,495,662	5.0
CNA Insurance Companies	1,438,229	4.8
Kemper Insurance Companies	1,350,448	4.5
Royal & Sun Alliance	1,179,654	4.0
St. Paul Companies	956,767	3.2
Ace INA Group	723,660	2.4
Everest Reinsurance US Group	634,949	2.1
Texas Mutual Insurance Group	609,064	2.0
Zenith National Insurance Group	581,653	2.0
Chubb Group of Insurance Companies	578,267	2.0
HDI US Group	521,154	1.8
WR Berkeley Group	508,514	1.7
Pinnacol Assurance Group	475,328	1.6
Aon Corporation Group	396,575	1.3
Fairfax Financial (U.S.) Group	393,767	1.3
PMA Capital Insurance Group	390,081	1.3
Accident Fund Insurance Company	368,117	1.2
Greater American P&C Group	362,666	1.2
FCCI Insurance Group	341,223	1.1
Old Republic General Group	337,251	1.1
SOURCE: A.M. Best Co, Best's Review, August 2003, p.81.

TABLE 10. State Insurance Funds And Pricing Methods By Jurisdiction
Jurisdiction	State Insurance FundCompetitive or Exclusive	Level of Access for Domestic Service Employers1	Number of Voluntary Carrier Refusals Need to Access State Insurance Fund2	Is an Agent Required to Access State Insurance Fund?	Competitive Pricing	Administrated Pricing
AZ	Competitive	Moderate	None	No		X
CA	Competitive	High3	None	Optional	X
ID	Competitive	Moderate	None	Recommended	X
MD	Competitive	Moderate	None	No	X
MT	Competitive	Moderate	Two Declination Letters	Recommended	X
NY	Competitive	Moderate	None	No		X
ND	Exclusive	High	N/A	N/A	N/A	N/A
OH	Exclusive	High	N/A	N/A	N/A	N/A
OR	Competitive	Moderate	None	No	X
PA	Competitive	High4	None	No	X
UT	Competitive	Moderate	None	No	X
WA	Exclusive	High	N/A	N/A	N/A	N/A
WV	Exclusive	High	N/A	N/A	N/A	N/A
WY	Exclusive	None5	N/A	N/A	N/A	N/A
PR	Exclusive	High	N/A	N/A	N/A	N/A
VI	Exclusive	High	N/A	N/A	N/A	N/A
As reported by state agency staff. A refusal is documented by obtaining a declination letter. Household employers can only purchase workers' compensation insurance through the State Compensation Insurance Fund (SCIF). PA State Workmen's Insurance Fund has the Domestic Service Exemption Policy that is specific to domestic service workers. WY does not allow household employers to purchase workers' compensation for their domestic service workers from the State Insurance Fund because they are exempt from the state's workers' compensation law.

TABLE 11. Residual Workers' Compensation Insurance Market By Jurisdiction
Jurisdiction	Assigned Risk Plan (ARP) and Administrator	Number of Voluntary Carrier Refusals Needed to Access ARP1	Is an Agent/ Producer Required to Access ARP?	Market/Insurer of Last Resort (M/ILR)/ Administrator2	Number of Voluntary Carrier Refusals Needed to Access M/ILR	Is an Agent/Producer Required to Access M/ILR?	Reinsurance Mechanism
AL	Yes/NCCI3	Two declination letters	Yes	None			NWCRP4
AK	Yes/NCCI	Two declination letters	Recommend	None			NWCRP
AZ	Yes/NCCI	Three declination letters, including one from the State Compensation Fund	Recommend	Yes/State Compensation Insurance Fund	None	No	NWCRP
AR	Yes/NCCI	Two declination letters	Yes	None			NWCRP
CA	None			Yes/State Compensation Insurance Fund	None	Optional	None
CO	None			Yes/Pinnacol Insurance Company	None	No	None
CT	Yes/NCCI	Two declination letters. For policy renewals, one must be from current carrier.	Yes	None			NWCRP
DE	Yes/Delaware Compensation Rating Bureau	Two declination letters for a new policy. For a policy renewal, one declination letter is required from the current carrier and two other carriers.	Recommended	None			NWCRP
DC	Yes/NCCI	Two declination letters	Yes5	None			NWCRP
FL	Yes/Florida Workers’ Compensation Joint Underwriting Association, Inc6	Two declination letters	Yes				None
GA	Yes/NCCI	Four declination letters	Yes	None			NWCRP
HI	None			Yes/Hawaii Employers’ Mutual Insurance Company	None	Recommended	None
ID	Yes/NCCI	Three declination letters; one from State Fund	Yes	Yes/Idaho State Insurance Fund	None	Recommended	NWCRP
IL	Yes/NCCI	Two declination letters	Yes	None			NWCRP
IN	Yes/IN Compensation Rating Bureau	Three declination letters	Yes	None			NWCRP
IA	Yes/NCCI	Two declination letters	Yes	None			NWCRP
KS	Yes/NCCI	Three declination letters	Yes	None			NWCRP
KY	None			Yes/Kentucky Employers’ Mutual Insurance Company	None	Yes	None
LA	None			Yes/LA Workers’ Compensation Corporation	None	Yes	None
ME	None			Yes/Maine Employers’ Mutual Insurance Company	None	Not required, but recommended	None
