CHAPTER 12: Workers Compensation

Courts eventually recognized that an employer did have certain obligations to employees. To satisfy these obligations, the employer was expected to provide:

-a safe place to work -safe equipment and tools -reasonably competent fellow servants -enforcement of safety rules -reasonable warnings about job dangers

the following classes of employees are typically exempt:

-certain farm and agricultural workers -charitable organization workers -domestic employees and casual labor -newspaper vendors -outworkers (those who take articles home for cleaning or repair).

Court decisions had created three basic defenses which could relieve an employer of legal liability:

-fellow servant rule -contributory negligence -assumption of risk

Workers compensation laws usually provide for the payment of four types of benefits:

1. medical benefits 2. income benefits 3. death benefits 4. rehabilitation benefits

California State Compensation Insurance Fund

A company run by the state that competes with private carriers* The State Compensation Insurance Fund is administered by its board of directors for the purpose of transacting workers' compensation insurance in a competitive market with other insurers. It is also referred to as the SCIF and is run by 13 directors from the state of California. The fund only writes worker's compensation coverage; however, this would be a last resort for a business after failing to obtain coverage from a private insurer. The majority of The Fund's business comes directly from employers, although some licensed brokers will also utilize the SCIF. (CIC 11770)

Workers Comp. Part. I covers:

All sums the insurer is required to pay by state law

Which of the following most accurately defines the Fellow Servant Rule?

Another employee was responsible for the employees injuries

Which employer defense said that the employee knew the risks when he took the job, so he is responsible for his own injuries?

Assumption of risk

What types of injuries are covered under the Employers Liability section of the Workers Compensation policy?

Bodily injuries

Death benefits

Death benefits are provided by every state, and there are two types of payments. Each state provides a modest burial allowance, which is a maximum dollar amount (usually within the $1,000 to $5,000 range). Each state also provides weekly income payments for a surviving spouse and/or children. Weekly benefits are usually a percentage of the deceased worker's wages, subject to stated minimum and maximum dollar amounts, and a time limit. Some states have an aggregate payment limit. A surviving spouse may receive benefits for life, or until remarriage. Surviving children generally receive benefits until age 18 or 19, and until age 22 or 23 if they are still in school.

Mary's husband Stan sues Mary's employer for loss of consortium for work-related injuries that left her in a wheelchair. His lawsuit is an example of a

Family Member Services

After an audit the estimated premium becomes the:

Final premium

Income benefits

Income benefits are paid to employees who suffer work-related disabilities. A waiting period (usually three to seven days) applies before benefits for loss of wages begin. If the disability continues beyond a longer period (usually two to four weeks), retroactive benefits will be paid for the initial waiting period. Within each state, the percentage is the same for either type of total disability (66-2/3 % is most common).

Workers comp policies have 8 parts:

Information page General section Part I—Workers compensation Part II—Employers liability Part III—Other states insurance Part IV—Duties if injury occurs Part V—Premium Part VI—Conditions

Medical benefits under workers comp

Medical benefits are provided without limit in every state. An injured or diseased employee is entitled to receive all necessary medical and surgical treatment to cure or relieve the condition. Certain maximums or limits may apply to a type of care or a particular medical item, but overall benefits are unlimited. There is no time or dollar limit*

Rehabilitation Benefits

Rehabilitation benefits are provided by all states. Some states have set up a special fund to provide these benefits, while others have not. Rehabilitation services are now recognized as a valuable tool for reducing workers compensation costs and returning disabled employees to their jobs as soon as possible. Rehabilitation may include therapy, vocational training, devices such as wheelchairs, and the costs of travel, lodging and living expenses while being rehabilitated. Various states impose weekly limits, maximum limits, and special limits for specific types of rehabilitation.

True or False Most workers compensation policies are written for 1 year terms.

True

Workers comp

Under workers compensation law, employers are strictly responsible for the costs of any employee injuries that arise out of any employment related injury regardless of fault.

Workers Compensation Law:

Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits.

Who is the insured under a workers comp. policy?

the employer