Property and Casualty Insurance Basics

Fair Access to Insurance Requirements (FAIR) Plan (continued)

Agents cannot issue any FAIR Plan binder or claim to represent the Association. An agent is permitted to help a consumer complete a FAIR Plan application. FAIR Plan Binders Each application must clearly indicate the availability of a binder to an applicant. Binders require the payment of estimated premium. A binder becomes effective at 1 minute after midnight (12:01 AM) the day after the estimated premium is submitted. A binder cannot take effect earlier than 12:01 AM of the 16th day after the application is submitted. If, through no fault of the applicant, an inspection has not been made and a quote furnished within 15 calendar days of the date the Association received the application, a binder will be issued to the applicant upon payment of the estimated premium. If, through no fault of the inspector or the Association, inspection is impossible at the time of application, the 15-day period will not start until the property becomes available for inspection. A binder is in effect until either: The risk is accepted and a policy is issued; OR The risk is not accepted, the binder is cancelled and the reason given to the applicant The Association calculates the actual premium upon accepting the risk, and will request additional funds if the actual premium is higher than the provisional premium paid. The insured will receive a refund of the balance if the actual premium is lower than what was paid. If a property does not meet underwriting requirements, the Association will cancel the binder on a pro rata basis. If an applicant requests binder cancellation, it will be cancelled according to provisions of approved coverage forms. Binders must be issued for a definite period of time and cannot exceed 1 year. The effective date of an issued policy is the effective date of the binder, and policies issued in this way are not subject to flat cancellation.

Controlled Business

Controlled business is business over which the agent can exercise power or influence, and includes an agent writing coverage for or on their own family, employees, or associates, or on their own interests. In Ohio, if a producer places controlled business with an insurer in an amount equal to or greater than 5% of the insurer's admitted assets in a single year, the insurer cannot accept any additional business from that producer without a written contract between them specifying the responsibilities of each party. Contracts must be approved by the insurer's board of directors and contain the following provisions: Insurer can terminate the contract for cause and with written notice, and can suspend the agent's authority to write business during any resulting dispute over the cause of termination Agent must give accounts to the insurer detailing all material transactions, including information necessary to support all commissions, charges, or fees received by or owed to the agent Agent must remit all funds due the insurer on a monthly basis, and premiums must be remitted no later than 90 days after the effective date of the policy Agent must hold all funds collected for the insurer's account in a fiduciary capacity, maintaining separate, easily-indentifiable records of all business written for the insurer Rates and terms of the agent's commissions, charges, or fees cannot exceed those applied to comparable business placed by producers that are not controlling producers The insurer must annually report to the Superintendent the amount of commission paid to the controlling agent, the percentage that amount represents of the net premiums written by the insurer, as well as the amount of commission paid to each non-controlling agent for the placement of the same kind of insurance, and the percentage that such amount represents of the net premiums written by the insurer. Notice to Prospective Insureds Each controlling producer, prior to the effective date of an insurance policy, must deliver a written notice to the prospective insured that discloses the controlling relationship between the producer and the controlled insurer. Noncompliance If the Superintendent believes that a controlling producer has not complied with Ohio laws and regulations, the Superintendent may order the controlling producer to cease placing business with the controlled insurer. If the Superintendent finds that the producer's noncompliance has caused the controlled insurer or policyholder any loss or damage, the Superintendent may take action for recovery of compensatory damages or other appropriate relief.

