Cpcu 552 Chapter 6

Front 1

common law defenses protected employers against employees' suits for occupational injuries before the enactment of workers compensation statutes

Back 1

employers protected by the assumption of risks defense, contributory negligence defense, and fellow-servant rule

Front 2

specific goals of the US workers compensation system

Back 2

* promptly paying adequate income and medical benefits, according to a fixed and predetermined schedule, to injured employees or their dept regardless of fault

* eliminating the delays and costs of litigation to the employee and society

* establishing a guarantee of benefit payment, secured by insurance

* promoting industrial safety & hygiene

Front 3

in what instances employees still be allowed to make tort suits against their employers for occupational injuries

Back 3

* when employee works job that is not subject to workers comp, such as domestic employee

* employees injuries are intentionally caused by employer

* employees injuries result from employer's performing in capacity other than employer

* employer fails to provide financial security for its workers comp obligations

Front 4

statutory employee

Back 4

independent contractor's employee who, because the independent contractor has not maintained workers comp insurance, is considered to be an employee of the principal employing the independent contractor

Front 5

distinction between independent contractors and employees important in workers compensation claims

Back 5

general rule, employer's legal obligation under workers compensation laws extend to employees only, not independent contractors

Front 6

what circumstances might a principal become liable to provide workers comp benefits to an employee of an independent contractor hired by the principal

Back 6

some workers comp statutes hold the principle liable to provide workers comp benefits to an employee of an independent contractor hired by the principal if the independent contractors does not have valid workers comp ins.

Front 7

what workers comp related precautions should an organization take when hiring an independent contractor to perform work for the organization

Back 7

when hiring independent contractor, organization should obtain certificates of ins from independent contractor to make sure contractor has workers comp.

Front 8

temporary total disability (TTD)

Back 8

disability caused by a work related injury or disease that temporarily renders are injured worker unable to perform any job duties for a period of time

Front 9

permanent total disability (PTD)

Back 9

disability caused by a work related injury or disease that renders an injured employee unable to ever return to gainful employment

Front 10

temporary partial disability (TPD)

Back 10

disability caused by a work related injury or disease that temporarily limits the extent to which a worker can perform job duties, the worker is eventually able to return to full duties and hours

Front 11

permanent partial disability (PPD)

Back 11

disability caused by a work related injury or disease that impaired the injured employees earning capacity for life but the employee is able to work at reduced efficiency

Front 12

3 basic requirements that an occupational injury must meet in order to be compensable under most states workers comp

Back 12

1. must be accidental

2. arise from employment

3. arise in course of employment

Front 13

why do most state's workers compensation statutes accommadate an extended period for filing a claim

Back 13

most states workers comp statutes accomadate extended period for filing a claim bc injuries that would qualify for workers comp coverage that are not specific to a date or time and that are not necessarily physical can take months or years to manifest

Front 14

positional risk doctrine

Back 14

specifies that an injury is considered to have arisen out of a workers employment if the injury would not have occurred but for the fact that the conditions and obligation of employment placed the claimant in position where injured

Front 15

purpose of second injury fund

Back 15

to encourage the employment of employees with disabilities

Front 16

conditions that define temporary total disability

Back 16

occurs when injured employee is unable to perform job duties for a period of time but is expected to return to full job duties after recovering

Front 17

how employer and employee benefit from encouraging employees to return to work on a light duty basis

Back 17

if employee returns to work on light duty bc continues to derive production from he employee. employee benefits bc they can continue to work with less physical demand

Front 18

how rehabilitation benefits can affect the cost of debilitating injuries

Back 18

can lead to reduced injury costs bc rehabilitation reduces the seriousness and the cost of disabling injuries

Front 19

components of death benefits

Back 19

consist of income replacement of deceased employees to surving spouse and dependents and burial allowance

Front 20

state fund

Back 20

workers comp insurer that is set up by the state in which it operates either as agency of the state government or as a mutual or not for profit insurer

Front 21

competitive fund

Back 21

state fund that sells workers compensation insurance in competition with private insurers

Front 22

monopolistic state fund (exclusive state fund)

Back 22

facility, owned and operated by a state government, that provides workers compensation ins and that does not permit any other insurers to sell workers comp insurance in that state

Front 23

self insured group (pool or trust)

Back 23

group of employers in he same industry that jointly and severally guarantee payment of workers comp benefits to the employees of the group's members

