[h] CPCU 552 – Module 6
[q] Workers compensation statute
[a] A statute that obligates employers to pay medical, disability, rehabilitation, and death benefits for job-related injuries and diseases suffered by employees. Provides no-fault protection to employees.
[q] Benefits provided by workers compensation statutes
[a] Benefits are provided for medical expenses and wage loss resulting from either occupational injury or occupational disease.
[q] Occupational disease
[a] Disease that is thought to be caused by work.
[q] Absolute liability
[a] Liability imposed without regard to fault. A typical workers compensation statute imposes this liability on employers.
[q] Temporary partial disability
[a] Disability caused by an injury or disease that temporarily limits the extent to which an employee can perform their job duties for a period of time.
[q] Temporary total disability
[a] Disability caused by an injury or disease that temporarily renders an injured employee unable to perform any job duties for a period of time.
[q] Permanent partial disability
[a] Disability caused by an injury or disease that impairs the injured employee’s earning capacity for life.
[q] Permanent total disability
[a] Disability caused by an injury or disease that renders an injured employee unable to ever return to employment.
[q] Workers compensation benefits
[a] A person hired to perform services under the direction and control of the employer.
[q] Individuals covered under workers compensation statutes
[a] Coverage generally applies to virtually all industrial workers and most other kinds of private employment.
[q] Extraterritorial provisions
[a] A workers compensation statute provision that extends protection to an employee who is injured while temporarily working in a state other than their state of hire.
[q] U.S. Longshore and Harbor Workers’ Compensation Act
[a] A statute that eliminates the right of most maritime workers to sue their employers. The statute requires employers to provide injured or sick workers with workers compensation-type benefits.
[q] Jones Act
[a] A federal statute enacted in 1920 that permits injured members of a vessel’s crew to sue their employer.
[q] Methods for satisfying employers’ workers compensation obligations
Assigned Risk Plans.
Qualified Self-Insurance Plans.
[q] Competitive state funds
[a] A state fund that sells workers compensation insurance in competition with private insurers.
[q] Workers Compensation and Employers Liability (WC&EL) Insurance Policy
[a] A policy form that was developed by the National Council on Compensation Insurance. The form primarily covers an employer’s obligation to pay workers compensation benefits.
[q] WC&EL information page
[a] A page contained in the Workers Compensation & Employers Liability policy that is similar to a declarations page.
[q] Part 1 -Workers Compensation Insurance
[a] A part of the Workers Compensation & Employers Liability policy that obligates the insurer to pay benefits required by the workers compensation law. Coverage applies to states listed in Item 3.A of the Information Page.
[q] Part 1 -Workers Compensation Insurance exclusions
[a] Part 1 contains no exclusions and does not contain a dollar limit.
[q] Other states insurance
[a] Insurance that automatically extends coverage to the insured’s operations in any state listed in Item 3.C. of the WC&EL Information Page.
[q] Part 2 – Employers Liability Insurance
[a] A part of the Workers Compensation & Employers Liability policy that covers an employer against liability for an employee’s occupational injury or disease that is not covered by a workers compensation statute.
[q] Part 2 – Employers Liability Insurance covered claims
[a] Covered claims include:
Third-party claim (third-party over action).
Claim for care and loss of services (loss of consortium).
[q] Dual-capacity doctrine
[a] A legal doctrine giving the employee the right to sue the employer when the employer acts outside their capacity as an employer.
[q] Part 2 – Employers Liability Insurance exclusions
Injury outside the United States or Canada.
Liability assumed under contract.
Bodily injury intentionally caused by the insured.
Fines or penalties imposed for violation of federal or state law.
[q] Part 2 – Employers Liability Insurance liability coverage limits
[a] Employers liability coverage limits:
Bodily injury by accident – most the insurer will pay for bodily injury resulting from one accident.
Bodily injury by disease – policy limit – most the insurer will pay for bodily injury by disease.
Bodily injury by disease – each employee – most the insurer will pay for bodily injury by disease to any one employee.
[q] Part 2 – Employers Liability Insurance liability supplementary payments
Expenses the insurer incurs.
Cost of bail bonds.
Cost of bonds to release attachments.
Reasonable expenses incurred by the insured.
Court costs taxed against the insured.
[q] Voluntary Compensation and Employers Liability Coverage endorsement
[a] An endorsement that amends the WC&EL policy to cover employees who are not subject to a workers compensation statute.
[q] Foreign voluntary workers compensation coverage
[a] Coverage that insures employees who are working outside the U.S. and who are not subject to a workers compensation law for benefits equal to those in the U.S.
[q] United States Longshore and Harbor Workers’ Compensation Act endorsement
[a] An endorsement that amends the WC&EL policy to cover the insured’s obligations under the U.S. Longshore and Harbor Workers’ Compensation Act.
[q] Alternate Employer endorsement
[a] An endorsement that extends coverage under the WC&EL policy to an additional organization named in the endorsement.