Unit 9 Worker's Compensation Law
Define disability benefits under the worker's compensation law. _I____ because of the injury to earn in the same or any other employment the _w____ that the employee was receiving at the time of the injury. Compensation for such "wage loss" is the _d____ between post-injury (if any) and pre-injury wages.
Inability, wages, difference
9.2b Employers and Employees
"Employee" is defined to mean every person engaged in any employment under any appointment or contract of hire including aliens and minors. "Employee" does not include independent contractors, in the non-construction business, "casual" work, commissioned real estate agents, certain musical and theatrical performers, certain truck owner-operators, certain taxicab, limousine and passenger vehicle-for-hire drivers or volunteers. Corporate Officers: An officer of a corporation is an employee if the officer performs services for the corporation for pay. When the officer is considered to be an employee, the worker's compensation law allows the officer the option to be exempt from worker's compensation coverage by filing a proper notice with the Division (the Division of Worker's Compensation of the Department of Labor in Employment Security is referred to as simply the Division). A corporation in the construction industry may only exempt three or fewer officers and those officers must own a minimum of 10% of the corporation; other corporations may exempt officers without limitation. Once the Division approves an officer's exemption, that person is no longer counted as an employee when determining whether a firm must carry compensation.
How are benefits of "permanent total" disability paid under the worker's compensation law? At ____% of the employee's average weekly wage during the period of disability without limit of time.
66 2/3%
How many categories of "benefits," and what are they, under the worker's compensation law? True or False: There are two (2) benefits: Compensation for disability and Death.
False
9.6 Medical Expenses:
Medical Expenses have no dollar limitation under the worker's compensation law. The employer is obligated to furnish any required medical treatment, care and attendance under a qualified physician or surgeon or other recognized practitioner, nurse or hospital including medicines, crutches, artificial members and other apparatus.
Is the worker's compensation law the same in every state? ____, although the law varies in detail from state to state, basically the end r____s are the same.
no, results
What is the worker's compensation law? Employees are compensated for injuries incurred on the job regardless of f____, in return for which employees i____ employers from injury lawsuits.
fault, immunized
How are the benefits paid for "temporary partial disability" under the worker's compensation law? Benefits are paid under the "w___ l____" formula, for a period of ____ weeks of impaired earnings. This benefit is computed weekly.
wage loss, 104
Which of the following is not true regarding the Workers' Compensation Law? Each state has a Workers' Compensation Law The basic thrust of the law is that employees are compensated for occupationally incurred injuries Workers' Compensation is regulated by The Division of Insurance of the Department of Financial Services Employers are immunized from injury lawsuits by employees
Workers' Compensation is regulated by The Division of Insurance of the Department of Financial Services
What are the employee's rights against their employer? An employee who is injured in the course of employment is b____ from an action against the employer except for c____ benefits.
barred, compensation
Who is an employer under the worker's compensation law? Typically, one who must provide and secure benefits for "e____," including the state, political subdivisions and public as well a quasi-public corporations.
employees
True or False: Part One - Worker's Compensation pays almost all benefits required of the insured under a worker's compensation law of most states declared in the policy for Part One coverage. There are a few exclusions and there are dollar limitations to the insurer's liability. Coverage applies to almost any accident occurring during the policy period. It covers bodily injury resulting from accident or disease and includes resulting death. It also covers the cost of defending the employer against most claim for these benefits.
False
Consider how worker's compensation laws vary from state to state. Then answer: True or False: In all states, the benefits are paid entirely through private insurance or self-insurance means, however the benefits are regulated by the state.
False This statement is True: In some states, worker's compensation benefits are provided entirely by the state. In other states, both state funds and private insurance are utilized.
Define medical expenses under the worker's compensation law? True or False: The employer is to furnish any required medical treatment, care and attendance under a qualified physician or surgeon or other recognized practitioner, nurse or hospital up to the dollar limitation upon this obligation.
False. with no dollar limitation.
9.3 Penalties for Noncompliance
Florida statute provides for significant penalties for employers who are required to carry worker's compensation insurance but failed to so. First, such failure is a third-degree felony. Second, the division may issue a Stop-Work Order that will cease all business operations. Third, the division will also assess a penalty equal to 2 times what the employer would have paid in premiums over the last 2 years or $1000, whichever is greater. Further, when an employee has a compensable injury, and the employer has not secured worker's compensation benefits, the employee may elect to collect statutory benefits or bring a common law suit. If the latter is elected, the employer is prohibited from pleading defenses what he or she normally may have used in the lawsuit.
