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Workers Compensation Coverage Guide
Description: The definitive guide to understanding Workers Compensation and Employers Liability Programs.
From basic to complex concepts, this comprehensive guide covers it all in plain language. You'll learn how the coverage works and how programs are established and monitored. This valuable guide has more than 200 pages of forms and information, including discussions that are vital for complete understanding of the workers compensation system.
The workers compensation system was one of the triumphs of the industrial age. The system is the cumulative result of years of strife and compromise between employer/owners and employee/labor. The struggle toward this useful social compromise began in the 1870s with the organized labor movement and came to fruition in 1911 with the passage of the first state workers compensation law in Wisconsin. In the workers compensation system, injured employees relinquish the right to sue their employers for employment-related injuries in return for a statutorily imposed mechanism that provides specific scheduled benefits.
These benefits are funded, for the most part, through insurance policies that employers purchase from insurance companies. Indeed, in most states, employers must insure their workers compensation exposure or become qualified self-insurers. Employers cannot simply decide to operate without insurance. If they do, they risk being fined—and still have to pay the benefits that are set by law when an employee is injured on the job.
This work is a guide to the workers compensation system: how to calculate premium; how experience rating and modifiers work; and various financial plans and considerations. It also provides a detailed analysis of workers compensation and employers liability insurance by way of an examination of the standard workers compensation insurance policy.
Contents: Introduction: The Workers Compensation System A Great Social Compromise
Chapter 1: Policy Organization, General Section Policy Organization
General Section
Chapter 2: Workers Compensation Insurance
To “Pay Promptly When Due the Benefits Required by Law” How This Insurance Applies
We Will Pay We Will Defend We Will Also Pay Other Insurance
Payments You Must Make Recovery from Others Statutory Provisions
Chapter 3: Employers Liability Insurance How This Insurance Applies
The Course of Employment We Will Pay
Employers Liability Exclusions We Will Defend
We Will Also Pay Other Insurance Limits of Liability
Recovery from Others Actions Against Us
Chapter 4: Other States Insurance Notice Clauses
Chapter 5: Duties After Injury Occurs/Conditions The Duties of the Insured
Conditions
Chapter 6: Endorsements
Alternate Employer Endorsement WC 00 03 01 A
Employers Liability Coverage Endorsement WC 00 03 03 B Joint Venture as Insured Endorsement WC 00 03 05 Medical Benefits Exclusion Endorsement WC 00 03 06 Medical Benefits Reimbursement Endorsement WC 00 03 07 Partners, Officers and Others Exclusion Endorsement WC 00 03 08
Sole Proprietors, Partners, Officers and Others Coverage Endorsement WC 00 03 10 Voluntary Compensation and Employers Liability Coverage
Endorsement WC 00 03 11
Voluntary Compensation and Employers Liability Coverage for Residence Employees Endorsement WC 00 03 12
Waiver of Our Right to Recover from Others Endorsement WC 00 03 13
Workers Compensation and Employers Liability Coverage for Residence Employees Endorsement WC 00 03 14
Domestic and Agricultural Workers Exclusion Endorsement WC 00 03 15 Employee Leasing Client Endorsement WC 00 03 19
Labor Contractor Endorsement WC 00 03 20 A
Labor Contractor Exclusion Endorsement WC 00 03 21 Employee Leasing Client Exclusion Endorsement WC 00 03 22 Anniversary Rating Date Endorsement WC 00 04 02
Experience Rating Modification Factor Endorsement WC 00 04 03 Premium Discount Endorsement WC 00 04 06 or WC 00 04 06 A Retrospective Premium Endorsement One Year Plan WC 00 05 03 A Retrospective Premium Endorsement Three Year Plan WC 00 05 04 A
Retrospective Premium Endorsement One Year Plan — Multiple Lines WC 00 05 12 A Retrospective Premium Endorsement Three Year Plan Multiple Lines WC 00 05 13 A Benefits Deductible Endorsement WC 00 06 03
Chapter 7: Nonprivate Insurance Monopolistic State Funds North Dakota Ohio Washington West Virginia Wyoming Residual Markets
Chapter 8: Federal Workers Compensation Coverage Introduction
The Longshore and Harbor Workers Compensation Act Scope of Coverage
Employer’s Liability Third Party Actions Compensation
The L&HWCA and the Workers Compensation Policy State vs. Federal Coverage
The Jones Act Scope of Coverage Definition of “Seaman” Jurisdiction of the Jones Act
Federal Workers Compensation Endorsements
Federal Coal Mine Health and Safety Act Coverage Endorsement WC 00 01 02 Federal Employers Liability Act Coverage Endorsement WC 00 01 04
Longshore and Harbor Workers Compensation Act Coverage Endorsement WC 00 01 06 A Nonappropriated Fund Instrumentalities Act Coverage Endorsement WC 00 01 08 A Outer Continental Shelf Lands Act Coverage Endorsement WC 00 01 09 A
Maritime Coverage Endorsement WC 00 02 01 A Chapter 9: Premium Manuals Classifications Remuneration Premium Payments Final Premium Records Audit
Workers Compensation Bureaus Classification of Exposures Premium Basis Payroll Limitation Rates Other Factors Limits of Liability
Sample Premium Calculation Extension of Information Page Chapter 10: Experience Rating Introduction
General Points The Mod
Anniversary Rating Date The Mod Formula Unit Statistical Plan Making the Calculation Applying the Mod
Recalculation and Revisions One Risk or Two?
Experience Rating Summary Schedule Rating
Why is This Important? Chapter 11: Financial Plans Introduction
Type of Financial Plans Guaranteed Cost Plans Dividend Plans
Standard Dividend Plans Sliding Scale Dividends Estimated Dividend Display Retrospective Rating Plans Retrospective Rating Formula Excess Loss Premium
How a Retro Works
Optional Retro Premium Components Audit vs. Retro Calculation
Retro Policy Cancellation Retrospective Rating Forms Incurred Loss vs. Paid Loss Plans Deductible Plans
Option Evaluation Form
Chapter 12: Cost Management Issues Introduction
A Typical Claims Review Location Coding
Return to Work Programs ADA Implications
Integrated Disability Management Loss Prevention Incentive Programs Premium Allocation Systems Financial Impact
Chapter 13: Issues in Workers Compensation Introduction
Exclusive Remedy Dual Capacity Intentional Tort Third-Party-Over
Other Possible Doctrines Mental Stress Claims
In the Course of Employment Relationship to Employment Employment of Minors Principals and Contractors Leased Employees Stop Gap Coverage
Workers Compensation and Volunteers Various Workers Compensation Doctrines The Positional Risk Doctrine
Odd Lot Doctrine Usual Exertion Doctrine Last Injurious Exposure Rule Peculiar Risk Doctrine Personal Comfort Doctrine Successive Injury Cases
Appendix A: NCCI WC Policy Information Page
NCCI Workers Compensation and Employers Liability Policy Form Appendix B: Sample Experience Modification Worksheet
Confidential Request for Information Form ERM-14
Appendix C: Application of Workers Compensation Laws by State Residual Markets
Successive Injury Funds by State Type of WC Law by State Index
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