MD				Yes/MD Injured Workers’ Insurance Fund	None	No7	None
MA	Yes/Workers’ Compensation Rating Bureau of MA	Two declination letters	Yes	None			MA Pool
MI	Yes/Compensation Advisory Organization of MI	None	No	None			MI WC Placement Facility
MN	Yes/MN Workers’ Compensation Insurers’ Assoc.	One declination letter	Yes	Yes/MN State Fund Mutual Company8	None	Yes	MN AR Pool
MS	Yes/NCCI	Two declination letters	Yes	None			MS AR Pool
MO				Yes/Travelers Insurance Company9	None	Recommended	Alternative11
				Missouri Mutual Insurance Company10	None	Recommended	N/A
MT	None			Yes/Montana State Fund	Two refusals; one can be a non-renewal of coverage from current insurer	Recommended	None
NE	None			Yes/Travelers Insurance Company	None	No	Alternative
NV	Yes/NCCI	Two declination letters	Yes	None			NWCRP
NH	Yes/NCCI	Two declination letters	Yes	None			NWCRP
NJ	Yes/ NJ Compensation and Rating Bureau	Three declination letters	Yes	None			NWCRP
NM	Yes/NCCI	Two declination letters	Yes	Yes/New Mexico Mutual Casualty Company	None	No	NM AR Pool
NY	None			Yes/New York State Insurance Fund	None	No	None
NC	Yes/ NC Rating Bureau	None	No	None			NWCRP
ND	None			None			None
OH	None			None			None
OK	None			Yes/Compsource OK	None	No	None
OR	Yes/NCCI	One declination letter12	Yes	Yes/SAIF	None	No	NWCRP
PA	None			Yes/State Workmen’s Insurance Fund	None	No	None
RI	None			Yes/Beacon Mutual Insurance Company	Recommended	Recommended	None
SC	Yes/NCCI	Two declination letters	Yes	None			Alternative
SD	Yes/NCCI	Two declination letters	Yes	None			NWCRP
TN	Yes/Aon Risk Services	Two declination letters. For a policy renewal, one must be from current carrier.	Recommended	None			Alternative
TX	None			Yes/Texas Mutual Insurance Co.	None	No	None
UT	None			Yes/Workers Compensation Fund of Utah	None	No	None
VT	Yes/NCCI	Two declination letters	Yes	None			NWCRP
VA	Yes/NCCI	Two declination letters	Yes	None			NWCRP
WA	None			None			None
WV	None			None			None
WI	Yes/WI Rating Bureau	None	No	None			WI WC Insurance Pool
WY	None			None			None
AS	None			None			None
GU	None			None			None
NMI	None			None			None
NN	None for household employers of domestic service workers			None for household employers of domestic service workers			N/A
PR	None			None			None
VI	None			None			None
A refusal is documented through the receipt of a declination letter from an insurance carrier. Competitive State Insurance Funds were included in the residual market as a "market/insurer of last resort" since a number of states with competitive state insurance funds also have a assigned risk plan. In addition, some are the residual market in a number of states. NCCI stands for National Compensation Commission NWCRP stands for National Workers' Compensation Reinsurance Pool Workers' compensation agency staff reported the requirement to use an agent is a barrier to obtaining insurance because the agent has no incentive to process a policy for a household employer because their compensation is low (e.g., $15-20 administrative fee/policy) and the paperwork burden and cost is significant. As the "market of last resort" in Florida, the JUA processes the applications from employers and then assign them to their third party administrator, Travelers Insurance Company, for processing. MD Injured Workers' Insurance Fund staff reported that agents could act as a barrier to residual market it he/she has no incentive to represent the household employer Representative at the organization reported that although they focus on small to medium sized employers they probably would not write a policy for a household employer and that an agent (which is required to access insurance through organization) probably would not approach them with an application, they would go right to the State's Assigned Risk Plan. Travelers' is the agent, administrator and service carrier for the residual market in MO. Missouri Mutual Insurance Company was created to provide workers' compensation insurance to small businesses acting as the "default" voluntary carrier in the State. Travelers' Insurance Company assumes all of the risk up to a 100% loss ratio. If the loss ratio exceeds 100%, the balance is spread over all voluntary carriers in the state. A refusal from the SAIF meets requirement.