9.9b Worker's Compensation and Employers' Liability Insurance Policy:
Part Two is subject to three limits of liability: (1) for all claims in each accident; (2) per employee for disease; and (3) for aggregate disease claims. The basic and minimum limits which are automatically included in all policies are $100,000/$100,000/$500,000. Increased limits are available. Part Three - Other States: As previously discussed, Part One lists the states covered by the policy. The insured is obligated to notify the insurer if work begins in any state not listed. Other States may be utilized to provide automatic coverage in other states.
Name the classes of disability benefits under the worker's compensation law. The classes are P____ Total (total in nature and of permanent duration), T____ Total (total in nature but of temporary duration), P____ Impairment (partial in nature but of permanent duration), and T____ Partial (partial in nature and of temporary duration).
Permanent, Temporary, Permanent, Temporary
9.2c Employers and Employees:
Sole Proprietors, Partners: A sole proprietor or partner is considered to be the employer, not an employee. Therefore, they are not required to be included as an employee when determining whether a firm must carry worker's compensation. A Florida statute provides sole proprietors or partners the opportunity to elect to be covered by filing the proper election form with the Division. Construction Industry Exceptions: Florida statute specifically designates sole proprietors and partners in the construction industry as employees. They are therefore provided compensation benefit. Sole proprietors, or partners, may not exempt themselves from coverage. Independent Contractors: As previously stated, independent contractors are not considered employees under Florida statute. The worker's compensation law lists several criteria, which an independent contractor must meet (non-construction industry must only meet four): 1. An independent contractor must maintain a separate business (their own facilities, vehicles, equipment, etc.); 2. An independent contractor must hold or have applied for a federal identification number unless not required by the federal government (i.e., sole proprietor); 3. An independent contractor must perform specific work or services for specific amounts of money and be in control of the method of performing the work or service. Compensation must be paid to a business rather than to an individual; 4. An independent contractor must hold one or more bank accounts in the name of the business entity for the purposes of paying business expenses or related expenses for work or services performed; 5. An independent contractor performs work or is able to perform work for any entity in addition to or besides the employer at his choice without the necessity of completing an employment application or completing an employment process; or 6. An independent contractor is the only compensated on a commission, per job, or competitive bid basis upon completion of a task or set of tasks as defined by a contractual agreement. The "independent contractor" status of individuals engaged in certain agricultural, forestry, or farming occupations and newspaper delivery persons are not subject to the nine criteria listed above, but rather are subject to common law principles (including Internal Revenue Service guidelines). Casual Labor: "Casual labor" is work being completed in 10 days or less, at a total labor costs of less than $500, and where the work is not the usual work done by the employer's normal business. Other Requirements: In addition, two additional requirements for required benefits are discussed: 1. Although a contractor has no worker's compensation liability to independent contractors, if a contractor sublets any part of contract work to a subcontractor, the contractor is liable for injuries to the subcontractor's employees if the subcontractor does not carry worker's compensation. 2. If an employee is covered by (1) the Federal Employers Liability Act (railroad employees); (2) the Longshore and Harbor Worker's Act (persons associated with loading, unloading, building and repairing ships); or (3) the Jones Act (seaman aboard ships), then compensation under the Florida worker's compensation law is not payable for injuries. While those non-construction risk that hire fewer than four employees, or any of the four exceptions to "employment," are not statutorily obligated to secure benefits for their worker's, they may purchase coverage. By purchasing worker's compensation coverage, the employee is covered, the employer becomes immune to lawsuits from injured workers, and both become subject to all provisions of the law.
9.5 Compensation (Benefits):
There are three categories of benefits under the Florida worker's compensation law: (1) Payment of medical expenses; (2) Compensation for disability; and (3) Death benefits.
What is covered by Part Four - Your Duties If Injury Occurs? True or False: The employer is required to inform the insurer at once of any injury which might be covered by the policy. The employer must also provide for immediate medical or other services required by the worker's compensation laws, give names and addresses of injured persons or witnesses, promptly provide any legal papers pertaining to a claim to the insurer, cooperate and assist the insurer if requested, do nothing that would interfere with the insured's right of recovery, and make no voluntary payments or assume any obligation except at the employer's own cost.
True
Is there a waiting period before disability benefits are paid under the worker's compensation law?
Yes. No benefits are payable for the first seven days of a disability. However, if the disability lasts more than 21 days, benefits are payable from the first day of injury.