Ohio Motor Vehicle Financial Responsibility Law

Financial responsibility laws assure compensation for victims of injury or property damage sustained in a crash. Proof of financial responsibility may be satisfied by one of the following: A financial responsibility identification card (auto insurance ID card) A certificate of proof of financial responsibility on a form provided by the court A liability insurance policy, or the declaration page from such a policy A $30,000 bond or certificate of deposit A certificate of self-insurance, which may be issued to a person who:Has over 25 motor vehicles registered in Ohio in their nameSubmits a self-insurance application to the Registrar of Motor VehiclesCan prove their financial ability to pay judgments. A person may be self-insured for property damage, or bodily injury liability, or for both. The most common way of proving financial responsibility is with an auto insurance ID card that demonstrates coverage meeting the Ohio minimum liability limits of $25,000/$50,000/$25,000. When proof of financial responsibility is required, it may be presented using a cellular phone, PDA, or computer. Proof of financial responsibility must be presented on demand: To any peace officer To any court or traffic violation bureau When an accident occurs that requires the filing of an accident report Whenever the Registrar of Motor Vehicles requests proof Parties to a motor vehicle accident can enter into a written agreement among themselves at any time, establishing damage amounts and a payment schedule. If they file the agreement with the Registrar, the Registrar can enforce the agreement by suspending the defaulted party's driver's license. Note A person whose license has been suspended must file proof of financial responsibility with the Registrar for 3 years for a class D, E, or F suspension and 5 years for an A, B, or C suspension. Failure to report a motor vehicle accident is a misdemeanor. Failure to surrender a suspended license or registration can result in a fine of up to $500, imprisonment of up to 30 days, or both. Other violations of financial responsibility/motor vehicle laws can result in a fine of up to $500, imprisonment for not more than 90 days, or both.

Fire Loss - Treasury Certificate/Demolition Fund

For Ohio municipalities that have opted in by enacting a resolution or ordinance on this matter, and filing a copy with the Superintendent, the following procedure applies to fire claims: When an insurer receives a claim for over $5,000 for fire damage to a building or structure, the insurer must first asks the county treasurer if there are any delinquent assessments or back taxes against the property. If any exist, they must be paid first out of the claim proceeds, transferred directly from the insurer to the county treasurer, before any proceeds are transferred to the insured. The purpose of this statute is to deter arson, discourage property abandonment, and prevent blight. In addition, for fire losses equal or greater than 60% of the policy limit, a portion of the proceeds must be reserved and held by a designated municipal officer until the property has been repaired, removed (demolished), or secured. When this has been done, the reserved funds are released to the insured. If the municipality is forced to repair/remove/secure the property, costs will be deducted from the reserved funds and any remaining funds released to the insured. The amount reserved must be $2,000 for every $15,000 of loss. As an alternative, the insured can provide a contractor's estimate and funds will be reserved in the amount of the estimate.

Covered Injuries

In addition to the standard WC exclusions, under Ohio WC law "injury" cannot refer to: Psychiatric conditions, except if arising from on-the-job injury, disease, or forced sexual contact Injury or disability primarily caused by natural deterioration of tissue, organ, or body part Injury or disability incurred while voluntarily participating in an employer-sponsored recreation or fitness activity, IF the employee signs a waiver prior to participating A condition that pre-existed an injury, unless the injury substantially aggravated the preexisting condition, and the substantial aggravation is documented by objective findings Refusing to be tested for substances can result in denial of benefits or compensation. Occupational Disease An occupational disease is disease contracted in the course of employment, where its causes, the characteristics of its manifestation, or employment conditions results in a hazard that distinguishes the employment in character from employment generally. Further, the employment creates a risk of contracting the disease in greater degree and in a different manner from the public in general.

Standards for Automobile Insurance Claims (continued)

Standards for Fire and Extended Coverage Claims The following applies to policies that base settlement of losses on replacement cost: If not otherwise excluded, the repair or replacement of any part/item and any consequential damage resulting from repair or replacement must be included in the loss If loss requires replacing an item, but the replacement does not match prior quality/color/size, insurer must replace as much as will result in a reasonably comparable appearance When an insurer settles a loss that includes the insured paying a portion of the repair or replacement as betterment, the insurer must maintain documentation showing how the betterment charge was computed and the insured's agreement to such charge prior to incurring the expense of the repair or replacement For losses where the insured pays part of the repair/replacement as betterment, the insurer must document how the charge was computed and the insured's agreement to the charge For policies that settle losses based on actual cash value (ACV), the insurer must determine ACV by calculating replacement cost at the time of loss, including sales tax, minus any depreciation. However, this requirement is waived if the insured's damaged property has nominal or no economic value, or a value disproportionate to replacement cost minus depreciation.