TABLE 12. Availability Of Workers' Compensation Insurance Through Homeowner's Insurance By Jurisdiction
Jurisdiction	WC Insurance Available Through Homeowners' Endorsement OptionYes/No	NCCI WC Endorsement Filed For Use1Yes/No	NCCI WC Endorsement Being Used	Description of Coverage and Cost
AL	No2	Yes	No	See footnote 2.
AK	No	Yes	No	N/A
AZ	Yes	Yes	Yes	No specific coverage or rate information available.
AR	No	Yes	No	N/A
CA	Yes	No	No	Section 11590 of the CA State Insurance Code mandates the availability of a WC endorsement for homeowner insurance policies for domestic service workers. Carriers submit their rating for this endorsement to the State’s Department of Insurance for approval. Carriers may modify the WC endorsement and the criteria for coverage (e.g., define number of hours works in order to be covered). The cost of the endorsement varies by carrier.
CO	Yes	Yes	State insurance agency staff could not confirm.	Coverage is for part-time/occasional workers. Insurers can modify endorsement to provide more coverage than insurance law requires. No rate information available.
CT	Yes	Yes	Yes	No specific coverage or rate information available.
DE	No	Yes	No	N/A
DC	Yes3	Yes	Yes4	No specific coverage or rate information available.
FL	No	Yes	No	N/A
GA	No	Yes	No	N/A
HI	Yes5	Yes	No	No specific coverage or rate information available.
ID	Yes	Yes	Yes6	No specific coverage or rate information available.
IL	Yes	Yes	Yes7	No specific coverage or rate information available.
IN	Yes	Yes	State insurance agency staff could not confirm.	Staff reported some homeowner’s insurance policies contain a contingent workers’ compensation rider that covers amounts awarded under workers’ compensation law. No specific coverage or rate information available.
IA	Yes	Yes	State insurance agency staff could not confirm.	No specific coverage or rate information available.
KS	No	Yes	No	N/A
KY	No	Yes	No	N/A
LA	Yes	Yes	Yes	No specific coverage or rate information available.
ME	No8	Yes	No	N/A
MD	No	Yes	No	N/A
MA	No	Yes	No	N/A
MI	No	Yes	No	N/A
MN	No	No	No	N/A
MS	Yes	Yes	Yes9	No specific coverage or rate information available.
MO	No	No	No	N/A
MT	Yes	Yes	No	No specific coverage or rate information available.
NE	No	Yes	No	N/A
NV	Yes	Yes	No	Title 53, Chapter 616B, Section 32 of the Nevada Revised Statutes permits a private carrier to provide industrial insurance (workers’ compensation) as part of a homeowner’s policy to a person who employs a domestic service worker. A covered domestic service worker is defined as an individual who is employed more than 20 hours per week or earns $150/ month if he/she is not employed more than 20 hours per week. Private carriers may, with the approval of the commissioner, determine and fix the premium rates.
NH	Yes10	Yes	Yes	Title XXII, Section 281-A:6 of the New Hampshire Insurance law mandates that all insurance companies authorized to provide comprehensive personal liability, tenant’s or homeowner’s insurance must, provide workers’ compensation insurance covering domestics. $3.00 rider for homeowners’ policies provides coverage for incidental domestic service workers.
