Workers compensation
What are examples of exclusive remedy?
1) A personal and willful intent (effort) to cause injury by a co‐worker may result in the injured worker bringing suit against the co‐worker. (Intentional injuries) 2) Dual Capacity - A relationship where an employer is not only an employer, but also a supplier of a product, provider of a service, owner of premises, etc. When a work‐related injury arises out of one of such secondary relationships, the exclusivity of WC as a means of recovery to the injured worker may be exempted and the employee may be able to sue the employer.
what is Alternate Employer Endorsement WC 00 03 01 A
1) Attach to the regular employer's policy to provide protection to the alternate employer from claims brought against the alternate employer due to injuries to an employee who is loaned or leased to them from their regular employer Examples: a) Temporary staffing company is the insured and the client is the alternate employer; b) Property manager is the insured and the property owner is the alternate employer 2) Coverage applies only with respect to compensable injury to employees of the insured when in the course of special or temporary employment by the alternate employer in the state(s) listed in Item 2. of the schedule 3) Part One (WC) and Part Two (EL) apply to the alternate employer as though they were an insured • The alternate employer must be named in the endorsement schedule 4) Item 3 of the endorsement schedule limits coverage to apply only to the specific jobs or contracts of the insured as scheduled
What is the assumption of risk defense?
1) Common law doctrine which finds by doing certain acts an employee assumes the risk of injury 2) Example: Agreeing to work at substantial heights or agreeing to work over trenches
If you want the client ot be responsible for purchasing WC coverage, what endorsement do you place on the leasing company?
1. Add Labor Contractor Exclusion Endorsement WC 00 03 21 or 2. Employee Leasing Client Endorsement WC 00 03 19
What are the three common law defenses employers used?
1. Assumption of risk. 2. Contributory negligence 3. fellow servant rule
What is the purpose of workers compensation system.
1. Negligence is no longer a basis for determining liability or recovery since it is a no fault system 2. Provides prompt and reasonable payments of benefits 3. Establishes what is categorized as exclusive or sole remedy 4. Employers gain predictability in controlling WC losses 5. Encourages loss prevention and promotes interest in safety
What are the prompt and reasonable payments that are under work comp
1. Statutory benefits are paid to an injured employee (Benefits are discussed in detail later) - exclusive remedy 2. Benefits are partial and final - you know ahead of time how much of the costs are allocated to wc. 3. Employee's Injury or disease must "arise out of" and "arise in the course of employment" 4. it covers work related injuries. Mental injures may or may not be covered depending on th estate 5. occupational diseases - states indicate which ones are considered to be compensable
What are the general exemptions for the classifications of employees not required to get WC?
1. domestic employees, 2. agricultual or farm workers 3. real estate sales people 4. CAsual labor
if common law is silent, how do you see who controls for the determination of if they are a independent contractor or employee?
1: behavior control- does the company control or have the right to control the worker 2. Financial control- who is the payer of the job 3. relationship of the parties- is this frequent or one in a blue moon type thing?
what is Voluntary Compensation and Employers Liability WC 00 03
2. Voluntary Compensation and Employers Liability WC 00 03 11 A - This is not for volunteers but rather exempted employement that you as an employer wish to provide anyways. If you have a long time housekeeper or nanny, you can use this. a. Provides statutory benefits for employees not covered under a WC act because of an exempt occupation (e.g. agriculture or domestic workers) or employed by an employer not subject to WC law. (Employer does not meet numerical requirement.) • Permitted for volunteers only where allowed by state WC law b. Employee(s) must be indicated on the endorsement schedule c. The endorsement requires that the person(s) seeking benefits sign a release in favor of the insured (employer) and the insurer or benefits will not be paid. d. The employer is also provided Employers Liability Insurance protection under Part Two.
what is the activation trigger for part 3 other states insurance?
3. Item 3.C: Part Three - Other States Insurance a. Activates both WC and EL Insurance for states where work begins after the effective date • Include states where unexpected work or incidental exposures may arise after the effective date • Accidental or incidental coverage b. States must be listed in 3.C. for Other States Insurance coverage to apply d. Some states, such as New York and Florida, may require their states be listed under 3.A. in lieu of 3.C.
If you want the client ot be responsible for purchasing WC coverage, what endorsement do you place on the client company?
Add Labor Contractor Endorsement WC 00 03 20 A
What is the suggested wording to use on 3.C. Other states in order to have broader coverage in other states if you are unsure if you will ever be working in them in teh future?
All states except North Dakota, Ohio, Washington, Wyoming, and the states designated in Item 3.A. of this Information Page
IF you want the leasing company to be responsible for purchansing WC coverage, what endorsement do you place on the leasing company policy?
Alternate Employer Endorsement WC 00 03 01 A
What were the issue of the common law defenses for the injured workers?
Common law held that only the injured employee, not the spouse or dependents, had the right to sue for an employee's work related injury. If the employee died, the spouse and dependents had no right to sue. Since employers won most of the suits, seriously injured workers and their families were left impoverished. This led to public pressure to enact workers compensation laws and modification of common law.
What are different types of state funds?
Competative state funds and Monopolistic state funds
Are farm and agricultural workers exempt from comp?
Depending on the state laws, they are exempt employees and no coverage is requried.
IF you want the leasing company to be responsible for purchansing WC coverage, what endorsement do you place on the client policy?
Employee Leasing Client Exclusion Endorsement WC 00 03 22
What is the domestic exemption for WC?
Employees that are hired for work around a residence are exempt for wc. This is like private cooks, housekeeprs, maids, butlers, babysitters that are employed by the residence owner.