Are all injuries, regardless of cause, covered under the worker's compensation law? A covered injury is considered to be "a____ out of" employment only if the work performed is the major c____ cause of the injury or death.
arising, contributing
What are the construction industry exceptions? Florida statute specifically designates sole proprietors and partners in the construction industry as e____. They are therefore provided compensation benefit. Sole proprietors, or partners, may not e____ themselves from coverage.
employees, exempt
What does the worker's compensation insurance policy cover? The basic and primary function is to provide an e____ the coverage required by law.
employer
What is an "employment" under the worker's compensation law? "Employment" includes all g____ employees regardless of the number of employees, and p____ employments with 4 (four) or more employees (one or more in construction).
government, private
What circumstances could cause a refusal of coverage under the worker's compensation law? An employee is not entitled to compensation if the injury is caused by that employee's i____ or wrongful use of d____, or willful i____ to injure or kill oneself or another. If it is found that an employee, at the time of injury, had .08% or more blood alcohol, there is a presumption that the injury was caused by alcohol.
intoxication, drugs, intention
What is the range of benefits under the worker's compensation law? Benefits range from a minimum of $___ per week (full weekly benefits if the employee's weekly wages are less than $___) to a maximum of the "statewide a____ weekly wage."
$20, $20, average
9.4 Injuries Covered:
Benefits are payable to an employee who suffers "injury." The term "injury" is defined to mean personal injury or death by "accident" "arising out of" work performed in the course of employment, and such diseases or infection as naturally or unavoidably result from such injury. "Accident" means an unexpected or unusual event or result, happening suddenly. "Accident" does not include: mental or nervous injury due to fright or excitement only; or disability or death due to accidental acceleration or aggregation of a venereal disease; or of a disease due to habitual use of alcohol or drugs; or a disease that manifest itself in fear or dislike of an individual's race, color, religion, sex, national origin, age or handicap. An injury is considered to be "arising out of" employment only if the work performed is the major contributing cause of injury or death. Occupational diseases are treated as injuries by accident under a section of the Florida statutes. Covered diseases are those resulting from the nature of the employment, meaning there is a particular hazard in that occupation that distinguishes it from hazards of other occupation. Injuries, which occur outside of the state of Florida, are covered under the Florida worker's compensation law if the contract for employment was made in Florida, or if the employment is principally in Florida. If the injured employee receives benefits under the law of another state, however, the total compensation received cannot exceed the Florida benefit levels. An employee is not entitled to compensation if the injury is caused by that employee's intoxication or wrongful use of drugs or willful intention to injure or kill oneself or another. If it is found that an employee, at the time of injury, had .08% or more blood alcohol, there is a presumption that the injury was caused by alcohol; the employee would therefore, not be covered by worker's compensation. Worker's compensation benefits otherwise payable to an injured employee are reduced by 25 percent if the employee willfully refuses to use an authorized safety appliance or observe a safety rule known to the employee, and the appliance or rule is required by statute or other formal rule.
True or False: Death Benefits are "paid" under the Worker's Compensation law as actual funeral expenses not to exceed $7,500, are payable, with benefits to dependent relatives are payable based on a maximum of 66 2/3% of the average weekly wage (not exceeding the statewide average wage), up to a maximum of $150,000 for all dependent claims combined. A spouse, children, parents and other relatives are listed as eligible dependents for various rate of compensation.
True
9.7a Disability Benefits:
"Disability" means the inability to earn in the same or any other employment what the employee was receiving at the time of an injury because of the injury. Compensation is for such "wage loss," being the difference between post-injury wages (if any) and pre-injury wages. The "average weekly wage" of the employee at the time of injury determines the disability benefits. That determination is based on the average of the prior 13 weeks pay. If the 13 weeks experience was not present, calculations are made based on the wages of employee who had the same or similar duties. Waiting Period: No benefits are payable for the first seven days of a disability. However, if the disability lasts more than 21 days, benefits are payable from the first day of injury. Amounts Paid: The range of benefits is from a minimum of $20 per week (unless the employee's wages were less than $20 per week in which event the full weekly wage applies) to a maximum of the "statewide average weekly wage," The "statewide average weekly wage" is revised annually based on state records for unemployment compensation.