NJ	Yes11	No	No	PL 1979, c.380 mandates the provision of comprehensive personal liability (workers’ compensation) coverage for domestic service on every homeowner’s or tenant’s policy. Coverage is for occasional workers and the premium is $1.00/policy /year. Employers must inform their carrier if they employ one or more full-time domestic service workers. Premium for full-time domestic coverage is $1 + $60 for each full-time worker employed/policy/year.
NM	State insurance agency staff could not confirm.	Yes	No	N/A
NY	Yes12	No	No	NY Insurance Law @3420(j) requires that every insurance policy that provides comprehensive personal liability insurance on a one-, two-, three- or four-family owner-occupied dwelling, make available compensation coverage for employees who work less than 40 hours in and about the residence if, and only if, they are employees for whom compensation insurance must be provided. Premium information not available.
NC	No	Yes	No	N/A
ND	Yes	No	No	No specific coverage or rate information available.
OH	No	No	No	N/A
OK	No	Yes	No	N/A
OR	No	Yes	No	N/A
PA	No	Yes	No	N/A
RI	No	Yes	No	N/A
SC	No	Yes	No	N/A
SD	Yes	Yes	Yes	No specific coverage or rate information available.
TN	No	Yes	State insurance agency staff could not confirm.	N/A
TX	No	No	No	N/A
UT	No	Yes	No	N/A
VT	No	Yes	No	N/A
VA	Yes	Yes	No	No specific coverage or rate information available.
WA	No	No	No	N/A
WV	No	No	No	N/A
WI	No	Yes	No	N/A
WY	No	No	No	N/A
AS	Yes	No	No	No specific coverage or rate information available. Household employer must request that the workers’ compensation insurance endorsement be added to his/her homeowner’s insurance policy.
GU	No	No	No	N/A
NMI	Yes	No	No	No specific coverage or rate information available.
NN	No	No	No	N/A
PR	No	No	No	N/A
VI	No	No	No	N/A
NCCI Endorsement WC 00 03 12, Voluntary Compensation and Employers Liability Coverage for Residence Employees, (ed. 4/84) is designed to be used with ISO homeowner's policies, comprehensive personal liability or other policies that provide similar personal liability coverage. The endorsement provides voluntary compensation and employers liability coverage for domestic workers in a state in which they are not included and cannot be brought within the workers' compensation law. There is no homeowners insurance option but employers, including householders, have the option of buying an Alternative Workers' Compensation Plan. This is a commercial insurance purchased in the voluntary market consisting of any combination of life, disability, accident, health, or other insurance provided that the coverage insures without limitation or exclusion any of the workers' compensation benefits as defined in the State workers' compensation law. But state workers' compensation agency staff said no insurers write these endorsements. It is on file, but District workers' compensation staff has reported that they don't know of any insurers who write the endorsement. State insurance agency staff reported that they do not know of any carrier that writes such an endorsement and believes they would be hesitant to do so. Idaho Insurance Department staff reported that only two carriers have ever filed rates for this endorsement. IL workers' compensation agency staff reported that they have seen homeowner/renter's policies include WC, they could not confirm whether these policies used NCCI's endorsement per se. Maine Division of Insurance staff reported that there is no state law that allows or prohibits the sale of these policies and knows of no insurers that sell them. MEMIC staff reported that this was not an option in Maine. Staff indicated that though this option exists, few if any insurers write such policies. In addition, the state allows insurers to modify the NCCI endorsement. Title XXIII Section 281-A:6 requires that all insurance companies authorized to provide comprehensive personal liability, tenant's or homeowner's insurance in NH, must, in connection with such insurance, provide workers' compensation insurance for domestics unless the employer has a separate poliby for worker's compensation covering domestics. However, this option is not available to persons with disabilities who hire persons to provide chore and personal supports because they can not consider their workers under the state's definition of domestic service (Title XXIII, Section 281-A:2 V-b(a). he/she can not consider his/her worker a domestic service worker and the homeowner's policy would not apply to them. State mandates that all homeowners insurance policy must include an endorsement to cover workers' compensation insurance for occasional domestic service workers. The homeowner's insurance option does not cover occasional workers who are exempt from the State's workers' compensation law. Occasional domestic service workers are exempt from the State's workers' compensation law and so would not be covered under the homeowner's provision.

