Worker's Compensation

Part Four: Your Duties if Injury Occurs

Addresses the insured's obligations when an injury occurs for which there may be coverage. The insured must provide medical services required for the injured party, report the injury to the insurer and cooperate with the insurer in the investigation and settlement of the claim.

Assumption of a Risk

Allowed the employer to deny liability on the basis that the employee knew what the situation was before employment and assumed all of the risk of injury.

Survivor/death Benefits

Compensate a surviving spouse, children, or other relatives of an employee whose death results from a work-related injury. In general, survivor benefits usually include a weekly benefit and a stipulated amount for funeral and burial expenses.

Disability/loss of Income Benefits

Compensate employees who are unable to work as the result of a work-related injury. These benefits are intended to replace a portion of lost income, but not all of it.

General Section

Contains definitions and conditions that apply to the policy as a whole.

Part Five: Premium

Explains how the cost of the policy is determined.

Federal Employers Liability Act (FELA)

FELA allows the injured worker or a representative of a deceased worker to sue the employer for negligence and eliminates two of the common law defenses: contributory negligence and assumption of risk. Awards provided under FELA are often more substantial than those provided under state workers' compensation laws because FELA does not limit an injured employee's remedies to scheduled benefits.

Worker's Compensation Laws

Give employees the right to collect from their employers for injury, disability, or death that occurs in the course of employment.

Rehab Benefits

Include medical rehabilitation, such as physical therapy designed to improve physical functioning, and vocational rehabilitation, such as retraining for a different occupation. Workers' compensation rehabilitation benefits usually pay reasonably justifiable expenses for these purposes.

Jones Act

Is a federal law that allows members of ships' crews to sue the employer/shipowner at common law for injuries caused by the employer's/shipowner's negligence.

Permanent Disability

Is one that will affect the worker for the rest of the worker's life.

Temporary Disability

Is one that will go away.

Part Three: Other States Insurance

May be used to provide coverage for states that are not specifically listed in the information page for part one coverage. The state must be listed in the information page for other states coverage, and the insured must provide notice to the insurer as soon as work begins in a new state.

Compulsory

Meaning the employer must accept and comply with all provisions of the law.

Medical Benefits

Pay for the cost of various types of medical services required because of an employment-related injury. Nearly any type of related medical expense is covered with neither an upper dollar limit nor a limit on the period of time for which expenses will be paid.

Part One: Worker's Compensation

Promises to pay all compensation and other benefits required of the insured by the workers' compensation law in the state or states where the insured's business operates (which are listed in the Information Page).

Part Two: Employers Liability

Provides coverage to the insured for sums the insured becomes legally obligated to pay under common law because of a work-related injury or occupational disease. Three separate limits apply with a workers' compensation policy. These limits are: per accident—for all bodily injury arising from a single accident (regardless of the number of employees injured); policy limit—for all bodily injury by disease during the policy term (regardless of the number of employees injured by disease); and per employee—for each employee injured by disease during the policy term.

Part Six: Conditions

Sets forth the conditions that apply to the policy, such as cancellation procedures, subrogation, and the insurer's right to inspect the insured's workplace.

Elective

The employer may choose not to be subject to the law. However, an employer who does so is denied any rights provided under the law and loses the use of the pro-employer defenses against liability discussed earlier.

Types of Disability

The level of disability suffered by an injured worker is categorized into one of four types: Permanent total Permanent partial Temporary total Temporary partial

Fellow Servant Rule

Was used to deny liability on the basis that the injury was caused by a fellow employee and, therefore, the employer could not be held liable.

Contributory Negligence

Was used to deny liability on the basis that, no matter how negligent the employer was, the employee also had been negligent, and therefore the employee should be responsible for the consequences.

Industrially Disabled

Which refers to the individual's loss of earnings.

Medically Disabled

Which refers to the physical condition that affects functioning.

Benefits Provided

Workers' compensation laws vary from state to state, but in general they pay benefits in four categories.