workers compensation insurance
Basic limits of employers liability insurance
-$100,000 for bodily injury per accident -$100,000 per employee for disease -$500,000 policy limit for disease
voluntary compensation
-endorsement added to a workers compensation policy provides statutory coverage for employees who do not fall under a state's workers compensation act, such as some types of farmworkers and domestic employees working fewer than 40 hours a week for one employer
conditions
-inspection -long-term policy -transfer of your rights and duties -cancellation -sole representative
exclusions of employers liability coverage
-liability assumed under a contract -punitive or exemplary damages -employees knowingly employed in violation of law -injury intentionally caused by the insured -injuries that occur outside the United States, its possessions, or Canada -damages caused by the employment practices or policies of the insured, including defamation, harassment, humiliation, discrimination, or termination of any employee -employees who are subject to federal workers compensation or employees liability laws -fines or penalties imposed because of a violation of state or federal laws -damages payable under the Migrant and Seasonal Agricultural Worker Protection Act or similar laws
5 categories of possible injuries
-permanent total disability -permanent partial disability -temporary total disability -temporary partial disability -death
Objectives of Oregon's workers compensation laws
-to provide sure, prompt, and complete medical treatment for injured workers and fair, adequate, and reasonable income benefits to injured workers and their dependents -to provide a fair and just administrative system for delivery of medical and financial benefits to injured workers -to restore the injured worker physically and economically to a self-sufficient status as quickly and to the greatest extent possible -to encourage maximum employer implementation of accident study, analysis, and prevention programs
Workers Compensation Handicapped Workers Program
The Handicapped Workers Program has been established for the benefit of complying employers and their workers in the State of Oregon to encourage the employment or reemployment of handicapped workers
occupational disease
a compensable occupational disease means any disease or illness that arises out of and in the course of employment and is medically caused or aggravated by substances or activities to which an amployee is not ordinarily subjectes or exposed, other than during the employment
covered injuries
any injury arising in the course of employment that is accidental, the requires medical services, or results in disability or death is considered a compensable injury and will be covered by the employer's workers compensation insurance
premium discount
applies when an insured owes a total standard premium greater than $5,000
Location
coverage applies to all locations listed in the information page and in 3A unless states listed in 3A have other insurance or self-insurance in place
Employers liability insurance
coverage protects the insured from situations not covered under a state's workers compensation law
experience modification factor
developed by a rating bureau. The calculations relate an employers losses, payroll, and premiums, segregated according to classifications of operations, all as reported to the bureau by the employer's insurance company
employment covered
every employer who employs 1 or more workers in the State of Oregon is required to maintain assurance with the Director of the Department of Consumer and Business Services that the employer's workers and their beneficiaries will receive compensation for eligible injuries, and that the employer will fullfill its obligations
premium
explains how premiums are determined, what the requirements are for insured record retention, and what rights the insurer has in auditing the insured's books and records
yourduties if injury occurs
explains the insured's duties in case of an employee injury -notify the insurer at once -provide immediate medical care required by the law -provide the names and addresses of the injured worker and any witnesses -promptly send any notices or other legal papers -cooperate with the insurer -do not make any voluntary payments or assume any obligations
contributory negligence
if the injured employee was even partially responsible for the injury, the employee was barred from any right to collect for damages
fellow servant rule
if the injury was caused by the negligence of a fellow employee, it was not considered the negligence of the employer
Medical payments
in all states medical payments are unlimited
competitive market
in other states, workers compensation is purchased by employers from those insurers authorized to write casualty insurance. The coverage and benefits are mandated by state regulations
Monopolistic state funds
in some states, employers are required to purchase workers compensation insurance from a state-operates entity
death benefits for dependents
in the event of the death of a covered worker, his or her survivors are entitled to benefits in addition to funeral expenses
rehabilitation expenses
include vocational training and necessary medical expenses for physical and mental therapy
benefits provided
medical benefits available to injured workers include payments for medical, surgical, hospital, nursing, ambulance, drugs, medicine, crutches, prosthetic devices, and physical therapy.
remuneration
often just referred to as payroll, is another component in determining remiums
Other states insurance
other states insurance coverage extends an insured's coverage for new or incidental operations in other states on an automatic and temporary basis, subject to certain conditions and time limits
disability income
payments for an injured employee's loss of wages
adjustment upon audit
premiums for workers compensation are based on the actual wages paid in a job classification and cannot be accurately calculated until after the end of the policy year
compulsory laws
require all employers, except those specifically excluded due to staff size or employment type, to provide workers compensation coverage for those meeting the definition of employee
Workers Compensation Law
requires that any compensable injuries are paid to subject workers regardless if the worker was employed by a complying or noncomplying employer; and in the amounts provided by the laws in force at the time of injury
Self-insured employers
responsible for providing compensation for claims from subject workers and their beneficiaries
other insurance clause
states that losses will be paid on a contribution by equal shares basis
assumption of risk
the asserted that the employee knew in advance the risks associated with the job and had been paid for these risks through his or her salary
who is insured
the employer named on the information page is the insured, and in case partnership, a partner is insured but only in the capacity as am amployer of the partnership's employees
exclusive remedy
the right to recover compensation for injuries sustained by workers, the workers beneficiaries, or anyone else entitled to recover damages, is the exclusive remedy against the employer and against the employer and against any officer, producer, or employee of the employer
second (or subsequent) injury fund
these funds are designed to pay for any additional benefits that may be required when an employee with a previous injury or disability suffers a second injury that causes the disability to be more serious than if there had been no prior diability
workers compensation law
this is an important section because the policy language refers back to the workers compensation laws in effect for states listed on the information page
state
this section defines a state, which in any state in the United States of America, and the District of Columbia
The policy
this section summarizes all the components of the policy
Oregon Workers Compensation Fund Insurance Plan
to assign risk and provide the equitable apportionment among workers compensation insurers, the Director. Applies to all authorized workers compensation insurer and the State Accident Insurance Fund Corporation, their agents and the Plan Administrator
death benefits
usually pay a small amount for funeral and burial expenses, and weekly income benefits to the surviving spouse and/or children
elective laws
which means the employer does not have to be subject to the state's workers compensation laws, but if an employer chooses not to be subject to the state's laws, it loses its common law defenses against liability suits
vocational assistance service payments
within 60 days of receiving a billing, the insurer or self-insured employer must pay for all vocational assistance services
workers compensation insurance
workers compensation coverage, which applies to accidental bodily injury, death, or occupational disease, provides coverage for the statuary benefits required under the state's workers compensation laws
job classification - payroll and rates
workers compensation rating is developed by applying a rating bureau job classification rate to each $100 of payroll