TABLE 13. Issues And Challenges Reported By State Workers' Compensation Agency And Insurance Carrier Staff Regarding The Administration Of Workers' Compensation System And Providing Insurance For Domestic And Personal Assistance Service Workers By Jurisdiction
Jurisdiction	Issues And Challenges Reported By State Workers' Compensation Agency And Insurance Carrier Staff Regarding The Administration of Workers' Compensation System And Providing Insurance For Domestic and Personal Assistance Service Workers by Jurisdiction
AL	Issues/challenges reported: “Insurance carriers in the voluntary market may not always be willing to write policies for household employers.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
AK	Issues/challenges reported: Medical costs have increased around 15 percent a year for the past 15 years. The insurance industry in Alaska, as well as the general population, is not very large, making it difficult to spread risk. The size of claims have continued to escalate, as have the length of time between the start of proceedings and eventual ruling. It is difficult for household employers to purchase workers’ compensation insurance through the voluntary market. “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
AZ	Issues/challenges reported: “Carriers have little financial incentive to write workers’ compensation insurance policies for small employers (domestic employers) due to small premiums and perceived high risk exposure.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
AR	Issues/challenges reported: “Insurers do not have any financial incentive to write workers’ compensation insurance policies for household employers due to small premiums and perceived high risk exposure.” “The voluntary market for domestic service employers is ‘non-existent.’” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
CA	Issues/challenges reported: “The only way to provide workers’ compensation insurance for domestic service employees outside of a homeowners’ insurance policy is through the residual market (SCIF).” “Workers who are hired by their spouse, parent or child may never be covered by workers’ compensation insurance either through the residual market or through a homeowners’ policy.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
CO	Issue/challenge reported, “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
CT	Issues/challenges reported: “Carriers have little financial incentive to write workers’ compensation insurance policies for small employers (domestic employers) due to small premiums and perceived high risk exposure.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
DE	Issues/challenges reported: “The residual workers’ compensation insurance market has grown substantially for all employer/worker classifications over the past five years with the tightening of the voluntary workers’ compensation insurance market. It is difficult for any employer to get workers’ compensation insurance through the voluntary market.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
DC	Issues/challenges reported: “Workers’ compensation premiums for domestic service employers are small and agents/producers do not have any incentive to write and submit applications to carriers because the agent only get $15-20 per policy. Agents feel they don’t receive enough to cover cost of paperwork.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
FL	Issues/challenges reported: “Insurers have no incentive to write workers’ compensation insurance policies for household employers due to small premiums and perceived high risk of exposure. The voluntary market for domestic service employers is ‘non-existent’.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
GA	Issues/challenges reported: “Insurers do not have a strong incentive to write workers’ compensation insurance policies due to the small premiums, significant level of paperwork and perceived high risk of injury.” “Employers who wish to access the residual market must obtain four refusals from voluntary insurers.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
HI	Issue/challenge reported: “A significant challenge is educating domestic service employers of their responsibility to provide workers’ compensation insurance coverage for their workers.”
ID	Issue/challenge reported: “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
IL	Issue/challenge reported: “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
IN	Issues/challenges reported: “The process of obtaining workers’ compensation insurance is complicated, the premiums are expensive, and private insurers are reluctant to write individual workers’ compensation policies for such a limited class.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
IA	Issues/challenges reported: “Private insurers are hesitant to write new workers’ compensation insurance policies for any category in the current economic climate.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
KS	Issues/challenges reported: “Insurers are hesitant to write new workers’ compensation insurance policies in the current insurance climate. “Very few domestic employers have ever purchased workers’ compensation insurance in Kansas so it is difficult to make a fair assessment of the situation/risk.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
KY	Issues/challenges reported: “It is virtually impossible for household employers to obtain coverage in the voluntary market.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
LA	Issues/challenges reported: “It is difficult to have workers’ compensation rates be affordable and keep claims at a level acceptable to private insurers.” “Private insurers may not be willing to write policies for employers with only 1-3 employees so household employees may need to access workers’ compensation insurance through the residual market that costs more.” “It is unclear what class personal assistance workers fall under in Louisiana.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.” There might be a higher risk of injury for personal assistance workers than for “traditional” domestic workers so the 0908-0913 NCCI classes may not always be appropriate.
