# Workers' Comp for NEMT Drivers in 2027: When You Need It and What Brokers Require

Canonical URL: https://nemtguide.com/guides/workers-comp-for-nemt/ · Updated 2026-09-29

You need workers' comp for NEMT drivers once you have the number of employees your state counts: one in California, New York, Pennsylvania, Illinois, and Ohio, three in Georgia and North Carolina, four in Florida, and five in Alabama and Tennessee. Texas lets most employers opt out. Brokers and health plans can require coverage anyway, and MTM Health asks for proof of any exemption.

- State law sets the line: from the first employee in states like California and Pennsylvania, at three to five in much of the South.
- Owners and officers often count toward the number even when they exclude themselves from the policy.
- Calling drivers 1099 contractors does not settle it. States look at the real working relationship.
- Brokers and health plans can require workers' comp where the state does not, and a lapse can end your contract.
- Workers' comp pays medical bills and part of lost wages, and it usually shields you from an injured driver's lawsuit.

NEMT driving is physical work. Drivers push wheelchairs up ramps, help riders stand, carry stretchers down steps, and spend the day on the road. When one gets hurt, workers' compensation decides who pays the medical bills and the lost wages. This guide covers when your state requires it, how owners and contractors count, what brokers ask for, what it pays, and how to keep it affordable.

## When you need workers' comp for NEMT drivers

Each state sets its own line, and the count usually includes part-time workers. The rules below are current as of September 2026.

| State | Coverage is required when you have | Who counts |
|---|---|---|
| California | One or more employees | All employees |
| New York | Any employee, with narrow exceptions | Part-time, temporary, unpaid, volunteer, and family workers all count. A sole proprietor, partnership, or LLC with no employees need not cover itself. |
| Pennsylvania | At least one employee | Part-time workers and family members, such as a spouse or child, count |
| Illinois | One employee, even part-time | Owners may exempt themselves |
| Ohio | One or more employees | Premiums go to the state insurance fund, unless you are approved to self-insure (Ohio Revised Code 4123.35) |
| North Dakota | Your first employee, with limited exceptions | Coverage is through Workforce Safety and Insurance, the state agency |
| Washington | Employees, and in some cases contractors | Coverage comes from L&I or approved self-insurance. Washington does not allow private policies. |
| Georgia | Three or more regular employees | Part-time counts. Corporate officers and LLC members count. |
| North Carolina | Three or more regular employees | Corporate officers count. Sole proprietors, partners, and LLC members are not counted automatically but may elect coverage. |
| Arkansas | Three or more employees, for most employers | Exceptions exist, so employers with fewer should check with the Commission |
| New Mexico | Three or more workers | Executive employees count even if they opt out of the policy |
| Virginia | More than two part-time or full-time employees | Officers, LLC managers, and family members count, and so do the workers of subcontractors who fill your contracts |
| Wisconsin | Three or more employees, or any employees paid a combined $500 or more in a calendar quarter | Full-time and part-time |
| Florida | Four or more employees outside construction | Corporate officers and LLC members count unless they hold an exemption |
| South Carolina | Four or more regular employees | Part-time and family members count. Businesses with annual payroll under $3,000 are exempt. |
| Alabama | Five or more employees | Part-time, officers, and LLC members count |
| Mississippi | Five employees regularly employed | Below five, coverage is voluntary |
| Missouri | Five or more employees outside construction | Executive officers count |
| Tennessee | Five or more employees outside construction | Sole proprietors, partners, and LLC owners do not count. Full-time corporate officers do. |
| Texas | Optional for most private employers | Employers that opt out must give notices (see below) |

If your state is not in the table, find its agency through the U.S. Department of Labor's list of state workers' compensation offices, and check your [state guide](https://nemtguide.com/states/).

### Texas: the opt-out state

The Texas Department of Insurance says most private employers may choose whether to carry workers' comp. Employers that opt out are called non-subscribers. They must post a notice of no coverage, tell each new employee in writing, and file a notice with the Division of Workers' Compensation every year between February 1 and April 30, after hiring the first employee, and after ending a policy. A non-subscriber with five or more employees reports injuries that cost more than a day of work on DWC Form-007.

Opting out has a price. An injured worker can sue a non-subscriber, and the employer cannot argue that the worker's own negligence, a coworker's negligence, or the worker's acceptance of a known danger caused the injury.

## Owners, family members, and 1099 drivers

**Owners and officers.** Many states in the table count corporate officers as employees but not sole proprietors. In Georgia, up to five officers or LLC members may waive coverage by filing Form WC-10 with the insurer, but they still count toward the three-employee line. Florida officers and LLC members file a Notice of Election to be Exempt online, and Florida says an exempt officer cannot recover benefits. Illinois owners who exclude themselves tell their insurer in writing. Virginia has no waiver form for a sole proprietor.