Front 24

2 sources of workers comp when cannot obtain ins from a private insurer

Back 24

1. workers compensation assigned risk plan

2. state fund

Front 25

2 basic state funds and how to they differ

Back 25

1. competitive fund offers workers comp in a state that permits other licensed insurers to sell workers comp in the state

2. monopolistic fund offers workers comp in state that does not permit any other insurer to sell workers comp ins

Front 26

2 alternatives to buying workers compensation ins to comply with security requirements of state workers comp

Back 26

1. instead of buying workers comp ins, employer that meets with self ins requirement of the statute can self insure its workers comp loss

2. also can join a self-insured group in the applicable workers comp statute permits such groups

Front 27

extraterritorial provision

Back 27

provision of a workers comp statute that extends protection to an employee who is injured while temporarily working in a state other than the state of hire

Front 28

2 provisions that can be included in a state's statutes that determine whether an insurer is required to pay workers comp benefits when statutes from more than 1 state apply

Back 28

extraterritoriality and reciprocal agreements are 2 provisions that determine whether an insurer is required to pay workers comp benefits when statutes from more than 1 state apply

Front 29

situs test

Back 29

test that a claimant must satisfy to be covered under the US Longshore and Harbor Workers Comp Act; it requires that at the time of injury, the claimant must been on navigable waters

Front 30

status test

Back 30

test that a claimant must satisfy to be covered under the US Longshore and Harbor Workers Comp act; requires that at the time of the injury, clmt must have been engaged in maritime employment

Front 31

types of employees are specifically excluded from the United States Longshore and Harbor Workers Compensation Act (LHWCA)

Back 31

specifically excludes several types of employees including masters or crew members of vessels; persons engaged to load and officers of the US government

Front 32

defense base act

Back 32

covers civilians working on military bases outside the us and civilian employees of contractors performing services outside the us under the contract w an us government agency

Front 33

outer continental shelf lands act

Back 33

covers employees engaged in exploration for and development of natural resources on the outer continental shelf of the us

Front 34

nonappropriated fund instrumentalities act

Back 34

covers civilian employees of the us government whose salaries are paid w funds generated from earnings rather than funds appropriated t the us armed services

Front 35

federal employees compensation

Back 35

covers civilian employees of the us government other than members of the US military

Front 36

Migrant and Seasonal Agricultural Worker Protection Act

Back 36

eligible employees can sue their employers for occupational injuries if the employees are not covered by workers comp ins

Front 37

type of employees covered by the Federal Employers' Liability Act (FELA) adn the remedy that FELA provides to such employees

Back 37

permits employees of an interstate railroad and employees of intrastate railroads by way of siding to sue their employer

Front 38

type of employees covered by the Jones Act and the remedy that the Jones Act provides to such employees

Back 38

permits members of a vessel's crew to sue their employer for damages resulting from occupational injuries resulting from the employer's negligence

Front 39

workers compensation insurance

Back 39

insurance that provides coverage for benefits an employer is obligated to pay under workers compensation laws

Front 40

experience modification faccor

Back 40

factor that tailors manual rates to an insured's experience based on the insured's payroll and loss record of certain prior years

Front 41

employers liability insurance

Back 41

insurance that protects an employer against employee injury claims that are not covered by workers compensation laws

Front 42

other states insurance

Back 42

insurance that automatically extends coverage to the insured's operations in any state listed in Item 3.C. of the WC & EL information page

Front 43

list information contained on the Information Page of Workers Comp and Employers Liability Insurance policy

Back 43

* insured's name, mailing addr, type of legal entity, & workplaces other than the mailing addr

* coverage period

* coverage provided by policy under parts A-D

* info necessary to calculate the estimated pol prem

* all endorsements and schedules attached to the policy

Front 44

coverage provided under Part 1 of WC&EL

Back 44

provides workers comp ins, which covers the insd's obligation as an employer to pay all compensation and other benefits required by the workers compensation law of any state listed in Item 3.A of the info page

Front 45

coverage provided by extraterritoriality provisions typically contained in workers comp statutes

Back 45

cover accidents occurring in other states when employees are working outside the home state temporarily.