ME	Issues/challenges reported: “Maine Employers’ Mutual Insurance Company (MEMIC) has experienced significant losses related to household employers who have purchased workers’ compensation for domestic service workers.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
MD	Issues/challenges reported: “Agents/producers might not have an incentive to represent some small businesses, such as household employers, due to significant paperwork burden and associated costs and low administrative fees. An agency/producer could act as a barrier to the workers’ compensation insurance market.” If agent/producer does not know workers’ compensation insurance issues, this could be a barrier to accessing insurance for the household employer and possibly be more costly. “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
MA	Issues/challenges reported: “Per capita-based premiums are problematic because it is difficult to estimate the number of workers working at the consumer’s residence at any given period of time due to significant worker turnover. This type of premium represents a high level of administrative effort and expense for the insurer and the consumer-employer.” “Per payroll-based premiums cover all workers in the class working at the residence thus reducing the administrative burden and possibly the costs for the insurer and the consumer-employer. However, the per payroll method could under estimate the risk of worker injury for the insurer (e.g., if a household employer has one worker with a payroll of $10,000, and is replaced by two workers at the same payroll amount, the potential risk of injury is more for two workers than one but the premium may not fully reflect the increase). “It is important that the employment classification code accurately reflects the risk of workplace exposure for the group. The domestic service classes 0908 and 0913 (part-time and full-time in-servants) do not accurately reflect the activities of personal assistance workers. That is why MA developed and implemented Class 0918 for personal assistance workers.” It is important to find a way to streamline the administrative process for writing, renewing and invoicing workers’ compensation policies for large numbers of household employers (e.g., that may be enrolled in a self-directed support service program). A Fiscal Employer Agent (FEA) can facilitate these activities and MA FEAs do. For example, Atlantic Charter bulk invoices the FEAs (e.g., one bill issued by insurer to FEA that represents all of the policies for the consumers that the FEA represents) can reduce administrative paperwork and related expenses.” “There may be a minimum number of household employers that a voluntary carrier would need to write policies for in order provide the insurer with an adequate financial incentive to write workers compensation policies for this classification group.” The MA insurance agent for the MA Personal Care Attendant Program reported a minimum number might be 3,600 polices that reflect $1.3 million in premiums. The MA Program served approximately 10,000 consumer-employers in 2002. So far claims have been low. In 2002, Atlantic Charter received approximately $2.5 million in premiums, processed 68 claims and paid out $200-300,000 in benefits to injured workers. This year was the first year that the State Rating Bureau had a significant database on losses for classification code 0918 to determine rates. It was anticipated that the rates for code 0918 would go down. Instead they went up $0.10. The should be Rating Bureau should be asked to demonstrate how they computed a rate increase for 0918 with such good loss experience information available to them. It is important that the insurer receive Wage Statements from employers that accurately report 52 weeks of wages prior to a workers injury so that the insurer can compute accurate benefits payments. Consumer-employers in self-directed support service programs need to rely on the FEA to complete the Wage Statements and submit them to the insurer and FEA staff need to be aware of the importance of accurate and timely Wage Statements." Unlike other employment groups, personal assistance workers often work part-time for more than one employer. A personal assistance worker who has one or more concurrent employers must report all employment to the insurer in order for the worker to receive the proper workers compensation benefit if he/she is injured. To count in wage calculations, the concurrent employer must have workers compensation insurance and not pay the worker under the table. This is not an issue in MA since all personal assistance workers have employment taxes filed for them by the FEA and all consumer-employers have workers compensation insurance coverage. FEAs can facilitate the collection of wages from concurrent employers for personal assistance workers.
MI	Issues/challenges reported: “Private insurers do not have a financial incentive to write workers’ compensation insurance policies for household employers.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
MN	Issues/challenges reported: “The voluntary workers’ compensation insurance market in MN is “hard.” Insurance carriers are very particular regarding what groups they write policies for. The residual market has grown substantially from $20 – 30 million over the past couple of years.” Individuals who have a disability and receive public assistance can not be considered the employer in MN according to State Unemployment laws.