**Family members.** Pennsylvania, New York, Virginia, and South Carolina all count family members who work in the business, and New York counts them even when unpaid. In Pennsylvania, a spouse who answers the dispatch phone counts.

**1099 drivers.** A 1099 does not decide whether a driver is covered. Virginia says the label is not important after an injury, and the facts of the work relationship are what count. New Mexico says a signed contractor agreement or a 1099 does not settle it, and the question is who controls the work. Tennessee uses a seven-factor test.

Using contractors can also raise your count and your premium:

- Virginia counts the workers of subcontractors who fill your contracts when it decides whether you are over two employees, even if the subcontractors carry their own coverage.
- Virginia warns that your insurer can charge premium at audit for any subcontractor you hire, even a sole proprietor, unless you have proof of that subcontractor's coverage.
- South Carolina treats a subcontractor's employees as a general contractor's statutory employees when the subcontractor has no coverage.

For the IRS and Labor Department tests on the same question, see [NEMT drivers: 1099 or W-2](https://nemtguide.com/guides/nemt-drivers-1099-or-w2/).

## What brokers and health plans require

Your broker contract can require workers' comp even where your state does not.

| Program | Workers' comp rule | Other terms |
|---|---|---|
| MTM Health, standard agreement (January 1, 2023 copy posted by Pennsylvania) | Statutory amounts for the state where you drive | Without coverage on drivers, you send the government document showing your exemption, contract each driver through the driver's own company, and send MTM that contract's first and signature pages. MTM may require coverage from exempt providers too. |
| Modivcare provider requirements (September 2026) | Required in most states if you have employees | Check your state's rules |
| MediTrans, Louisiana | Workers' comp or an approved waiver | The waiver form is for owner-operators without employees. MediTrans is listed as certificate holder. |
| Arizona health plan subcontracts (AHCCCS rules effective October 1, 2024, revised January 9, 2025) | Statutory, with employer's liability of $1 million each accident, per employee for disease, and policy limit for disease. Contracts under $50,000 use $500,000 limits. | Waiver of subrogation for the State of Arizona. Exempt sole proprietors and independent contractors sign the waiver form. |
| Texas Medicaid health plans (Uniform Managed Care Manual 16.4, version 2.0.1) | Statutory, with $1 million employer's liability each accident, per employee for disease, and policy limit for disease | Waiver of subrogation for the State of Texas, and insurers rated A or better and VII or better by A.M. Best |

Two terms show up on these lists:

- **Employer's liability** is Part Two of a workers' comp policy. The California Department of Insurance (guide revised June 23, 2025) says it protects the employer when an employee's injury or disease is not subject to the workers' comp laws. The three limits above are the amounts your certificate must show.
- **A waiver of subrogation** means your insurer gives up its right to recover what it paid from the party named in the endorsement, such as the broker or the state. The Texas standard endorsement (WC 42 03 04) applies it only where a written contract requires it.

Keep the coverage in force every day. MTM's agreement ends immediately if you fail to maintain required insurance. For the auto and liability limits on the same contracts, see [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/), and for what a certificate shows, see certificate of insurance.

## What workers' comp pays when a driver is hurt

Washington's L&I calls workers' comp no-fault insurance and lists its two main parts: medical care and partial wage replacement. The Texas Department of Insurance adds burial and family benefits after a work death.

Cash benefits follow a formula. In California, temporary disability pays two-thirds of the gross wages a worker loses while recovering. It starts when the doctor says the worker cannot do the usual job for more than three days, or the worker is hospitalized overnight. For injuries in 2026, the weekly payment is at least $264.61 and at most $1,764.11.

| Example driver in California, injured in 2026 | Amount |
|---|---|
| Average weekly wage | $900 |
| Temporary disability rate | Two-thirds |
| Weekly payment | $600 |

Coverage also protects you. The Texas Department of Insurance says an insured employer is protected from most lawsuits by injured employees. Without coverage, the protection disappears. In California and Illinois, an employee hurt while the employer was illegally uninsured can sue in civil court as well as claim benefits, and California makes the uninsured employer pay all the injury bills.

Some injuries are not covered. Texas lists injuries a worker caused on purpose, injuries from horseplay or intoxication, injuries outside work or at off-duty social events, and injuries caused by someone for personal reasons. Other states have their own lists.