Employment Covered (Required, Voluntary)

The following types of employees must be included in the definition of "employee:" Minors, aliens, part-time/seasonal workers, employees related to the employer Elected officials at all government levels Off-duty persons responding to an inherently dangerous situation as if on duty, such as:Off-duty peace officersOff-duty firefighters of a lawfully-constituted fire department (whether paid or volunteer)Off-duty first responders, EMTs, paramedics, (whether paid or volunteer) Coverage is not required for the following employees, although employers can choose to cover them: Domestic and casual workers who earn less than $160 from 1 employer in any 3-month period Ordained ministers, officers of a family farm corporation, or incorporated individuals

Ohio Commercial Insurance Joint Underwriting Association

This is a nonprofit, unincorporated association that provides assistance in placing commercial insurance risks in Ohio, including liability for commercial multi-peril insurance. Membership includes all authorized insurers who provide liability insurance in Ohio on a direct basis. The plan is administered by a Board of Governors, subject to the supervision of the Superintendent. An applicant will be considered for a policy if the applicant provides evidence (3 denials of coverage from insurers) that the Ohio commercial market assistance plan was unable to help the applicant get coverage. Requests must be in writing and submitted by a licensed Ohio agent broker. Policies are issued for a term of 1 year. The Association must submit a policy form for the Superintendent's approval at least 30 days before use. The policy form is deemed approved if not disapproved within that 30-day period. All members participate in the plan proportionally based on the premiums written by each member compared to the aggregate premiums written by all plan members.

Maximum Limits of Liability

$1.5 million, per location, for basic property and homeowners' insurance $10,000 for residential crime insurance $15,000 for commercial crime insurance

Any policy that includes UM and/or UIM coverage must also offer UM/UIM property damage coverage in what required amount?

$7,500, or the amount otherwise available for vehicle damage, whichever is less

Employer Reimbursement

An employer can request reimbursement from the BWC for benefits or compensation the employer provided to an employee for injury/occupational disease, as long as: The employee was not receiving any WC compensation or benefits at the time; AND The injury/disease was subsequently determined to be compensable Professional Sports Franchise Employees If an employee of a professional Ohio sports franchise is disabled by injury/occupational disease, the amount paid to the employee under a contract/collective bargaining agreement is considered an advanced payment of Workers' Compensation. The employer will be reimbursed the amount of the payments out of any compensation award made pursuant to Ohio Workers' Compensation statutes.

Ohio Automobile Insurance Plan

Auto insurance for persons who cannot obtain coverage through normal markets is made available through this assigned risk plan. All insurers providing auto insurance in Ohio must participate. When an automobile policy is cancelled or nonrenewed by the insurer for a reason other than nonpayment of premium, the notice must include a statement informing the insured of the availability of the Ohio Automobile Insurance Plan and how to apply. The plan must file annual audited financial reports with the Superintendent, and must comply with all filing requirements for forms, endorsements, rates, and rating plans.

Benefits Provided (continued)

Cardiovascular/Pulmonary Disease 30 weeks at 50% of the state average weekly wage; then 75 weeks at 66 2/3% 200 weeks of compensation is paid if the percentage of permanent disability is 90% or higher. No award will be made based upon a percentage exceeding 100%. Permanent disability compensation is payable beginning from the date of last payment of compensation, or, in cases where no previous compensation has been paid, from the date of the injury or of the occupational disease diagnosis. Of an award made prior to the death of an employee, all unpaid installments accrued or to accrue are payable to the surviving spouse, or to the children, or to other dependents of the employee.

Benefits Provided (continued)

Death Benefits If a deceased worker has no dependents, death benefits are limited to funeral costs, up to $5,500. If there are dependents, the total weekly death benefit compensation is 66 2/3% of the deceased worker's average weekly wage, subject to the following limits: Maximum: 66 2/3% of the state average weekly wage Minimum: 50% of the state average weekly wage Where there is only one dependent, they receive the entire weekly benefit. Where there are multiple dependents, the BWC administrator apportions the weekly benefit among them. Death benefit payments to a dependent spouse continue from the date of the worker's death until: The spouse's death, OR The spouse's remarriage, at which point the remarried spouse receives a lump sum amount equal to 2 years of benefits, and compensation ends For dependents other than a spouse, death benefit payments continue: Until age 18, or until age 25 if enrolled full-time in an educational institution Beyond age 25 for dependents physically or mentally incapacitated from earningBenefits cannot be denied or terminated if a physically/mentally incapacitated dependent is employed in a sheltered workshop earning under $2,000 a calendar quarter Spouses and children are considered wholly dependent, or "full" dependents. Other family members may be considered partial dependents, or prospective dependents if they are the descendant, ancestor, or sibling of the deceased. The administrator determines who qualifies as a partial or prospective dependent, the apportion of benefits (if any), and duration of payments. If the deceased worker was living with one or both parents at the time of death, a one-time single benefit of at least $3,000 is paid to the parent(s). Payments to any prospective dependents (other than parents) cannot exceed $3,000 aggregate. Note Under this section of law, a "full dependent" also includes a surviving spouse who was separated from the employee at the time of death because of the employee's aggression.

