Workers Comp

Compulsory vs. Elective

*Compulsory - Employers required to provide Workers' Compensation benefits to employees or demonstrate the ability to provide. *Elective - Employers have choice to accept or reject Workers' Compensation laws.

What are the basic limits of Part II of a standard WC policy?

100K per bodily injury incident 100K for employee disease 500K all disease claims *can purchase more for higher premium

How long can go by before a FELA action can no longer be filed?

3 years from the day the cause of action began

Defense Base Act

Applies to workers on military bases

If the premium charged for a particular insured is increased or decreased for a future period based on that insured's loss experience for a period in the recent past, the policy uses a(n)

Experience Rating

T or F: The insurer must provide the insured with at least 15 days of notice before any type of cancellation

False -- the required condition is 10 days advanced notice

T or F: the rights and duties can be transfered to to anyone else without the insurer's written consent

False. written consent is required. This is called assignment

If an employer in a state with elective workers compensation laws chooses not be to subject to those laws, what does the employer lose?

Its common law defenses against liability suits

Federal Employees Compensation Act

Mandates workers' compensation insurance protection for federal civilian employees.

Monopolistic State Fund

Method of providing worker's comp where employers purchase Worker's comp from a state fund.

Workers compensation will pay under which of the following situations?

Paid without consideration of fault or negligence on the part of either employee or employer

Workers compensation statutes require employers to meet capital reserves requirements sufficient to pay any claims that might arise. Employers can meet such obligations through all of the following EXCEPT Second injury funds programs. Self-insurance plans. Assigned risk plans. Competitive state funds.

Second injury funds programs. Self-insurance plans. Assigned risk plans. Competitive state funds. Second injury funds are a method by which employers manage the risks associated with the hiring of previously injured potential employees.

In order to be covered by the U.S. Longshore and Harbor Workers Compensation Act, a worker must meet the requirements of the

Situs and status test. A worker is covered under the U.S. Longshore and Harbor Workers Compensation Act (LHWCA) only if he or she meets a situs and a status test. The injury must occur on the navigable waters or on an adjoining wharf, pier, dock, or similar facility used in the loading, unloading, building, or repairing of vessels. In addition, the individual must have been engaged in maritime employment when injured.

Under the workers compensation system, who is responsible for the expenses resulting from work-related injuries and occupational diseases?

The employer, regardless of who was at fault for the injury or disease. Employers are required to purchase workers compensation policies. Part One pays for work-related injuries to employees without regard for negligence.

The voluntary compensation endorsement in a workers comp policy provides that the insurer will pay statutory benefits to the insured person in exchange for what?

The injured person must release the employer and the insurer from further liability

What is the primary objective of workers compensation?

The payment of benefits to employees for injuries arising out of their employment

If an employer in a state with elective workers compensation laws chooses not to be subject to these laws, what do they forfeit?

Their common law defense against liability law suits

Prior to state-directed workers compensation statutes being enacted, employees had

To sue an employer for the "loss" and prove that the employer was at fault.

Employers liability insurance, Part II of a standard policy form excludes intentional or negligent acts by the insured -- T or F?

True -- an intentional act that is caused by the insured is excluded because the employer is not liable for damages caused by intentional acts (negligence) of the insured.

Shipbuilders and repairers are covered by the

U.S. Longshore and Harbor Workers Compensation Act.

Ship builders and repairers are covered by the

US Longshore and Harbour Workers Compensation Act

Federal Employers liability act

allows workers to sue their employer for negligence. makes an interstate railroad liable for bodily injury on the job. covered under section II

According to the conditions of a workers compensation policy, the insurer has the right to inspect the insured workplace

anytime

If an employee is injured while visiting an employers out of state office, how will the workers comp benefits be determined?

benefits will be provided if the state was listed on the policy information page (employers must list all states in which they do business on the policy information page for coverage to apply in out of state injuries)

Workers compensation laws provide for all of the following EXCEPT: compensatory medical rehab death

compensatory - awards for pain and suffering are not compensated under workers compensation

The jones act covers

crews of ships

Who is required to set up a workers compensation program or purchase it for their employees?

everyone. All businesses

True or false: the insurer may inspect the workplace after giving the insured five days notice

false -- the insurer has the right to inspect the insured without giving notice - this is called the inspection condition

Competitive market - workers comp

insurers are authorized to write casualty insurance. coverage and benefits are mandated by the state regulations

What are the factors in rating workers comp policies?

job classification - hazard of the work payroll - amount of payroll loss experience - employer's prior loss experience

What does FELA allow workers to recover?

lost earnings, past, present and future medical expenses paid out of pocket payment for reduced earning capability pain and suffering compensation

A plant worker was just diagnosed with a rare blood disease. She tells her doctor that she was required to handle toxic chemicals at work. Which of the types of injuries is covered under workers compensation policy?

occupational disease caused or aggravated by a condition of employment.

Federal Black Lung Benefits Act

pays to coal miners specified death and disability benefits related to chronic diseases of the lung

What is the name for such disabilities as the loss of limb, hearing, or eye sight?

permanent partial disability

Migrant and Seasonal Agricultural Worker Protection Act

protects migrants and seasonal workers Farm Labor Contractors must register with Dept. of Labor

To be covered under the US Longshore and Harbour Workers Compensation Act a worker must meet the requirements of

situs and status test must have happened on navigatable waters, wharf, dock, or similar, WHILE engaged in maritime employment

Which workers compensation conditions state that the first named insured will act on behalf of all insureds under the policy?

sole representative

Which of the following terms refers to a person's ability to do some work or the need to do alternative work?

temporary partial disability

True or False: If the policy period is longer than 1 year and 16 days, all policy provisions will apply as though a new policy was issued on each anniversary date

true - this is called long term policy condition

True or False: the first name insured will act on behalf of all insured under the policy

true - this is called sole representative condition

United States Longshoresmen's and Harbour workers Compensation

workers comp benefits to boat crews, shipbuilders or repairmen