## Where NEMT driver injuries come from

BLS does not publish an injury rate for NEMT alone. The closest group is other transit and ground passenger transportation (NAICS 4859), which includes special needs transportation (NAICS 485991). In 2024 that group had more injuries than the average private employer, and more than twice as many cases that kept a worker home.

| Industry, 2024 | Injury and illness cases per 100 full-time workers | Cases with days away from work |
|---|---|---|
| All private industry | 2.3 | 0.8 |
| Transit and ground passenger transportation | 3.4 | 1.6 |
| Other transit and ground passenger transportation | 3.7 | 2.1 |
| Ambulance services | 5.9 | 2.8 |

Three hazards come with the job:

- **Lifting and transfers.** NIOSH calls patient handling the single greatest risk factor for work-related musculoskeletal disorders among health care workers (May 9, 2024). The fix is equipment and technique, covered in [passenger transfer techniques](https://nemtguide.com/guides/safe-passenger-transfers/).
- **Crashes.** A driver hurt in a crash during a trip is a workers' comp claim. The steps for the whole crash, riders included, are in [what to do after a NEMT vehicle accident](https://nemtguide.com/guides/nemt-vehicle-accident/).
- **Slips and falls** on ramps, lifts, curbs, and icy driveways.

### Your OSHA duties

- **Injury logs.** If your company had more than 10 employees at any time last year, you keep OSHA injury and illness records. Ground passenger transportation is not on OSHA's list of partially exempt industries (29 CFR 1904.1 and Appendix A to Subpart B).
- **Severe injury reports.** Every employer reports a work death to OSHA within 8 hours, and an in-patient hospitalization, amputation, or loss of an eye within 24 hours, at 1-800-321-6742 or online (29 CFR 1904.39).
- **The crash exception.** A death or hospitalization from a crash on a public street outside a construction work zone is not reported to OSHA, but it still goes on your log if you keep one.

## What happens if you go without

Going uninsured when your state requires coverage brings fines, and in some states jail time.

| State | Penalty for an uninsured employer |
|---|---|
| California | A misdemeanor with a fine of at least $10,000, up to a year in jail, or both. A stop order bars using employees until you are covered, plus the greater of twice the missed premium or $1,500 per employee. |
| Georgia | A penalty of $500 to $5,000 per violation, and willful failure to insure is a misdemeanor |
| Virginia | Up to $250 for each day uninsured, to a $50,000 maximum, and you owe the injured worker's benefits |
| Pennsylvania | Up to $2,500 and a year in prison for each day as a misdemeanor, or $15,000 and seven years for each day of intentional violation as a felony |
| Illinois | Up to $500 a day with a $10,000 minimum, a work-stop order, and possible criminal charges for corporate officers |

The broker side can hurt faster. A lapse can end an agreement like MTM's at once.

## How to buy workers' comp and keep the price down

1. **Get quotes from a licensed agent** who writes transportation accounts. In Ohio, North Dakota, and Washington, you buy from the state fund instead.
2. **Know your fallback.** If no insurer will write you, Georgia and South Carolina have assigned risk plans run by NCCI (1-800-622-4123), and Pennsylvania's State Workers' Insurance Fund sells policies directly (570-963-4635). See NEMT insurance denied for why carriers turn down new companies.
3. **Put each worker in the right job class.** Premium is set by job class and payroll. Washington's L&I says most states charge a percentage of payroll, while Washington charges per hour worked and workers pay about a quarter of the premium. Washington puts paratransit driving, helping riders in and out, and van upkeep in class 1404-12, and dispatchers with no other duties in clerical class 4904 (WAC 296-17A-1404). See [NEMT insurance cost](https://nemtguide.com/guides/nemt-insurance-cost/) for published rates.
4. **Estimate payroll honestly.** Premium is usually billed on estimated payroll and adjusted once actual payroll is known. Ohio's statute, for example, bills estimated premium before the policy year and settles the difference after the payroll report.
5. **Collect certificates from every subcontractor** before they drive, so an audit does not add them to your premium.
6. **Prevent the injuries that cost the most.** Train every driver on transfers, carry gait belts and transfer boards, and never let one person do a two-person stretcher move.
7. **Bring injured drivers back on light duty.** Dispatch, phone confirmations, and trip record checks are real work for a driver who cannot lift yet.
8. **Watch your claims history.** Each claim shows up on your loss runs, and claims can raise your experience modification rate.