MS	Issues/challenges reported: “The voluntary insurers do not have an incentive to write policies for household employers because, one large claim can exceed the premiums collected from a domestic service employer.” “Insurers who write homeowners’/renters’ insurance policies are reluctant to write endorsements for workers’ compensation coverage for domestic service workers.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
MO	Issues/challenges reported: “Workers’ compensation insurance rates in the State are high, despite the presence of a competitive market.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
MT	Issues/challenges reported: “It is difficult to verify that the household employees are only performing the duties they’re supposed to under the classification.” “There have been very few claims from domestic service workers, making it difficult to compile meaningful data. “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
NE	Issues/challenges reported: “Voluntary insurance carriers appear to be limiting what worker/employer classification codes they are willing to write policies for. More employers are obtaining workers’ compensation insurance through the residual market.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
NV	Issues/challenges reported: “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
NH	Issues/challenges reported: “Classification codes for domestic service workers do not match the statutory definition.” “Employers are statutorily obliged to provide workers’ compensation coverage for domestic service workers, but there does not appear to be a classification code for domestic service workers who work for persons with disabilities.” “The voluntary market for household employers is ‘non-existent.’” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
NJ	Issues/challenges reported: The insurance agent that is facilitating the workers’ compensation insurance policies for the NJ Personal Preference Program reported that getting consumers to renew their policies on a regular basis is problematic and represents a lot of work for agency staff that is not reflected in the consumers’ premiums. They given notice to the State that they will no longer be the insurance agent for the Program. Fiscal Employer Agents should be responsible for the renewal process on behalf of the consumer-employer. “Voluntary insurers are not willing to write policies for household employers due to small premiums and perceived high risk of exposure.” In the three years that the Personal Preference Program has been serving consumer-employers (approximately 500), there have been no workers’ compensation claims filed. “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
NM	Issues/challenges reported: “The voluntary market is not willing to write policies for personal assistance workers. The market is ‘non-existent’ for household employers.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
NY	Issues/challenges reported: “Insurance carriers do not ‘deal’ with the domestic service classification very often. State agency has not received any issues/challenges from insurers regarding the classification.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
NC	Issues/challenges reported: “Carriers are increasingly reluctant to write policies for small employers in high risk categories like domestic service workers.” “The voluntary market is ‘non-existent’ for household employers.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
ND	No issues/challenges reported.
OH	Issues/challenges reported: “Occasional users of domestic services should not be allowed to avoid tort liability at a cost unfairly low for the employer and, because of low premiums, unreasonably high to the State workers’ compensation insurance system.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
OK	Issues/challenges reported: “Voluntary workers’ compensation insurance market is tightening for all classifications and insurers are less willing to write policies for domestic service employers. More employers are accessing insurance through the residual market.” “Workers’ compensation premiums for domestic service employers are small. One claim can ‘eat up’ all of the premium that the insurer receives, and in some cases, an insurer may never recover the full cost of the claim through the receipt of premiums.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
OR	Issues/challenges reported: “In the case of foster care providers, if a home health agency has five or fewer clients registered with the Department of Human Services at a foster care site, the agency does not have to provide workers’ compensation insurance for the workers. Agency can have a chain of foster care sites and not have to provide insurance. This is problematic for workers and a concern of the State and labor unions. There has been proposed legislation to address this issue but it hasn’t gotten anywhere.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
PA	Issues/challenges reported: The State Workmen’s Insurance Fund (SWIF) staff reported that the Workmen’s Compensation Appeals Board was not interpreting the definition of domestic service correctly in the Viola case. “Domestic service is not just a maid. It also includes working for a disabled person in their home, doing laundry, cleaning and meal preparation and helping them with personal needs.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
RI	Issues/challenges reported: “Voluntary workers’ compensation insurance market getting very “tight” for all employers. Not many insurers are offering credits.” “Insurance carriers do not immediately think about domestic service employers since they are exempt from the workers’ compensation law.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
SC	Issues/challenges reported: “Figuring out if the worker is an employer or an independent contractor is a big issue related to classifying workers in the State.” “Voluntary insurers are less willing to write policies for household employers due to small premiums. State is seeing more household and other small employers coming to the residual market to obtain workers’ compensation insurance coverage.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
SD	Issues/challenges reported: “Insurance carriers are increasingly apprehensive about writing new workers’ compensation insurance policies especially for small/household employers. As a result, the number of employers accessing insurance through the residual market has been on the rise in recent years.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
