Ains 23 Ch9

Front 1

Employee's "exclusive remedy"

Back 1

Recovery under applicable workers compensation law

Front 2

Deductible for income benefits from workers compensation

Back 2

Waiting period of 3-7 days

Front 3

Temporary Employees

Back 3

Hired for short-term assignments to cope with peak loads or replace an employee on leave

Front 4

Leased Employees

Back 4

Work continuously for the same firm and are subject to control by the firm as if they were its direct employees

Front 5

Who supplies workers compensation for temporary and leased employees?

Back 5

Temporary - firm supplying the employee

Leased - Professional Employer Organization

Front 6

Professional Employer Organization (PEO)

Back 6

Provides leased employees and covers their payroll, employee benefits, and workers compensation

Front 7

Extraterritorial Provisions

Back 7

Provide that employees can receive benefits provided by the law of the state in which they are hired even if the accident occurs in another state

Front 8

Foreign Voluntary Workers Compensation Coverage

Back 8

Provides "home state" coverage without a time limit for US employees who are working outside the US

Often includes repatriation expense and endemic disease

Front 9

5 ways employers can demonstrate financial ability to pay claims

Back 9

Voluntary Insurance,

Assigned Risk Plans,

State funds or employers mutual insurance companies,

Disappointed self-insurance plans,

Self-insured groups

Front 10

Assigned Risk Plan

Back 10

State "assigns" each rejected applicant to be insured by a private insurer

Insurers are compelled to accept assigned risk policies in a quantity proportionate to their share of the voluntary market

Front 11

Aggregate excess/Stop loss excess insurance

Back 11

Insurance that covers losses only after the insured has retained a stated amount if aggregate loss during the policy period

Front 12

Self-insured Groups

Back 12

Aka Pools or Trusts

Employers in same industry that jointly and individually guarantee payments if workers compensation benefits to employees of group's members

Front 13

3 parts of a complete WC&EL policy

Back 13

Information Page,

policy form,

any applicable endorsements

Front 14

6 Parts of standard WC&EL following General Section

Back 14

1. Workers Compensation Insurance

2. Employers Liability Insurance

3. Other States Insurance

4. Your Duties If Injury Occurs

5. Premium

6. Conditions

Front 15

4 Items of Information Page

Back 15

Item 1 - essential information about insured

Item 2 - Coverage period

Item 3 - summarizes coverage

Item 4 - information necessary to calculate premium

Front 16

4 subsections of Item 3 of Information Page

Back 16

A - Part 1 applies to workers compensation laws of state(s) listed in Item 3.A

B - Limit of Liability for Part 2

C - Part 3 applies to any additional states under Item 3.C

D - Endorsements and schedules

Front 17

General Section of WC&EL

Back 17

Explains nature of the policy and defines important terms

Front 18

Limit and Exclusions of Part 1 - Workers Compensation Insurance

Back 18

No dollar limit; insurer will pay benefits required by workers compensation laws

No exclusions in Part 1

Front 19

Third Party Over Claims

Back 19

Employee sues a third party and that third party sues the employer

Front 20

Claim for care and loss of services

Back 20

A family member of an employee sues for loss of companionship or loss of services (housekeeping, yard work, etc)

Front 21

3 Limits of Liability that apply to Employers Liability Coverage

Back 21

BI injury by accident limit

BI injury by disease policy limit

BI injury by disease employee limit

Front 22

What two factors does premium if workers compensation depend on?

Back 22

Employers payroll (premium base)

Type of business (classification)

Front 23

Advisory Organization

Back 23

Gathers statistics for workers compensation, often insurers are required to belong to one

Front 24

What is the most common advisory organization?

Back 24

National Council on Compensation Insurance

Front 25

Standard Exception Classifications

Back 25

Classifications that are separate from government classification

Front 26

4 Types of Standard Exception Classifications

Back 26

Classical office and drafting employees physically separated from other operations

Telecommuting clerical and drafting employees

Salespersons, collectors, or messengers

Drivers, chauffeurs, and their helpers

Front 27

8 WC&EL Premium Adjustments

Back 27

Experience rating,

Retrospective rating,

Premium discount,

Merit or schedule rating Factors,

Rate deviations,

Expense constant,

Deductible plans,

Dividend plans

Front 28

Experience Rating

Back 28

Increases or reduces premium for a future period based on insured's own loss experience

Front 29

Flat dividend plan

Back 29

All eligible policies receive the same percentage of their premium as a dividend regardless of their individual loss experience

Front 30

Sliding scale dividend plan

Back 30

Size of dividend varies with insureds own loss experience