### Light-duty programs that pay you back

Two state programs pay part of an injured worker's wages when you bring them back on approved light duty. The amounts below are current as of September 2026.

| Program | What it pays |
|---|---|
| Washington Stay at Work (state fund employers) | For injuries on or after January 1, 2025: 50 percent of base wages for up to 120 days worked, to $25,000, plus up to $5,000 for tools and equipment, $2,000 for training, and $1,000 for clothing. The attending provider must approve a written light-duty job description. |
| Oregon Employer-at-Injury Program | 50 percent of early return-to-work gross wages for up to 66 work days within 24 months, and up to $5,000 combined for worksite changes, tools, and equipment. You ask your insurer to start it. |

## When a driver gets hurt: step by step

1. **Take care of people first.** Call 911 for any emergency. Make sure riders are safe and get a backup vehicle to finish their trips. Texas requires health plans or their subcontractors to arrange one when a driver is seriously hurt.
2. **Tell the broker.** Texas requires health plans or their transportation subcontractors to report an accident with serious injury to a member, an attendant, or a driver to the state within four hours of notice, so your broker will want to hear from you right away.
3. **Give the claim form and report to your insurer fast.** California requires the claim form within one working day after an injury is reported, the report to the claims administrator within one working day of getting the form back, and authorization of up to $10,000 in medical treatment within one working day of the claim. New Mexico asks for a report to the insurer within 72 hours. Other deadlines are in the [accident guide](https://nemtguide.com/guides/nemt-vehicle-accident/).
4. **Remind the driver to report.** Georgia warns workers that waiting longer than 30 days to report an injury can cost them benefits.
5. **Call OSHA** within 8 or 24 hours if the injury is a death, a hospital stay, an amputation, or a lost eye, unless it came from a crash on a public road outside a construction work zone.
6. **Offer light duty** that fits the doctor's restrictions, and write the job description down.
7. **Record it.** Put the injury on your OSHA log if you keep one, and keep the incident report with the driver's file.

## Frequently asked questions

### Do I need workers' comp if I am the only driver?

Often not under state law, but your broker may still ask for paperwork. New York does not require coverage for a sole proprietor with no employees, and Georgia treats sole proprietors as employers, not employees. MediTrans in Louisiana has a waiver form for owner-operators without employees, and MTM Health's standard agreement asks for the government document that shows your exemption.

### Do 1099 drivers count toward the workers' comp threshold?

They can. Virginia says the 1099 label does not matter after an injury, because the facts of the work decide, and it counts a subcontractor's workers when it tallies your employees. Virginia also warns that your insurer can charge premium for an uninsured subcontractor at audit, even a sole proprietor, so keep proof of each one's coverage.

### Does workers' comp cover a driver hurt in a crash during a trip?

Yes, when the driver was working. Workers' comp pays medical care and part of lost wages for injuries caused by the job, and driving riders is the job. OSHA does not need a report of a hospital stay from a crash on a public road outside a work zone, but the injury still goes on your OSHA log if you must keep one.

### Can I leave myself off my own policy?

In many states. Georgia lets up to five officers or members waive coverage on Form WC-10, and they still count toward the three-employee line. Florida officers and LLC members file a Notice of Election to be Exempt online. Illinois owners tell their insurer in writing. Once exempt, you cannot collect benefits for your own injuries, as Florida spells out.

### What happens if my workers' comp lapses?

You can lose the contract and face state penalties. MTM Health's standard agreement ends immediately if you fail to keep required insurance. California can issue a stop order that bars you from using employees until you are covered, and it assesses the greater of twice the missed premium or $1,500 per employee. Virginia charges up to $250 a day, to a $50,000 maximum.

### Is Texas different?

Yes. Most Texas private employers may choose not to carry workers' comp. Those that opt out must file an annual notice with the state, post notices, and tell new hires in writing, and an injured worker can sue them. Texas Medicaid health plan rules for NEMT still require workers' comp at statutory limits with $1 million employer's liability.

## Official resources

- [U.S. Department of Labor: State workers' compensation officials](https://www.dol.gov/agencies/owcp/wc)
- [California DWC: Employer FAQs](https://www.dir.ca.gov/dwc/faqs.html)
- [Texas DWC: Non-subscriber notices and Employer E-File](https://www.tdi.texas.gov/wc/nonsubscriber.html)
- [Florida Division of Workers' Compensation: Exemptions](https://www.myfloridacfo.com/division/wc/employer/exemptions)
- [Washington L&I: Stay at Work program](https://lni.wa.gov/claims/for-employers/employer-incentives/stay-at-work)
- [Oregon Workers' Compensation Division: Employer-at-Injury Program](https://wcd.oregon.gov/rtw/Pages/eaip.aspx)
- [eCFR: 29 CFR 1904.39, Reporting severe injuries to OSHA](https://www.ecfr.gov/current/title-29/section-1904.39)