Front 46

4 types of claims that are covered by employers liability (EL) insurance

Back 46

* third party over claims

* claims for care and loss of services

* claims for consequential bodily injury

* dual-capacity claims

Front 47

3 limits of liability applying to employers liability (EL) coverage

Back 47

* bodily injury by acc limit is the most that the insurer will pay for all bodily injury resulting from any 1 act regardless of the # of employees injured

* bi by disease - policy limt is most insurer will pay for all bi by disease regardless of # employees sustained disease

* bi by disease - each employee limit is the most that the insurer will pay for bi by disease to any one employee

Front 48

how other states insurance is activated

Back 48

to activate, the names of one or more states must be shown in item 3.C. of the info page. when state is listed in 3.C, policy will cover the named insd obligations under the workers comp law of that state just as if the state was listed in item 3.A

Front 49

obligations of the parties to the WC&EL policy under the inspection condition

Back 49

insurer has the right but is not obligated to inspect a policyholder's workplaces and operations to determine that safe practices are used and proper precautions taken for the safety of employees

Front 50

voluntary compensation and employers liability coverage endorsement

Back 50

endorsement that amends the WC&EL policy to cover employees who are not subject to a workers compensation statute

Front 51

foreign voluntary workers comp coverage

Back 51

cov that insures employees who are working outside the US and who are not subject to a workers comp law for benefits equal to those provided under either the workers comp statute of a specified state or specified federal comp act

Front 52

US Longshore and Harbour Workers' Comp Act Endorsement

Back 52

endorsement that amends the workers comp and employers liability insurance policy to cover the insd's obligations under the US Longshore and Harbor Workers Comp Act

Front 53

maritime coverage endorsment

Back 53

endorsement that amends the workers comp and employers liability ins policy to cover an employers liability for injury or death of crew members

Front 54

waiver of our right to recover from others endorsment

Back 54

endorsement in which a workers comp insurer agrees not to enforce its right to subro against any organization listed in the endorsement schedule

Front 55

alternate employer endorsment

Back 55

endorsement that extends workers comp and employers liability cov to an additional organization named in the endorsement

Front 56

purpose of voluntary compensation and employers liability cov endorsement

Back 56

is to provide statutory workers comp benefits to employees who are not covered by workers comp statute such as farm and domestic employees

Front 57

foreign voluntary workers comp cov

Back 57

provides "home-state" cov or for US employees who are working outside the country with no time limit, coverage equal to that required by defense base act or the Longshore and harbor workers comp act

Front 58

identify additional coverage often included in foreign voluntary compensation endorsment

Back 58

often include coverage for repatriation expense and endemic disease

Front 59

standard policy form and endorsement do insurers use to provide employer with ins for its obligations under the US Longshore and Harbor Workers Comp Act

Back 59

attach the US Longshore and Harbor Workers Comp endorsement to the standard WC&EL policy

Front 60

limitations of Maritme Coverage Endorsement regarding coverage territory

Back 60

bi occurring only in the continental US, Alaska, Hawaii, or Canada, or bi occurring in the operation of a vessel sailing directly btwn ports in these places

Front 61

limitations of Maritme Coverage Endorsement regarding coverage maintenance and cure

Back 61

does not cover insd's obligation to provide maintenance & cure. however coverage can be added for additional premium

Front 62

what situations is the alternative employer endorsement added to WC&EL policy and how does end affect coverage

Back 62

added when more than 1 entity can be regarded as the employer of an employee, such as an employee provided to an org by a temporary help agency

Front 63

experience rating plan

Back 63

rating plan that increases or reduces the prem for future period based on the insd's own loss experience for a period in the recent past

Front 64

how does experience rating encourage employers to exercise risk control for their workers comp exposure

Back 64

by linking premiums to the insd's actual loss experience in prev pol perioid

Front 65

basic operation of the experience rating formula

Back 65

compares an insd's actual losses with the losses expected for an average insd in the same classification as the insd's and adjusts future rates up or down based on the result

Front 66

eligibility criteria to experience rating plan

Back 66

applies only to employers whose average premium for prior policy periods exceed a certain amount which varies by state

Front 67

what periods are the losses derived that are used in experience rating for the current policy period

Back 67

three 1 year policy periods preceding the most recently expired 1 year policy period.

Front 68

possible sources of errors in an experience modification calculation

Back 68

* using incorrect classifications codes or payroll allocations

* failing to include all payroll data when calculating expected losses

* incorrectly reporting loss reserves

* failing to remove the reserves for closed claims from the rating data

* failing to revise claim values to reflect subro recoveries, second injury fund recoveries and loss apportionment among different insurers