Flitner & Trupin - Wc & Misc Cov

Front 1

Types of benefits provided by WC statutes

Back 1

1. med benefits
2. disability income benefits
3. rehabilitation benefits
4. death benefits

Front 2

Types of disability income benefits for WC statutes

Back 2

1. temporary partial disability: disability that prevents injured worker from performing some job duties for a definite time period
2. temporary total disability: disability that prevents injured worker from performing any job duties for a specific period but that ultimately allows worker to resume all job duties
3. permanent partial disability: disability due to an irreversible injury that allows injured worker to resume some job duties
4. permanent total disability: disability that prevents injured worker from ever being able to return to gainful employment

Front 3

Second injury fund

Back 3

established to encourage employers to hire partially impaired workers. Limits second employer's share of loss to what would have been payable for 2nd injury if 1st injury has not occurred
-losing both eyes

Front 4

Noted federal legislative acts regarding WC

Back 4

1. US Longshore and Harbor Workers Compensation Act (LHWCA): provides exclusive remedy for injured maritime workers engaged in longshoring and shipbuilding

2. Jones Act: federal statute that permits injured workers to sue their employer for damages due to employers negligence

3. Federal Employers Liability Act: provides exclusive remedy for injured interstate railroad workers

Front 5

Alternative methods for meeting the employers obligations re: WC

Back 5

- private ins
- assigned risk plans
- state funds and employers mutuals
- self ins
- excess ins
- pools

Front 6

Types of state funds & employers mutuals

Back 6

1. competitive state fund
- owned and operated by state
- competes w/ other private ins in the state

2. monopolistic state fund
- owned and operated by state
- other insurers are not allowed to write in the state

3. employers mutual ins co's

Front 7

Sections of the standard WC & EL pol form

Back 7

- informational page general section
- Part 1: WC ins
- Part 2: EL ins
- Part 3: Other States ins
- Part 4: Your duties if injury occurs
- Part 5: Premium
- Part 6: Conditions

Front 8

Exclusions to EL ins

Back 8

EL - employer can be help liable under common law as a result of employy injuries (spouse of injured employee sues employer for loss of companionship or services resulting from injury)

Aimed at eliminating cov for claims that would be covered under various other statutes

- injury outside US or Canada unless employee is temporarily outside US or Canada
- liab assumed under contract b/c covered by CGL
- punitive damages for injury or death to illegally employed persons
- BI to employees employed in violation of the law w/ the knowledge of the insured
- BI intentionally caused by the insured
- damages arising out of employment practices
- fines or penalties imposed for violation of federal and state law

Front 9

Types of limits of liab defined in EL ins

Back 9

- BI by accident lim
- BI by disease - pol lim
- BI by disease - each employee

Front 10

Types of prem adjustments in WC ratemaking

Back 10

1. experience rating plan
2. retrospective rating plan
3. premium discount
4. merit or schedule rating factors
5. rate deviations
6. expense constants
7. deductibles
8. dividend plans

Front 11

Experience rating plan

Back 11

plan that increases or reduces prem for a future period based on the insureds own loss experience for a period in the recent past

Front 12

Retrospective rating plan

Back 12

plan that increases or decreases prem for a pol period based on the insureds own losses during the same period

Front 13

Forms of XS liab pols

Back 13

1. a "following form" subject to the same terms as the underlying pol lims if the loss is covered by the underlying ins

2. a self-contained pol is subject to its own terms where cov applies to a loss that exceeds the underlying lims only if the loss is covered under the terms of the XS pol

3. a combination of the following form and the self-contained pol

Front 14

Three basic characteristics of liab ins that are not shared by prop ins

Back 14

- difficulty in estimating PML for liab expos

- layering of liab coverages

- effect of agg limits

Front 15

Basic functions of the umbrella liab pol

Back 15

1. provide add'l lims above the occ lims of the insureds primary pol

2. takes the place of the primary ins when primary agg lims are reduced or exhausted

3. covers some claims that are not covered by primary pols (subject to retention)

Front 16

Drop down cov

Back 16

cov for claims that are not covered by an underlying pol due to:

- type of claim not being covered
- underlying pol's agg lims being depleted by previous claims

Front 17

Self-insured retention

Back 17

amt that is deducted from claims that are payable under an umbrella pol and that are not covered at all by any primary policies

Front 18

When self-insured retention does not apply

Back 18

1. when paying in XS of a claim covered by the primary pol

2. dropping down to pay a claim b/c the primary pol's agg lim has been exhausted

Front 19

Common differences btw professional liab & CGL pols

Back 19

1. claims-made trigger: PL prefers CM. ISO CGL uses 5yr extended reporting period

2. consent to settle req's: PL insured is frequently given right to participate in decisions to settle a claim

3. selection of defense counsel: PL gives insured right to select counsel subject to insurers approval

4. deds: PL is usually subject to a ded

Front 20

Exclusions common to most professional liab pols

Back 20

- contractual liab
- punitive damages
- insureds dishonest, criminal, or malicious acts

Front 21

Examples of wrongful acts usually covered under employee practices liab ins

Back 21

- sexual harassment
- wrongful termination
- unlawful discrimination

Front 22

Examples of ins agents & brokers E&O liab

Back 22

- failure to properly advise the client regarding ins needs
- failure to obtain ins for a client in a timely manner
- failure to renew a pol at expiration w/o giving proper notice to client
- failure to properly advise the client regarding appropriate limits

Front 23

D&O liab

Back 23

covers corporation's D&O against liab for their "wrongful acts" that would not be covered under a CGL or auto pol. Also covers the sums that the insured co is req'd or permitted by law to pay to the D&O as indemnification. Written on a claims-made basis