How is a worker's compensation and employers' insurance policy structured? A standard policy by all insurers contains six parts; Part One - Worker's Compensation Insurance; Part Two - Employers' Liability Insurance; Part Three - Other States Insurance; Part Four - Your Duties If Injury Occurs. A standard policy by all insurers contains six parts; Part One - Worker's Compensation Insurance; Part Two - Your Duties If Injury Occurs; Part Three - Premium and; Part Four - Conditions. Included is also a general section and information page corresponding to the declarations of other policies. A standard policy by all insurers contains six parts; Part One - Worker's Compensation Insurance; Part Two - Employers' Liability Insurance; Part Three - Other States Insurance; Part Four - Your Duties If Injury Occurs; and Part Five - Premium. A standard policy by all insurers contains six parts; Part One - Worker's Compensation Insurance; Part Two - Employers' Liability Insurance; Part Three - Other States Insurance; Part Four - Your Duties If Injury Occurs; Part Five - Premium and; Part Six - Conditions. Included is also a general section and information page corresponding to the declarations of other policies.
A standard policy by all insurers contains six parts; Part One - Worker's Compensation Insurance; Part Two - Employers' Liability Insurance; Part Three - Other States Insurance; Part Four - Your Duties If Injury Occurs; Part Five - Premium and; Part Six - Conditions. Included is also a general section and information page corresponding to the declarations of other policies.
9.7b Disability Benefits:
Classes of disability benefits depend upon which of four classes of disability is incurred: (1) Permanent Total - total in nature and a permanent duration (2) Temporary Total - total in nature but of a temporary duration (3) Permanent Impairment - partial in nature but of permanent duration (4) Temporary Partial - partial in nature and of temporary duration Each of these classifications of disability is compensated as follows: Permanent total disability is compensated at 66 2/3 percent of the employee's average weekly wage during the period of disability without limit of time. Only claimants with "catastrophe injuries" are eligible for permanent total benefits. "Catastrophe injury" means a permanent impairment constituted by: (1) Spinal cord injury involving severe paralysis of an arm, and leg, or the trunk of the body; (2) Amputation of an arm, a hand, a foot, or a leg involving the effective loss of use of that appendage; (3) Severe brain or closed-head injury; (4) Second-degree or third-degree burns of 25 percent or more of the total body surface or third-degree burns of 5 percent or more to the face and hands; or (5) Total or industrial blindness; or if one who is being compensated for a permanent total injury becomes rehabilitated to the extent that earning capacity is restored, benefits are changed to those described below for "wage loss." Temporary total disability is compensated at 66-2/3 percent of the employee's average weekly wage for a period not to exceed 104 weeks, except the employee may receive as high as 80 percent of average weekly wage up to $842 per week for up to six months during a period of retraining or rehabilitation after certain defined injuries. If the employee is still disabled at the end of the 104 weeks, or at the "the date of maximum medical improvement" whichever comes first, temporary total disability benefits end and a determination is made as to whether the worker qualifies for permanent impairment status benefit. "Date of maximum medical improvement" means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.
9.9a Worker's Compensation and Employers Liability
Insurance Policy: A standard policy is used by all insurers and contains six parts: Part One - Worker's Compensation Insurance; Part Two - Employers Liability Insurance; Part Three - Other States Insurance; Part Four - Your Duties If Injury Occurs; Part Five - Premium; and Part Six - Conditions. There is also a general section and an information page corresponding to the declarations page of other policies. General Section: The general section contains basic conditions and definitions that apply to the policy. This section states the insured is the employer named in the information page. It also states that the policy covers all workplaces listed in Item I of the information page. It also covers temporary workplaces except in states where the worker's compensation and employers liability policy does not apply. Part One - Worker's Compensation: This agreement pays all benefits required of the insurer under a worker's compensation law of any state declared in the policy for Part One coverage. There are no exclusions and there are no dollar limitations to the insurer's liability. Coverage applies to any accident occurring during the policy period. It covers bodily injury resulting from accident or disease and includes resulting death. It also covers the cost of defending the employer against any claim for these benefits. Part One has some supplementary benefits including reasonable expenses incurred by the insured at the insurer's expense, interest on judgments, premiums for appeal bonds, etc. There are no exclusions under Part One. The employer is responsible for any payments in excess of those paid by law, such as payments required because of the employer's serious and willful misconduct, knowingly employing an employee in violation of the law, failure to comply with a health or safety laws or discrimination against an employee in violation of the worker's compensation law. Part Two - Employers Liability Employers Liability covers the insured for: 1. Claims by employees or injuries not subject to the worker's compensation law; 2. Claims by others for liabilities to the insured's employees; and 3. Claims by relatives of injured employees for consequential damages. Exclusions: The following exclusions apply to part two coverage: 1. Liability assumed under contract; 2. Punitive or exemplary damages for employment in violation of a law; 3. Injuries to employees while employed in violation of a law with actual knowledge of such violation; 4. Obligations under any other compensation law (i.e. Federal laws); 5. Injuries intentionally caused or aggravated by the insured: 6. Injuries outside the U.S. and its territories or Canada, except to U.S. or Canadian citizens while temporarily elsewhere; 7. Claims arising from discharge, coercion or discrimination in violation of a law; 8. Obligations under Federal acts such as the Longshore and Harbor Worker's or Jones Act; 9. Finds or penalties imposed for violation of state or federal law.