What is the employers liability insurance?
Employers Liability Insurance may respond to suits from exempted employments a. Exempt employee must prove negligence, and the employer maintains the three common law defenses 1) Contributory/comparative negligence 2) Assumption of risk 3) Fellow servant rule b. Employers Liability Insurance may not apply to specific factual situations
What are competitive state funds?
Employers in many states can purchase WC insurance and EL from state funds that compete with private carriers. Are also used as a last resort type fund. Essentially states allow private entities and state run policies to compete with eachother
What is the casual labor exclusion from WC?
Generally means a worker that is hired to perform work that is not in the usual course or furtherance of the business. Example: Hiring a worker to help move furniture to a new office.
Are you required to get WC coverage for volunteer workers ?
No because they are typically not considered employees and are not entitled benefits under WC. But this can be fixed with endorsements?
What are the monopolistic states?
North Dekota Oklahoma Washington Wyoming Remember the acronym NOWW
What is a carrier funded WC policy
Policy for WC and employer liability that is purchased from a insurance company
What are elective states? This is states
States that do not require employers to buy a state run workers compensation plan. But they are still required to purchase a separate type of WC policy with different rules
What are compolsory workers compensation states?
States where state's workers comensation is required to be purchased. Compulosry states are all states except for texas and Nj.
What is a statutory employer?
This is a employer who takes responsibility over workers of another company that are working under his company. Typically this is seen in gc and sub situations. If the sub does not have coverage, the GC takes over
How is WC typically funded?
Through: 1. Private Carriers 2. State Funds 3. Self insurance
If you are getting a state fund WC policy, how can you add a employer liability policy with it?
a) Add Employers Liability Coverage (WC 00 03 03 C) to a separate existing WC Policy or to a stand‐alone EL Policy. Does not apply to Ohio exposures. b) For Ohio, add Ohio Employers Liability Coverage WC 34 03 01 C OR c) Add a Stop Gap - EL Endorsement to a CGL Policy • North Dakota CG 04 20 • Ohio CG 04 41 • Puerto Rico CG 04 51 • Washington CG 04 42 • Wyoming CG 04 44
What is the activation trigger for part two employers liabiltiy insurance?
a. Applies only for those states listed under Item 3.A. • When you activate a state in part A, you activate it in part B b. Limits of liability 1) Standard limits BI by Accident - $100,000 each accident BI by Disease - $500,000 policy limit BI by Disease - $100,000 each employee 2) May be increased
What is the exclusive remedy for an employer that WC provides?
a. Exists to protect the employers from additional exposure after being legally required to provide benefits on a no‐fault basis per statute b. The protection generally extends to co‐workers (fellow servants) who may have caused injury to another worker c. There are exceptions in various states to the exclusive remedy provision that allow an injured worker to bring suit.
What is the activation trigger for part one WC insurance?
a. List all states in which insured has operations known or expected • Has to be honest and list every state that he expects to work in • At the time of inception. • It activates the laws in those states by listing it in 3A b. Activates compensation laws for those states c. Cannot list monopolistic states
what is Sole Proprietors, Partners, Officers, and Others Coverage WC 00 03 10
a. Only permitted in certain states b. This endorsement is added when a person elects to be covered when not automatically covered by WC law. c. Those individuals must be designated in the endorsement schedule for coverage to apply
What are the five common law obligations for an employer?
a. Reasonably safe place to work b. Reasonably safe tools c. Competent (safe and sober) fellow employees d. Safety rules established and enforced e. Warn workers of any known dangers
What is the contributory negligence defense
b. Contributory negligence 1) Common law doctrine holding that if an employee was injured in part due to his/her own negligence, the injured employee would not be entitled to collect any damages from his/her employer who supposedly caused, in part, the injury 2) Example: Employee knowingly using unsafe tools and riggings such as fall protection apparatus
What is the fellow servant rule defense?
c. Fellow‐servant rule (aka fellow employee rule) 1) Common law doctrine holding if a worker was injured because of the actions of a coworker as opposed to the negligence of the employer, the employer was not liable. 2) Example: An employee drops a load of lumber causing injury to a nearby employee. The employer would not be held responsible for this injury.
What are is the specific positions exemption from WC?
certain positions like owners, executive, or directors can opt out of coverage if they file with the state. Some due to them not wanting coverage and some due to getting coverage through another policy.
What is the current WC system like?
compensation laws and modification of common law. 5. The current system based on workers compensation law supersedes common law; however, the common law system is not totally eliminated. Tort action can still arise in certain circumstances which will be discussed later in this Section. Gross negligence
How are leased workers not able to qualify for WC?
employer with exclusive remedy prodection is typically responsible for providing WC benefits to leased workers. They are the ones with the job and employment. This is if the law does not say anything about leased employees.
What can happen if you do not carry work comp?
fines, imprisonment, Cease work orders, employees can directly sue you.
Are real estate sale people considered employees and are entitled to WC?
no they are typically considered to be independent contractors.
What is the numeric exemptions for WC?
that companies with a specfic amount of employees are not required to have WC
What is the employer denied by selecting a non state run WC plan?
they are denied the use of the 3 common law defenses
what is Partners, Officers, and Others Exclusion WC 00 03 08
used to exempt partners, officer or others not be able to get work comp. a. Only permitted in certain states b. This endorsement is added when a person elects not to be covered as permitted by WC law. c. Those individuals who elect not be covered must be indicated in the endorsement schedule d. Caution: Be aware that with the endorsement, both WC and EL coverage does not apply for those scheduled individuals.
What are monopolistic state funds?
you are only able to purchase WC coverage directly from the state.