Medical Malpractice - Cancellation and Nonrenewal

For medical malpractice policies, the cancellation effective date (for other than nonpayment of premium) must be at least 60 days from mailing the notice. An insurer must file with the Superintendent a written notice of its intended action to cancel, terminate, or otherwise not renew all policies of medical malpractice insurance: It has issued to any class, type, or specialty of practitioner In a specific geographic area, which can include the state as a whole The following time frames must be kept for this notice: 180 days' advance notice when the insurer is intending to terminate all medical malpractice policies it has issued in Ohio 120 days' advance notice when the insurer is intending to terminate all medical malpractice policies for a specific class, type, or specialty of practitioner or in a specific geographic area other than this state as a whole 120 days' advance notice when the insurer is making changes in its underwriting guidelines, if the effect of those changes will be to cancel, terminate, or otherwise not renew all policies of medical malpractice insurance for a specific class, type, or specialty of practitioner or in a specific geographic area other than this state as a whole. Notification of FAIR Plan Eligibility Insurers who cancel or nonrenew a risk that is eligible for FAIR Plan coverage must include in the 30 days' written notice an explanation of the insured's eligibility and application procedures. This does not apply to binders of 30 days duration or less, and does not apply if the cancellation or nonrenewal is for nonpayment of premium, misrepresentation, or evidence of arson.

Homeowners ('11) Policy

Homeowners Policy Endorsements Ohio Special Provisions (HO 01 34) The insurer only has to give 10 days' notice if cancelling for any of the following reasons: Nonpayment of premium Material misrepresentation of facts related to insurance Evidence of arson Cancelling for any other reason requires notice of at least 30 days. Insurers can nonrenew for any reason at the anniversary by providing at least a notice of 30 days before the policy expiration date.

Retaliatory Provisions

If the laws of any other jurisdiction (state, district, territory, or nation) impose any requirements on Ohio insurers doing business in that jurisdiction, or upon Ohio agents, the same requirements shall be imposed upon insurers of the other jurisdiction doing business Ohio, and upon their agents. 20% of any fees collected as a result of these requirements from foreign insurers doing business in Ohio must be paid the Ohio Fire Marshal's fund. Declination of Insurance and Unfair Discrimination It is illegal to cancel, nonrenew, or refuse to issue a policy due to the applicant's or policyholder's gender or marital status, or to discriminate between persons of the same class and/or hazard.