9.9c Worker's Compensation and Employers Liability Insurance Policy:
Part Four - Your Duties If Injury Occurs: The employer is required to inform the insurer at once of any injury which might be covered by the policy. The employer must also provide for immediate medical or other services required by the worker's compensation laws, give names and addresses of injured persons or witnesses to the insurer, promptly provide any legal papers pertaining to a claim to the insurer, cooperate and assist the insurer if requested, do nothing that would interfere with the insured's right of recovery, and make no voluntary payments or assume any obligation except at the employer's own cost. Part Five and Six - Premiums and Conditions: Businesses and types of work are classified and charged a premium according to their estimated payroll. The insurer reserves the right to audit the insured's records for up to three years after the policy expires. The conditions section includes an inspection condition that gives the insurer the right but not the obligation to inspect the insured's workplace at any time for purposes of determining insurability or establishing a premium. Other Exclusions, Provisions: The basic policy does not cover the insured's liability under federal laws. Coverage for the Federal Employers Liability Act, the Longshore and Harbor Worker's Compensation Act, and the Jones Act may be endorsed onto the policy to provide such coverage. The worker's compensation policy does not cover benefits that are provided under another policy or that are self-injured. A certificate showing coverage must be filed with the Division for each policy. The Florida worker's compensation law prohibits cancellation of coverage without 30 days notice to both the insured and the Division. Once a policy has been in effect for over 90 days, a 45-day notice of cancellation/non-renewal is required. Cancellation for non-payment of premium requires a 10 day notice.
9.7c Disability Benefits:
Permanent impairment benefits are made up of two parts: (1) "impairment," and (2) "wage-loss". "Impairment benefits" are based upon a medical impairment-rating schedule approved by the Division of Worker's Compensation. The rating is based upon the degree of injury. Once the rating is assigned, the benefits are paid weekly at the rate of 75 percent of the employee's average weekly temporary total disability benefit, and continue until the earlier of either: (1) 2 weeks for each percentage point of the impairment rating up to 10%; 3 weeks for each percentage of impairment from 11% to 15%; four weeks for each percentage of impairment from 16% to 20%; six weeks for each percentage of impairment above 21% or; (2) the death of the employee. "Wage-loss" benefits are called "supplemental benefits" in Florida statute. These benefits are payable if the injured employees sufferers a loss in wages due to the disability. For as long as earnings are impaired, the employee receives 80 percent of the difference between 80 percent of the pre-injury less post-injury monthly earnings for up to 104 weeks from the date of the injury, subject to a maximum of 66 2/3 percent of the employee's monthly wage at the time of injury. Temporary partial disability is compensated under the "wage loss" formula for a period of up to 104 weeks of impaired earnings. This benefit is computed weekly. If the disability still exists at the end of 104 weeks, the employee is reviewed for permanent impairment benefits.
9.2a Employers and Employees:
The law defines an employer as every person carrying on any "employment" including the state, political subdivisions, public and quasi public corporations, employment agencies, and employee leasing companies. An "employment" includes all government employees regardless of the number of employees, and private employments with four or more employees (except the construction industry where one or more employees is considered "employment"). The following employees are exempt by the law: (1) Domestic servants in private homes. (2) "Small" farms (those with five or less regular employees and less than 12 other employees at one time for seasonal labor not exceeding 30 days). "Farm" means stock, dairy, poultry, fruit, fur-bearing animals, fish and truck farms, ranches, nurseries and orchards. (3) Professional athletes. (4) Sports officials for interscholastic sports and public or private non-profit amateur sports events. (5) Labor under sentence of a court to perform community services (community services required by those convicted of Driving Under the Influence (DUI laws)). (6) State and county prisoners unless working for private employers. (7) Employees covered by the Defense Base Act; The Defense Base Act extends coverage to employers and their employees on overseas military bases and other overseas locations under public works contracts being performed by contractors with agencies of the United States Government.