TN	Issues/challenges reported: “Determining who is a domestic service worker and who is not. Generally, professionally trained individuals are not considered domestic service workers.” “Some domestic service employers are involved in other business activities that include employees and they may have domestic service workers work in both areas. This needs to be clarified in all cases where it applies.” Voluntary insurance carriers are reluctant to cover domestic service employers due to small premiums and perceived high risk of exposure.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
TX	Issue/challenge reported: “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
UT	Issues/challenges reported: “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
VT	Issues/challenges reported: “Voluntary insurers concerned about the potential risks for worker injury related to domestic service workers.” “Insurers are also worry about the administrative burden and expense of writing policies, managing renewals and processing claims for 1,000 small household employers with what insurers consider low premiums and moderate to high potential risk of injury.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
VA	Issues/challenges reported: The State Workers’ Compensation Agency considers domestic service workers as independent contractors, contrary to IRS’ position. They also said they don’t think workers’ compensation premiums are high. “Voluntary insurers have a problem writing policies for small employers (1-3 workers). Premiums are low but risk of worker injury is high.” “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
WA	Issues/challenges reported: “Workers’ compensation insurance rates are going up for all employer/worker classifications but State Fund has been able to remain solvent.” “Small domestic service premiums do not always cover losses and could jeopardize the solvency of the Fund.” “State uses per hours worked-based premiums rather than per capita or per payroll. This method more accurately predicts the risk of injury (e.g., more hours worked the greater the possibility of workplace injury) while reducing the administrative burden and costs for employers and the State Fund.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
WV	Issue/challenge reported: “The final determination of whether a personal assistance worker falls in the domestic service classification code for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
WI	Issues/challenges reported: Personal assistance services are not considered domestic service by the State’s workers’ compensation division or the WI Labor & Industry Review Commission. They are called home care providers. However, for rating purposes, home care providers hired by a household employer are rated under the 0908 and 0913 domestic service code. “The pool of employers under that hire personal assistance workers is not large enough to generate adequate loss information need to develop workers’ compensation insurance rates for this group of employers.” Under Section 102.07(4)(a) of the State’s workers’ compensation law, domestic service specifically exempt from the State’s workers’ compensation law and home care providers hired by household employers are exempt because the home care provider is not in the trade, business, profession or occupation of the employer. Household employers may elect to cover both types of workers under the law, and “we wish that all employers would.” “We particularly would like to see the Department of Family Services cover individuals enrolled in the self-directed personal assistance programs the counties are currently operating.” Workers’ compensation insurance used to be affordable (e.g., in the $200/policy range). It has gone up significantly in the past few years. Now it is expensive and the per capita approach used to estimate rates can result in significant premiums for individuals who hire multiple personal assistance workers.”
WY	No issues or challenges reported except for the fact that domestic service workers may not elect to purchase workers’ compensation insurance for their domestic service workers including personal care workers.
AS	Issue/challenge reported: “Making sure that employers obtain the required coverage. There are at least 800 employers in the jurisdiction and Northern Pacific Insurance (NPI) writes 80 percent of the policies. However, NPI only manage 260 policies currently. The Government needs a full time inspector to make sure employers are obtaining the required insurance.”
GU	Issues/challenges reported: “ Not having enough staff to administer the jurisdiction’s workers’ compensation insurance act, in particular, not having enough inspectors to make sure that employers have the proper coverage for their workers.” Workers’ Compensation Agency staff does not know of a case where a household employer has purchased workers’ compensation insurance for their domestic worker. “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”
NN	Issue/challenge reported: a household employer may not purchase workers’ compensation insurance through the Nation. Household employers must buy workers’ compensation insurance policies from an AZ voluntary carrier or through the State’s residual market.
NMI	Issues/challenges reported: “Obtaining accurate reporting of domestic service workers’ actual duties and hours worked. Classification code may not always reflect the actual duties performed or hours worked.” Workers’ Compensation Agency staff does not know of a case where a household employer has purchased workers’ compensation insurance for their domestic worker.
PR	Issues/challenges reported: “Getting employers to obtain the correct amount of workers’ compensation insurance. Many have only the minimum policy of $65/year (which is the premium when you do not have employees but want coverage if you do) and have a lot of workers.” “The legislature is considering passing legislation that would allow housewives to be covered for workers’ compensation insurance through the State Fund. The initiative has not been successful to date.”
VI	Issues/challenges reported: “Getting employers to obtain the proper level of coverage for their workers. Very few household employer elect to cover their domestic service workers.” “The final status of a personal assistance worker for workers’ compensation purposes can only be determined based on the results of a claim appeal decision.”