Workers Compensation Laws

Describe the mission of the New York State Insurance Fund (NYSIF) and the New York Workers Compensation Fund

-provide timely and appropriate indemnity and medical payments to injured workers -drive down the cost of workers compensation insurance for business operating in this state -ensure all NY business have a market for workers comp insurance available at a fair price -maintain a solvent state insurance fund- always available for NY businesses.

In a competative state, an employer can obtain workers compensation insurance from whom?

A private insurance company or the state fund

What are the employee's duties if injury occurs?

After an injury, an employee's duties are to: -notify the insurer at one -provide immediate medical care required by law -provide the names and addresses of any workers injured- and any witnesses -promptly send any notices or legal papers -cooperate with the insurer -do not make any voluntary payments or assume any obligations

Employers liability insurance, Part Two of a standard workers compensation and employers liability (WC&EL) policy form, exclude what?

An intentional act that is caused by the insured- no policy will cover intentional acts of negligence or tort.

What is the premium computation for workers compensation insurance?

Because the initial premium calculation is based on estimated payrolls, a premium auditor may inspect actual payrolls paid to ensure that adequate premiums are being paid.

An employee is injured while visiting the employer's out-of-state site. How will the workers compensation 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 those states.

Workers compensation laws Do Not provide coverage for this specific benefit:

Compensatory benefits. Awards for pain and suffering are not compensated under workers compensation.

How are compulsory laws different from elective laws?

Compulsatory laws require employers to provide workers compensation coverage to employees- Elective laws do not.

How many weeks of paid time off does Paid Family Leave currently guarantee?

Currently it guarentees 8 weeks- this will be adjusted to 12 weeks by 2021

What is the purpose of employers liability insurance?

Employers liability insurance protects the insured from situations that are not covered under a state's workers-comp laws.

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 what type of plan?

Experience rating plan. An experience rating plan adjusts the premiums charges based on the claims history, positive or negative, of the individual insured.

Under which part of a workers compensation and employers liability policy would you find a description of the insured's obligations when an injury occurs?

Part Four- Your Duties if Injury Occurs

Under which part of a workers compensation and employers liability policy would you find a description of employers liability coverage provided?

Part Two- Employers Liability Insurance

How are premiums determined for workers compensation insurance?

Premiums are determined based on the payroll or each occupational classification.

All of the following are factors in rating workers compensation insurance EXCEPT: Payroll. Loss experience. Job classification. Sales.

Sales The hazard of the work, the amount of payroll, and the employer's prior loss experience are all rating factors.

Under workers compensation, crews of ships are covered by what?

The Jones Act

What rules apply to states with monopolistic state workers compensation funds?

Under the monopolistic state fund program, no private insurer is allowed to market competitive programs in the state. In such states, workers compensation is available to all employers, but employers liability coverage may or may not be offered.

What are the basic limits provided for employers liability insurance?

-$100k for bodily injury per accident -$100k per employee for disease -$500k policy limit for disease (for all disease claims within the policy term)

What is the difference between a monopolistic state fund and a competative market?

In monopolistic state funds, employers are required to purchase workers compensation insurance from a state-operated entity. In a competative market, workers comp is purchased by employers from insurers authorized to write casualty insurance.

What should an employer/insured NEVER DO if an injury occurs at the workplace?

Make voluntary payments for treatment of the worker's injury The insured's duties are to 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, and to not make any voluntary payments or assume any obligations.

Which of the following benefits are paid under workers compensation laws? -medical -rehabilitation -disability income -pain and suffering

Medical & Rehabilitation

What do the supplemental payments for workers compensation include?

Payments include defense costs, expenses incurred at the insurer's request, premium for certain bonds, litigation costs, interest on judgements required by law until the insurer offers a settlement, and all the expenses the insurer incurs.

In this state, all employees must be covered by the employer's workers compensation insurance EXCEPT?

Public school aides. Public school aides are excluded from the required workers compensation coverage. All the other types of employees listed must be covered by the employer's workers compensation insurance.

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

The employer, regardless of whether it 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 legal concept that requires that worker's compensation coverage benefits to be accepted by an injured employee as the only recourse the employee has in the settlement of injury claims is called?

The exclusive remedy concept. Workers compensation is the exclusive remedy for all injury claims against employers.

According to the standard workers compensation and employer liability policy form, a state should be listed in Part Three - other states' insurance of the workers compensation and employers liability policy when?

The insured expects to extend operations to that state. By naming a state in Part Three of a workers compensation and employers liability (WC&EL) policy, an employer provides that company operations may be conducted in that state.

In most states, workers compensation laws apply to whom?

To most workers, except those specifically excluded by law.