Standards for Automobile Insurance Claims

In settling partial losses, the insurer must give the claimant a copy of any estimate it uses to determine settlement. If that estimate is less than the claimant's estimate, the insurer must either: Pay the different between the estimates; OR Name at least one shop that will make all repairs for the amount of the insurer's estimate An insurer that reduces a claim amount because of betterment, depreciation or comparative negligence must keep all information pertinent to the reduction in the claim file. Such deductions must be itemized and specified as appropriate dollar amounts on the estimate. Betterment deductions are only allowed if they reflect measurable decrease in market value due to: Poor condition of or prior damage to the vehicle General overall condition of the vehicle, considering its age Wear, tear, rust and/or missing part(s) (deduction cannot exceed part replacement cost) Any "like kind and quality" parts used must be obtained from a licensed salvage dealer, clearly indicated and with the dealer's location included in the estimate. If an insurer designates a specific repair shop, the following conditions apply: Vehicle must be restored to its condition prior to the loss Insurer cannot assess additional cost against the claimant other than stated in the policy Repairs must be effected within a reasonable period of time The insurer cannot require repairs be done at a specific shop In Ohio, a total loss is determined by insurer using the Total Loss Formula, where the cost of repair is added to the projected salvage value. If this total is more than the ACV, it is an Economic Total Loss. However, if the vehicle is demolished or beyond repair, this is a Constructive Total Loss. In settling total losses, an insurer that chooses to offer a replacement automobile must: Provide an auto by the same maker, of the same/newer year, with similar body style, options, and mileage as the claimant's auto (equal/better condition than the auto pre-loss) Make the auto available for inspection within a reasonable distance of the claimant's residence Pay all taxes, licenses, and fees to transfer ownership to the claimant, minus any deductible Document the offer of the replacement auto and any rejection of the offer in the claim file In settling total losses, an insurer that chooses to offer a cash settlement must base the offer on the actual cost to purchase a comparable auto, minus any applicable policy deductible and/or betterment deduction. Offer value can be derived from one of the following: Average cost of 2 or more comparable autos in the local market, if such autos were available to consumers within the last 90 days Average cost of 2 or more comparable automobiles in nearby markets, including the closest in-state or out-of-state major metropolitan areas If comparable vehicles are not available, the average of 2 or more price quotes obtained by the insurer from licensed dealers within the local market area Cost estimate by a generally-recognized used motor vehicle industry source Note Any of the above methods or sources must be used consistently. If the claimant receives a cash settlement and buys a replacement auto within 30 days, the insurer must reimburse the claimant for sales tax if the replacement costs the same or less than the settlement. Insurers can also include the sales tax amount in the settlement. If the replacement auto costs more than the settlement, the insurer is only responsible for paying sales tax to the level that the settlement amount would have purchased. Claimant must provide documentation of auto purchase and payment of sales tax within 33 days after receiving the settlement, otherwise the insurer is excused from reimbursing such sales tax. An insurer must notify the claimant of any rights to renegotiate the settlement if a comparable vehicle is not available for purchase within 35 days of receipt of the settlement.

Mine Subsidence

Mine subsidence refers to loss caused by the collapse or movement of buildings/structures resulting from the caving in of underground mines, specifically. Mine subsidence does not include loss caused by strip mining, earthquake, landslide, volcanic eruption, or collapse of drains or tunnels. The Ohio Mine Subsidence Insurance Underwriting Association (OMSIUA) was created to make mine subsidence coverage available by transferring risk from association members to the association itself. All admitted Ohio property insurers are required to be members. OMSIUA and any participating insurer can assume and cede reinsurance on insurable risks. OMSIUA manages the Mine Subsidence Insurance Fund, which is funded by member reinsurance premiums. The fund is audited annually by the State Auditor and the State Treasurer is the custodian. Eligibility The following structures are eligible for OMSIUA coverage: 1-4 family dwellings, with at least 50% of total living area occupied Builders' risks, if constructing a 1-4 family occupied dwelling structure Seasonal properties Structures with incidental occupancy, IF:The structure is not commercially rated; ANDQualifies for a Homeowners or Dwelling policy In addition, the structure must be: Currently covered by a valid Homeowners, Farm, Mobile Home, or basic property policy Located in an eligible county where coverage is either required or must be offered Coverage can be denied for: Material misrepresentation of facts or circumstances concerning mine subsidence An increase in occupancy hazard known to the insured and within the insured's control. Coverage and Limits of Liability There is an annual premium of: $1 in a mandatory county (where insurers are required to include this coverage) $5 in an optional county (where insurers are only required to offer this coverage) There is a 2% deductible per occurrence, which must be at least $250 and not more than $500. For property damage to the structure caused by mine subsidence, OMSIUA provides up to $300,000 of coverage, or the amount of insurance on the dwelling, whichever is less. The Valued Policy Law does not apply to mine subsidence policies. If a structure is covered for mine subsidence by multiple policies, the liability limit is the highest Coverage A limit on a single policy, or $300,000, whichever is less. Coverage includes: Cost of excavation or grading Foundations, boilers, or engines below the basement floor (if applicable) or the ground Underground pilings, piers, pipes, flues and drains and/or pilings below the watermark Private garages (up to 10% of coverage limit) Sidewalks/driveways (up to 10% of coverage limit, and only if structure is also damaged) Up to $5,000 for living expenses and/or fair rental value if the structure is unfit to live in. Payment will be for the shortest time required for repair. Coverage excludes land, trees, crops/plants, items, barns, or commercial/industrial buildings. The total of all amounts of coverage compensable to an insured will not exceed $300,000. Effective Dates of Coverage In optional counties, there is a 15-day waiting period if coverage is purchased mid-term.