9.8 Miscellaneous Law Provisions:
There are three basic ways for an employer to "secure the payment of compensation." The most common method is to purchase worker's compensation insurance with any stock or mutual company authorized to do business in Florida. Second, an employer may file to be an individual self-insurer by furnishing satisfactory proof to the Division of financial ability to pay such benefits. Third, the law allows for "pooling liability;" two or more employers may enter into agreements to pool their liabilities for the purposes of qualifying as self-insurers. These arrangements are known as group self-insurance funds. An employer who has secured a method of compensation must display a prescribed form known has a "posting notice" in a conspicuous place at the business premises, notifying the employees of coverage. This notice must give the name and address of the insurance company and the expiration date of the policy. An employer may not deduct from payroll or assess employees for the cost of compensation. Any agreement by an employee to waive rights to compensation is invalid. An employer guilty of such practices is guilty of a third-degree felony. Anyone who willingly makes any false or misleading statement or representation to obtain or deny benefits is guilty of a second-degree felony. An employee injured in the course of employment is barred from an action against the employer except for compensation benefits. The employee is not precluded from bringing actions against third parties who may have legal responsibility for the injury. If an employee receives compensation benefits and also recovers from a third party, the law provides for reimbursement of the compensation benefits out of the proceeds of the third-party payment to prevent duplicate recovery. For one year after a cause of action arises, any rights against third parties belong solely to the employee. During the second year (if the employee or his dependents have not sued the third party) the employer, if a self-insurer, or the insurer may do so. After the second year, recovery rights revert solely to the employee.
Are there any "persons" excluded from the employee definition in the worker's compensation law? True or False: Yes as defined, independent contractors, "casual" work (which is work that is to be completed in not over 10 days), commissioned real estate agents, certain musical and theatrical performers, certain trucking owner-operators, certain taxicab, limousine and passenger vehicle-for-hire drivers or volunteers.
True
Are there any types of employments not requiring covered under the worker's compensation law? True or False: Domestic servants in private homes, small farms (five or less regular employees and less than 12 other employees at one time for seasonal labor not exceeding 30 days), professional athletes, sports officials for interscholastic sports and public or private non-profit amateur sports events, labor under sentence of a court to perform community services (DUI law), state and county prisoners unless working for private employers, and employees covered by the Defense Base Act.
True
How are Claims Disputes resolved under the Worker's Compensation law? True or False: Disagreements over claims are resolved through hearings by appointed deputy commissioners. A prescribed form of notice must be filed if an employer wishes to contest a claim of an employee within 21 days after knowledge of the injury, stating the grounds upon which the right to compensation is contested.
True
How are corporate officers treated under the worker's compensation law? True or False: An officer of a corporation is an employee if the officer performs services for the corporation for pay. When the officer is considered to be an employee, the worker's compensation law allows the officer the option to be exempt from worker's compensation coverage by filing a proper notice with the Division. A corporation in the construction industry may only exempt three or fewer officers and those officers must own a minimum of 10% of the corporation; other corporations may exempt officers without limitation. Once the Division approves an officer's exemption, that person is no longer counted as an employee when determining whether a firm must carry compensation.
True
How is a worker's compensation and employers insurance policy rated? True or False: Worker's compensation coverage is rated by classifying the risk according to the employer's operations. A rate is charged for each $100 of payroll to employees. Premiums are charged on the entire payroll of the insured with exceptions: (1) if proper breakdowns are shown on the accounting records, overtime is excluded from chargeable payroll; (2) payroll charged for corporate executive officers is subject to a minimum and maximum amount per week; and (3) when sole proprietors and partners are included in the coverage, a flat annual payroll is assigned to each officer or partner. A "manual" premium is determined by multiplying the rate for each hundred dollars of payroll by the payroll for each classification. The experience rating plan is mandatory for risks exceeding certain annual premiums. The experience rating plan recognizes prior loss experience of the employer and applies either a debit for unfavorable experience or a credit for better-than-expected loss results. This debit or credit is called an experience modification. The debit or credit is applied to the manual premium.
