If you run a chiropractic practice, workers' compensation insurance probably isn't the most exciting part of your business plan. But here's the thing: get it wrong, and you could face hefty fines, lawsuits, or worse—being unable to help an injured employee when they need it most. The good news? Workers' comp for chiropractors is typically more affordable than many other business types, and understanding how it works can save you thousands of dollars over time.
Whether you're opening your first practice or adding staff to an established office, this guide breaks down everything you need to know about workers' compensation for chiropractic businesses—from when you're required to have it, to how much it costs, to practical ways to keep your premiums low.
When Chiropractic Practices Need Workers' Comp
The short answer? Almost always, once you hire your first employee. In most states, workers' compensation insurance becomes mandatory as soon as you bring on staff—whether that's a receptionist, chiropractic assistant, or massage therapist. The specific threshold varies by state. Some states require coverage with your very first employee, while others set minimums of three to five employees.
But here's where it gets tricky: the rules differ if you're a solo practitioner or work with independent contractors. If you're the only person in your practice, you typically don't need to cover yourself (though you can choose to). Independent contractors—like a part-time bookkeeper who sets their own hours and works for multiple clients—generally aren't covered under your policy either.
The catch? You can't just call someone an independent contractor to avoid workers' comp requirements. States use specific legal tests to determine worker classification, focusing on how much control you have over their work, schedule, and methods. Misclassifying employees as contractors is one of the fastest ways to land in hot water with your state's labor department. When in doubt, treat them as an employee and get them covered.
Understanding Class Codes and How They Affect Your Rate
Workers' compensation insurance uses class codes to determine your premium. Think of class codes as risk categories—they tell insurers how likely workers in your field are to get injured on the job. For chiropractic practices, you'll typically see class code 8832, which covers all employees in a chiropractor's office, from front desk staff to chiropractic assistants.
These codes are assigned by the National Council on Compensation Insurance (NCCI), which analyzes injury frequency and severity across different professions. Here's the good news for chiropractors: your profession is considered relatively low-risk. You're not hauling heavy equipment or working at construction sites. The result? Lower base rates compared to industries like roofing or manufacturing.
In 2025, the average workers' comp rate for chiropractors is $0.27 per $100 of payroll. That means if your annual payroll is $50,000, you'd pay roughly $135 per year in base premium (before any modifiers). But rates vary widely by state—Arkansas, for instance, charges just $0.13 per $100, while states with higher costs of living and medical care tend to charge more.
The Experience Mod Factor: Your Premium Wild Card
Here's where things get interesting. That base rate we just talked about? It's only part of the equation. Your actual premium is calculated using something called an experience modification factor, or E-Mod for short. Think of your E-Mod as your workers' comp report card—it reflects your claims history compared to other businesses in your industry.
An E-Mod of 1.00 is average—it means your claims history is typical for a chiropractic practice. An E-Mod below 1.00 is great news: it indicates fewer or less severe claims than average, and you'll get a discount on your premium. An E-Mod above 1.00 means you've had more claims activity, and you'll pay a surcharge.
Your E-Mod is calculated using the most recent three-and-a-half years of payroll and claim data. Here's the counterintuitive part: the formula weighs claim frequency (how many claims you file) more heavily than claim severity (how much those claims cost). Multiple small claims can hurt you more than one large claim. That's why having a solid workplace safety program matters—preventing injuries altogether is better than just hoping they'll be minor.
Let's say your base premium is $500 per year with an E-Mod of 1.00. If you maintain a clean safety record and your E-Mod drops to 0.85, you'd pay $425 instead—a 15% discount. Conversely, if claims drive your E-Mod up to 1.20, your premium jumps to $600. Over several years, those differences add up significantly.
Common Workplace Injuries in Chiropractic Offices
Even in a relatively low-risk environment like a chiropractic office, injuries happen. The most common ones include repetitive strain injuries from administrative work, slips and falls in reception areas, and back injuries from assisting patients or moving equipment. Chiropractors themselves can develop musculoskeletal issues from performing adjustments day after day.
The good news? Most of these injuries are preventable with basic safety measures. Ergonomic workstations for administrative staff, proper lifting techniques, non-slip flooring, and regular equipment maintenance can dramatically reduce your risk. Some insurers even offer premium discounts if you implement formal safety programs—and the reduction in claims will lower your E-Mod over time, creating a double benefit.
State-Specific Considerations
Workers' compensation is regulated at the state level, which means the rules can vary significantly depending on where you practice. Some states, like California, have additional requirements for chiropractors who treat workers' comp patients. California requires special certification in workers' compensation evaluation and limits chiropractors to 24 treatment visits before needing approval for continued care.
Other states have different fee schedules, reporting requirements, and penalties for non-compliance. New York, for example, updates its workers' compensation chiropractic fee schedule regularly—the most recent update took effect January 1, 2026. It's crucial to understand your state's specific requirements, both for insuring your own employees and for treating workers' comp patients if that's part of your practice.
How to Get Coverage and Keep Costs Down
Shopping for workers' compensation insurance doesn't have to be complicated. Start by contacting insurance brokers who specialize in coverage for healthcare practices—they'll understand your specific needs and can compare quotes from multiple carriers. In some states, you'll purchase coverage through a state fund; in others, you'll work with private insurers.
To keep your premiums low, focus on three key areas. First, maintain accurate payroll records—your premium is based on payroll, so proper classification and documentation matter. Second, implement a workplace safety program, even if it's basic. Train staff on proper lifting techniques, maintain clean walkways, and address hazards promptly. Third, manage claims carefully. Have a clear protocol for reporting injuries, and work with injured employees to get them appropriate care and back to work safely.
Don't assume your workers' comp needs are set-it-and-forget-it. Review your policy annually, especially if you've hired new staff, changed your services, or expanded to a new location. As your E-Mod improves with a clean claims history, you may be able to negotiate better rates or switch carriers for a better deal.
Workers' compensation insurance protects both you and your employees. It ensures that if someone gets hurt on the job, they receive medical care and wage replacement without having to sue you—and it protects your practice from potentially devastating lawsuits. With relatively low rates for chiropractic practices and clear steps to keep costs down, there's no reason to put this coverage off. Get the right policy in place, focus on safety, and you can run your practice with confidence knowing everyone's protected.