Property and Casualty Insurance Basics

Ohio Laws, Regulations, and Required Provisions Ohio Valued Policy Law Ohio is one of many states with a valued policy law, the purpose of which is to protect the policyholder in the event of a total loss. Ohio law requires an agent inspect and produce a full description of a building before insuring it, in order to establish its insurable value. With the value of the property established up front, in the event of a total loss by fire or lightning the whole policy amount must be paid (as long as there was no fraud or increased risk). However, if the policy specifically stated any repairs were required in order for the insured to be paid the full policy value, and the insured had not made such repairs at the time of loss, then the claim will instead be paid according to the policy. Note The cellar and foundation walls are excluded from settlements.

Dwelling ('14) Policy

Ohio uses the 2014 Dwelling Policy, which adds the following to Coverage D - Fair Rental Value: The policy will pay only the proportionate share of the total value of the rental amount for each month the rented part of the Described Location is unfit for its normal use. The proportionate share corresponds to the number of months the Described Location is rented or held for rental. Dwelling Policy Endorsements Selected Endorsements - Ohio Special Provisions (DP 01 34) The insurer only has to give 10 days' notice if cancelling for any of the following reasons: Nonpayment of premium Material misrepresentation of facts related to insurance Evidence of arson Cancelling for any other reason requires notice of at least 30 days. Insurers can nonrenew for any reason at the anniversary by providing at least a notice of 30 days before the policy expiration date.

Other Coverages and Options

Residual Markets Fair Access to Insurance Requirements (FAIR) Plan The Ohio FAIR Plan Underwriting Association makes basic property and homeowners' insurance coverage available for qualified Ohio property when coverage cannot be obtained in the normal insurance market. Membership is required for all property insurance companies doing business in Ohio. Property must be an insurable risk and meet reasonable underwriting standards. Perils covered are fire and extended coverage endorsements. The association may require coverage for vandalism and malicious mischief. The Association is under no obligation to issue coverage on uninsurable risks. The condition of surrounding property(ies), where such condition is not within the applicant's control, cannot be grounds for refusal to insure. Application and Policy Issue Every policy written by the Association includes conditions requiring that: At least 2 Ohio admitted carriers have declined the coverage requested in the application The property bears no outstanding taxes, assessments, or penalties The applicant either:Has not received any written notice of a public code or ordinance violation; ORHas received written notice of a building, housing, pollution, sanitation, health, fire or safety violation and has included a detailed plan of correction with the application A detailed plan of correction may also be required if violations are found upon inspection. If satisfied that violations will be corrected in a reasonable period of time, and the applicant otherwise meets the underwriting requirements, the Association can issue a policy or binder of basic property insurance on the condition that the plan be implemented on schedule and that the property be re-inspected. No coverage will be provided unless repairs are to start within 30 days after the application date. Policies issued by the Association are for a term of 1 year. Commissions must be paid to the resident licensed agent designated by the applicant. Nonresident agents cannot be paid commission for Association risks

Ohio Workers' Compensation Laws

Statute of Limitations for Filing Claims Claims for injury or resultant death must be made within 1 year of the injury/death. Claims for occupational disease or resultant death must be made: Within 2 years after disability due to the disease began; OR Within 6 months of diagnosis of the disease by a physician; OR Within 2 years after death from the disease occurs Exclusive Remedy If an employee is a resident of another state, and is insured under Workers' Compensation or similar laws of that state, the employee and their dependents cannot receive compensation or benefits from Ohio. The laws of their resident state are the exclusive remedy against the employer in such cases. An employee or their dependent who chooses to receive benefits/compensation from Ohio cannot receive benefits/compensation from any other state for the same claim, and must sign a waiver to that effect within 28 days after the claim request is submitted. If an employee or their dependent receives benefits/compensation from Ohio and subsequently accepts benefits/compensation from another state for the same claim, the Ohio employer can sue to recover amounts paid, with interest, costs, and legal fees. If any of an employee's work is to be done in a state other than Ohio, the employee and employer can agree in writing to be bound by the laws of Ohio, or by the laws of another state in which some or all of the work is to be done. Agreements must be filed with the BWC within 10 days after creation. The state of Ohio will not provide compensation or benefits for employees covered under the federal Longshore and Harbor Workers' Compensation Act. Instead, employee/dependents' rights under that Act are the exclusive remedy against the employer in such cases.