True
True or False: Benefits for "permanent impairment" are based upon a medical impairment rating schedule approved by the Division and are in two parts, "impairment" and "wage-loss"; Once the rating is assigned, the benefits are paid weekly at the rate of 75% of the employee's average weekly temporary total and continue until the earlier of (1) 2 weeks for each percentage point of the impairment rating up to 10%; 3 weeks for each percentage of impairment from 11% to 15%; four weeks for each percentage of impairment from 16% to 20%; six weeks for each percentage of impairment above 21% or; or (2) the death of the employee.
True
What are the employee's rights against third parties? True or False: The employee is not precluded from bringing actions against third parties who may have legal responsibility for the injury. If an employee receives compensation benefits and also recovers from a third party, the law provides for reimbursement of the compensation benefits out of the proceeds of the third-party payment to prevent duplicate recovery. For one year after a cause of action arises, any rights against third parties belong solely to the employee. During the second year, if the employee or his dependents have not sued the third party, the employer if a self-insurer or the insurer may do so. After the second year, recovery rights revert solely to the employee.
True
What do Part Five and Six - Premiums and Conditions, cover? True or False: Businesses and types of work are classified and charged a premium according to their estimated payroll. The insurer reserves the right to audit the insured's records for up to three years after the policy expires. The conditions section includes an inspection condition that gives the insurer the right but not the obligation to inspect the insured's workplace at any time for purposes of determining insurability or establishing a premium.
True
What is covered by Part Two - Employers' Liability? True or False: Employers' liability covers the insured for: (1) Claims by employees or injuries not subject to the worker's compensation law; (2) Claims by others for liabilities to the insured's employees; and (3) Claims by relatives of the injured employees for consequential damages.
True
Who is NCCI? True or False: All aspects of rating are administered and enforced by the National Council on Compensation Insurance (NCCI). NCCI files rules and rates with the Office of Insurance Regulation, establishes classifications, promulgates experience modifications, and audits all policies for correctness under a rule that requires that a copy of every policy issued be filed with NCCI.
True
9.10 Rating:
Worker's compensation coverage is rated by classifying the risk according to the employer's operations. A rate is charged for each $100 of payroll to employees. Premiums are charged on the entire payroll of the insured with exceptions: (1) if proper breakdowns are shown on the accounting records, overtime is excluded from chargeable payroll; (2) payroll charged for corporate executive officers is subject to a minimum and maximum amount per week; and (3) when sole proprietors and partners are included in the coverage, a flat annual payroll is assigned to each officer or partner. A "manual" premium is determined by multiplying the rate for each hundred dollars of payroll by the payroll for each classification. The experience rating plan is mandatory for risks exceeding certain annual premiums. The experience rating plan recognizes prior loss experience of the employer and applies either a debit for unfavorable experience or a credit for better-than-expected loss results. This debit or credit is called an experience modification. The debit or credit is applied to the manual premium. Retrospective Rating Plans are an optional alternative providing for adjustment of premium after expiration, based on a guaranteed basic premium, to which is added the actual losses incurred by the injured. Several rating plans offered by insurers will recognize the insured's experience. All aspects of rating are administered and enforced by the National Council on Compensation Insurance (NCCI). NCCI files rules and rates with the Office of Insurance Regulation, establishes classifications, promulgates experience modifications, and audits all policies for correctness under a rule that requires that a copy of every policy issued be filed with NCCI.
Define an employee under the worker's compensation law. Every person engaged in any _e____, under any appointment or contract for hire, including _a____ and _m____.
employment, aliens, minors
What is covered by Part Three - Other States? As previously discussed, Part One lists the s____ covered by the policy. The insured is obligated to notify the insurer if w____ begins in any state not listed. Other States may be utilized to provide a____ coverage in other states.
states, work, automatic
9.7d Disability Benefits:
Death Benefits: The death benefit is payable if the death results within one year of an accident or, if it follows continuous disability, within five years after the accident. Actual funeral expenses are payable to a limit of $7500. Benefits to dependent relatives are payable based on a maximum of 66 2/3percent of the average weekly wage (not exceeding the statewide average wage), up to a maximum of $150,000 for all dependent claims combined. A spouse, children, parents and other relatives are listed as eligible dependents for various rates of compensation. Claims Disputes Disagreements over compensation claims are resolved through hearings by appointed deputy commissioners. If an employer wishes to contest the claim of an employee, a prescribed form of notice must be filed with the Division within 21 days after knowledge of the injury, stating the grounds upon which the right to compensation is contested.
