Workers Compensation

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Monopolistic States

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States that do not allow the employer to buy private Workers' Compensation insurance: North Dakota, Ohio, Washington, and Wyoming. These states created their own state funds to pay for worker injury.

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Stop-Gap Insurance

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Employer's liability protection that can be sold as an endorsement to a Commercial General Liability (CGL) policy and also the Business owners policy (BOP) for small businesses.

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Workers compensation

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Original No-Fault Coverage

Negligence does not need to be established

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Workers Compensation is occupational

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meaning it covers only job related accidental

injury and/or sickness

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Ohio Workers Comp under 2 jurisdictions

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Bureau of Workers Compensation

State Industrial Commission

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Workers Compensation Insurance

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policy purchase by an employer to indemnify his obligation to pay out of pocket worker injury

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4 monopolistic States

Have set aside state funds to pay

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North Dakota

Ohio

Washington

Wyoming

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Workers Compensation Law also called

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Exclusive Remedy Doctrine

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US Longshoremen's and Harbor Workers

Compensation Act

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Those working on the docks who load, unload

build and repair ships

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The Jones Act

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masters and members of the crew of ocean going vessels are protected by this Merchant Marine Act

Permits injured seaman to sue employer for damages and to have a jury trial

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Federal Employers Liability Act (FELA)

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Allows railroad workers to sue employer for negligence

Railroad workers are exempt from Workers Compensation in most states

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Workers Compensation Policy 6 parts

First 3 contain the coverage's

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Part 1 Workers Compensation

Part 2 Employers Liability

Part 3 Other States Covered

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Part 1 workers compensation

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protects the insured against all claims presented under the statutory coverages

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Part 2 Employers Liability

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Protects the employer in the event the injured worker elects to forego coverage under Part 1

Decides to sue the employer for negligence

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Workers Comp Benefits Package

4 Categories

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Medical Benefits (no Limit)

Disability Income (short-term income

Rehabilitation (job re-training)

Death/Survivor (long-term income)

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Medical Benefits

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Covered under Part 1

Unlimited basis with no dollar or time limit

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Disability Benefits

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begins after a 2 week elimination period

Unable to perform duties of current position

66 2/3% of wages

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Dismemberment Benefits

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provide on a lump sum basis for loss of limbs or eyesight

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Death Benefit

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$5,500 is paid out for burial allowance

Income benefits are provided to surviving spouse and children

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Survivor Benefits

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provided to spouse and minor children up to

66 2/3% of wages

Until minor child is 18 or later for FT student

Spouse until they remarry

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2 types of accidents can be denied by

Workers Comp

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Accidents involving intoxication

Intentional self infliction of injury

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Minimum Policy Limits

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$100,000 per person per accident

$100,000 per person per disease

$500,000 per occurrence for all disease claims

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Excluded from Part 2

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Injury occurring outside the US it territories or Canada

Employee discharge, hostile work environment

Contractual liability exposures

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Punitive Damages

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If awarded because of gross negligence of the

employers the damages are NOT covered by

Part 2

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Workers Comp Part 4

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Your Duties If Injury Occurs

Must provide medical services

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Workers Comp Part 5

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Premium

Describes how the policy premium is determined

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Workers Comp Part 6

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Conditions

sets various conditions that apply to the policy including cancellation and subrogation rights

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Blankenship vs. Cincinnati Milicron

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Employees right to sue the employer for work-related injury was re-established in 1980

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The Ohio Workers Comp fund pays

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Statutory Benefits only

Insurance protection for these suites is

Part 2 of Workers Comp Policy

Ohio employers do NOT buy it

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Employers Liability can be sold as an

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Endorsement to a Commercial General

Liability Clause

Also the BOP for small businesses

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Employers Liability Endorsement often called

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Stop-Gap Insurance

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Voluntary Compensation Endorsements

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provides coverage to workers or volunteers who are exempt from statutory workers compensation benefits

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Foreign Coverage Endorsements

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voluntary compensation insurance for employees hired in the USA while traveling or temporarily residing outside the US and Territories

Period no longer than 90 days

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Type of work the employers is engaged is called

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Classifications

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Premium Discount

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based on the size of the manual premium

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Scheduled Rating Factor

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percentage discount or surcharge based on the insurers view of the safety/quality/desirability of the insured

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Experience Modification Factor

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number calculated by NCCI annually for larger insured's based upon the insured's past losses

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Punitive Damages

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is not paid by Part 2 Employers Liability

Workers Comp

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Most important factor to calculate Workers Comp Is

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Dollar amount of employee payroll