Insurance WC

Overall limit of liability coverage (as opposed to the amount available for a single incident).

Termination of an insurance contract, whether by the insurer or the insured.

An explanation to prevent misinterpretation.

The entity or business leasing the employees.

To bring about by force or threat.

The legal right of one spouse to the company, affection and assistance of and to sexual relations with the other.

To harm the reputation of by libel or slander.

An arrangement in which a business engages a third party to provide it with workers for a fee or other compensation.

Obligations imposed by law for injury to employees in the course of employment that are not compensable under the workers compensation section

Makes workers compensation scheduled medical and lost-wage benefits the exclusive recourse against employers for employees injured in the course of employment. Employees receive the benefits in exchange for giving up the right to sue their employers. A legal theory that makes employers liable for and responsible for payments to their employees for injuries under the US L&HWCA.

A mathematical comparison between a company’s workers compensation losses and those of other businesses engaged in similar types of work that may increase or decrease the premium.

Determining the state in which to file a workers compensation claim by comparing the quality of benefits mandated by two or more states in which the claim could legally be filed.

An action brought by an employee against a vessel owned by the insured that bypasses the issue of whether or not the vessel owner carried liability insurance.

Compensation for security against hurt, loss or damage; reimbursement for incurred penalties or liabilities.

The right to inspect the workplace “at any time.”

Longshore and Harbor Workers Compensation Act

A company that contracts the services of its employees to other businesses.

One who is dispatched by his employer to another for some service.

A workers compensation policy written for longer than one year and sixteen days; such policies are considered to be “newly written” on each annual anniversary date.

States in which employers are required to buy insurance from a state fund; currently North Dakota, Ohio, Washington, West Virginia and Wyoming are monopolistic states.

The National Council on Compensation Insurance, Inc. files forms on behalf of its member states and establishes the rules for classification and premium determination, and compiles statistical data involving workers compensation premiums and losses.

Provides workers compensation and employers liability coverage in states that are not listed in item 3.a. of the information page (coverage part one) and reimburses the insured if the insurer is not permitted to pay benefits required by the applicable workers compensation law directly to persons entitled to them.

Protection and indemnity coverage is an ocean marine form that provides legal liability coverage for marine exposures.

Owners of businesses that employ contractors or subcontractors.

Payroll and other compensation for work done by employees.

A plan in which the final insurance premium is not determined until all claims are closed or the insured and insurer agree to close the plan. The final premium is determined by the insured’s actual loss experience during the policy period.

Duties that are imposed through state or federal laws.

Provides employers liability coverage in monopolistic states when the state operated system provides only workers compensation coverage and does not offer employers liability insurance.

Entitles the insurer to recover its workers compensation payments from a party that can be shown to be actually liable for an employee’s injuries.

A suit or claim by an injured employee against a third party that is liable for the injuries.

These arise when an injured employee sues a negligent third party who, in turn, is able to bring an action against or enjoin the employer.

The transfer of the insured’s rights or duties under an insurance policy to another party.

A condition of the policy that prevents the insured from transferring his or her rights or duties to another party without the written consent of the insurer.

A system in which injured employees lose the right to sue employers for employment-related injuries in return for a statutorily imposed mechanism that provides specific scheduled benefits.

Part One is the workers compensation section under which the insurer agrees to pay the benefits imposed upon the insured by the workers compensation law of the state(s) listed on the information page.

Part Two is the employers liability section which protects the insured against liability imposed by law for injury to employees in the course of employment that is not compensable under the workers compensation section.

Part Three provides other states insurance for workers compensation and employers liability coverage in states that are not listed on the information page for purposes of Part One coverage and if the insurer is not permitted to pay benefits required by the applicable workers compensation law directly to persons entitled to them.

• The effective dates of the policy
• Applicable endorsements
• The insured and the insurer
• The estimated premium
• The various states in which the coverage parts of the workers compensation policy apply

The first clause identifies the policy as a contract of insurance between the employer (named on the information page) and the insurer.

The benefits paid under a workers compensation claim may go to an employee but the employer is the insured. In this way, the policy is a liability policy covering legal obligations imposed (in this case, by law) upon the insured. And, since the policy is a contract, this clause notes that the only agreements related to the coverage provided by the policy are those that are stated in the policy - no outside contracts or side agreements affect coverage.

The second clause confirms that the employer named in the information page is the named insured under the policy.
The insured can be an individual, a partnership, a corporation or some other entity. If the employer is a partnership, this clause specifies that an individual partner is an insured but only in the capacity as an employer of the partnership’s employees. The phrase recognizes the legal status of a partner; that is, it makes an individual partner an insured so that the partner’s private holdings won’t become subject to a claim by an injured worker.

The third clause notes that the coverage and benefits paid to injured workers are based on the workers compensation law of each state or territory named in Item 3.A. of the information page. All states in which the insured conducts operations should be listed in Item 3.A.
The insured might have operations in more than one state, such as plants, retail stores or traveling representatives; in some cases, major corporations have operations in every state. Or, the insured may regularly send employees to work out-of-state. In all these instances, the insured faces multi-state workers compensation exposures and since the insured is charged with the responsibility of listing the appropriate state(s) or territory so that the proper benefits can be paid to injured employees, it is crucial that insured employers understand and comply with this clause.

The fourth clause in the general section defines “state” as any state of the United States of America and the District of Columbia. This does not mean that the workers compensation policy is applicable only in the fifty states and the District of Columbia. Any state or territory named in Item 3.A. of the information page shows the territorial applicability of the policy but “state” is defined here just to clarify other paragraphs and phrases found throughout the policy.
For example: If an employee is traveling temporarily in a foreign country on business, benefits for injuries suffered will be based on the workers compensation law of the state or states listed in Item 3.A.

The Fifth or last clause in the general section declares that the policy “covers all of your workplaces listed in Items 1 or 4 of the information page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self-insured for such workplaces.” If the insured has one workplace or twenty workplaces, this policy can apply; there is coverage as long as the insured lists all the states in which there are workplaces on the information page.

1. Notification
2. Provide for immediate medical and other services required by law
3. Make no voluntary payments or incur expenses
4. Provide information about the incident to the insurer
5. Give the insurer all notices, demands and legal papers related to the injury
6. Cooperate with the insurer in investigation, settlement or defense of any claim, proceeding or lawsuit
7. Do nothing to interfere with the insurer’s right to recovery from others
First and foremost is the duty to notify the insurer if an injury that may be covered by the policy occurs.

1. Inspections
2. Long Term Policies
3. Transfer of Rights
4. Cancellation
5. Sole Representative on Behalf of All the Insureds