9.1 Summary of the Worker's Compensation Law:
This unit discusses the various worker's compensation laws along with the worker's compensation and employers' liability insurance policy. As stated in the study manual, each state has its own worker's compensation laws. While the details of the each state's laws vary greatly, the basic laws are the same. Employees are compensated for on the job injuries and occupational injuries regardless of fault. In return employers are immunized from lawsuits brought by employees for occupationally incurred injuries. In some states, worker's compensation benefits are provided entirely by the state. In other states, both state funds and private insurance are utilized. In the majority of states, including Florida, the benefits are regulated by the state and paid entirely through private insurance or self-insurance. In Florida, the Division of Worker's Compensation of the Department of Financial Services regulates the Worker's Compensation law. The worker's compensation policy's primary function is to provide an employer that coverage required by law. Accordingly, the study manual gives primary attention to the Florida law rather than the policy. Chapter 440, Florida Statutes, governs the Florida worker's compensation law: Three important sections of the statutes state: 440.09(1) the employer must pay compensation or furnish benefits required by this chapter if the employee suffers an accidental compensable injury or death arising out of work performed in the course and in the scope of employment. 440.10(1)(a) Every employer coming within the provisions of this chapter shall be liable for, and shall secure, the payment to his or her employees...Of the compensation payable...(2) Compensation shall be payable irrespective of fault as a cause for the injury, except as provided in ... 440.11 Liability of an employer prescribed in Florida Statute 440.10 shall be exclusive in place of all other liability of such employer to any third party tort feasor and to the employee, the legal representative thereof, husband or wife, parents, dependents, next of kin, and anyone otherwise entitled to recover damages from such employer at law or in admiralty on account of such injury or death.s the worker's compensation law the same in every state?
Are there penalties to an employer who fails to carry worker's compensation benefits? True or False: First, such failure is a third-degree felony. Second, the division may issue a Stop-Work Order that will cease all business operations. Third, the division will also assess a penalty equal to 2 times what the employer would have paid in premiums over the last 2 years or $1000, whichever is greater. Further, when an employee has a compensable injury, and the employer has not secured worker's compensation benefits, the employee may elect to collect statutory benefits or bring a common law suit. If the latter is elected, the employer is prohibited from pleading defenses what he or she normally may have used in the lawsuit.
True
Define "injury" under the worker's compensation law? True or False: Personal injury or death by "accident" "arising out of" work performed in the course of employment, and such diseases or infection as naturally or unavoidably result from such injury. "Accident" means only an unexpected or unusual event or result, happening suddenly.
True
How are benefits for "temporary total" disability paid under the worker's compensation law? True or False: At 66 2/3% of the employee's average weekly wage for a period not to exceed 104 weeks, except the employee may receive as high as 80% of average weekly wage up to $842 per week for up to six months during a period of retraining and rehabilitation after certain defined injuries, subject to additional conditions.
True
How are sole proprietors and partners treated under the worker's compensation law? True or False: A sole proprietor or partner is considered to be the employer, not an employee. Therefore they are not required to be included as an employee when determining whether a firm must carry worker's compensation. Florida statute provides sole proprietors or partners the opportunity to elect to be covered by filing the proper collection form with the Division.
True
True or False: The "wage-loss" benefits portion of the "permanent impairment" disability paid under the worker's compensation law is called supplemental benefits in the statute; they are payable if the injured employee suffers a loss in wages due to the disability. For as long as earnings are impaired, the employees receive 80% of the difference between 80% of the pre-injury less post-injury monthly earnings, for up to 104 weeks from the date of injury, subject to a maximum of 66 2/3% of the employee's average monthly wage at the time of injury.
True
What are the basic and minimum limits of liability for employers' liability? True or False: Part Two is subject to three limits of liability: (1) for all claims in each accident; (2) per employee for disease; and (3) for aggregate disease claims. The basic and minimum limits which are automatically included in all policies are 100,000/$100,000/$500,000. Increased limits are available.
True
What are the three basic ways to "secure payment of compensation"? True or False: There are three basic ways for an employer to "secure the payment of compensation." The most common method is to purchase worker's compensation insurance from any stock for mutual company authorized to do business in Florida. Second, an employer may file to be an individual self-insurer by furnishing satisfactory proof to the Division of financial ability to pay such benefits. Third, the law allows for "pooling liability"; two or more employers may enter into agreements to pool their liabilities for the purposes of qualifying as self-insurers. These arrangements are known as group self-insurance funds.
True
How are Death Benefits defined under the Worker's Compensation law? Compensation for death is payable if the death results within one year of an a____ or, if it follows continuous d____, within f____ years after the accident.
accident, disability, five