Terrorism Risk Insurance Program Reauthorization Act of 2015

The Reauthorization Act amended TRIA to include acts committed by persons with no foreign affiliation to also be treated as acts of terrorism. Insurance Limits The program has a trigger applying to certain acts with insurance losses exceeding $140 million. This trigger is set by law to increase incrementally by $20 million per year. Before the program is triggered, the industry must cover a portion of the losses, called a retention amount. This amount is set to increase incrementally until it equals $37.5 billion in 2020 and thereafter. The insurer deductible is 20% of all covered losses. Once the deductible is met, the insurance company's coinsurance, or share of loss, is 15%, while the federal government is responsible for the remaining 85%.

Benefits Provided

The first 7 days are not payable until the affected employee has missed 14 consecutive days, at which point benefits for the first week must be paid immediately in addition to any other weekly benefits due. Benefits and compensation for injuries and occupational diseases include: Medical, nursing, and hospital services, including exams, diagnoses, and recommendations Medicine, rehabilitation, death benefits, and funeral expenses Provision, repair, and replacement of artificial limbs Repair/replacement of glasses, dentures, or hearing aids, if damaged in the same accident that caused the employee's qualifying injury Temporary Partial Disability Under Ohio law, temporary partial disability—where an employee returns to work but cannot perform the same duties or with the same duration as before—is handled through wage loss benefits. Wage Loss Benefits An employee who suffers wage loss as a result of taking employment other than their former position because of injury/occupational disease will be compensated at 66 2/3% of the difference between their prior and current average weekly wage, not to exceed the state average weekly wage. Such payments can continue for up to a maximum of 200 weeks. An employee who suffers wage loss due to not being unable to find employment consistent with a disability resulting from injury/occupational disease will be compensated at 66 2/3% of the difference between their former average weekly wage and present earnings, but not to exceed the state average weekly wage. Such payments can continue up to 52 weeks. The first 26 weeks of payments are in addition to the above 200-week maximum, but compensation beyond 26 weeks is deducted from the 200-week maximum. No one can get these benefits for over 226 total weeks.

Ohio Property & Casualty Insurance Guaranty Association (OIGA)

The guaranty association exists in order to provide a way to cover the financial obligations of an insolvent insurer. All admitted property and casualty carriers are required to be members in order to do business in Ohio. The association is funded by member assessment. The Superintendent will notify the association within 3 days of receiving notification of an insurer's insolvency. When an insurer becomes insolvent, the guaranty association will cover its claim obligations where: The claimant was an Ohio resident when the loss occurred; OR The claim is for property permanently located in Ohio Claim payment by the guaranty association is also subject to the following conditions: Claims must be at least $100 and no more than $300,000 Maximum $10,000 on an unearned premium claim Claims arising out of bodily injury or death to any one person constitute a single claim regardless of the number of policies issued or the number of claims made The guaranty association will refuse to pay any claim that is: Due to a reinsurer, insurer, insurance pool, or underwriting association through subrogation Due to any person who is an affiliate of the insolvent insurer Due to an insured whose net worth exceeds $50 million at the end of the last fiscal year The association covers claims that existed before the insolvency and that arise within 30 days after insolvency. It will also cover claims that arise before a policy's expiration date if it's less than 30 days after the insolvency date. Policy provisions between the insured and insolvent carrier still apply. The Superintendent can order: The association to notify an insolvent carrier's insureds of the insolvency and of their rights (After notice and hearing) the suspension/revocation of the Certificate of Authority of any member that fails to pay assessment, or fails to comply with the association operation plan In lieu of suspension/revocation, a penalty on a member that fails to pay assessment when due, of at least $100 per month and not more than 5% of the unpaid assessment per month Revocation of a servicing facility's designation if claims are being handled unsatisfactorily Claimants seeking the association's protection must cooperate to the same extent as they would have been required to cooperate with the insolvent insurer. The association will be subrogated to the rights of any person recovering to the extent of the person's recovery from the association. If a person has a claim that is payable by the association but also payable under a policy issued by another insurer, the person must first exhaust the rights under the other policy with the non-insolvent insurer. The association's liability will be reduced by the amount recovered under the other policy. An insurer's rate cannot be found excessive solely because it contains a factor designed to recover amounts paid to the association as assessment. The association can establish a payment plan making assessments or projected assessments payable periodically.