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