Workers Compensation Guide: Interpretation and Analysis

by Thamann, David D.

• ISBN13: 9780872183841
• ISBN10: 087218384X
• Format: Paperback
• Copyright: 2000-04-01
• Publisher: Natl Underwriter Co

Summary

The Workers Compensation Coverage Guide provides an in-depth description and explanation of how the coverage works: exclusions, limits of liability, state insurance and how it applies, endorsements and policy wording. It provides comprehensive information on establishing and monitoring Workers Compensation programs: premiums, experience modifiers and financial plans.

Table of Contents

Introduction: The Workers Compensation System	1	(1)
A Great Social Compromise	1	(4)
Policy Organization, General Section	5	(4)
Policy Organization	5	(1)
General Section	6	(3)
Workers Compensation Insurance	9	(6)
To ``Pay Promptly When Due the Benefits Required by Law''	9	(1)
How This Insurance Applies	9	(1)
We Will Pay	10	(1)
We Will Defend	11	(1)
We Will Also Pay	12	(1)
Other Insurance	12	(1)
Payments You Must Make	12	(1)
Recovery from Others	13	(1)
Statutory Provisions	13	(2)
Employers Liability Insurance	15	(8)
How This Insurance Applies	16	(1)
The Course of Employment	16	(1)
We Will Pay	17	(1)
Employers Liability Exclusions	17	(2)
We Will Defend	19	(1)
We Will Also Pay	19	(1)
Other Insurance	19	(1)
Limits of Liability	20	(1)
Recovery from Others	21	(1)
Actions Against Us	21	(2)
Other States Insurance	23	(2)
Notice Clauses	24	(1)
Duties After Injury Occurs/Conditions	25	(6)
The Duties of the Insured	25	(2)
Conditions	27	(4)
Endorsements	31	(8)
Alternate Employer Endorsement WC 00 03 01 A	31	(1)
Employers Liability Coverage Endorsement WC 00 03 03 B	32	(1)
Joint Venture as Insured Endorsement WC 00 03 05	32	(1)
Medical Benefits Exclusion Endorsement WC 00 03 06	32	(1)
Medical Benefits Reimbursement Endorsement WC 00 03 07	32	(1)
Partners, Officers and Others Exclusion Endorsement WC 00 03 08	33	(1)
Sole Proprietors, Partners, Officers and Others Coverage Endorsement WC 00 03 10	33	(1)
Voluntary Compensation and Employers Liability Coverage Endorsement WC 00 03 11	33	(1)
Voluntary Compensation and Employers Liability Coverage for Residence Employees Endorsement WC 00 03 12	34	(1)
Waiver of Our Right to Recover from Others Endorsement WC 00 03 13	35	(1)
Workers Compensation and Employers Liability Coverage for Residence Employees Endorsement WC 00 03 14	35	(1)
Domestic and Agricultural Workers Exclusion Endorsement WC 00 03 15	35	(1)
Employee Leasing Client Endorsement WC 00 03 19	36	(1)
Labor Contractor Endorsement WC 00 03 20 A	36	(1)
Labor Contractor Exclusion Endorsement WC 00 03 21	36	(1)
Employee Leasing Client Exclusion Endorsement WC 00 03 22	37	(1)
Anniversary Rating Date Endorsement WC 00 04 02	37	(1)
Experience Rating Modification Factor Endorsement WC 00 04 03	37	(1)
Premium Discount Endorsement WC 00 04 06 or WC 00 04 06 A	37	(1)
Retrospective Premium Endorsement One Year Plan WC 00 05 03 A	37	(1)
Retrospective Premium Endorsement Three Year Plan WC 00 05 04 A	38	(1)
Retrospective Premium Endorsement One Year Plan---Multiple Lines WC 00 05 12 A	38	(1)
Retrospective Premium Endorsement Three Year Plan Multiple Lines WC 00 05 13 A	38	(1)
Benefits Deductible Endorsement WC 00 06 03	38	(1)
Nonprivate Insurance	39	(8)
Monopolistic State Funds	39	(1)
North Dakota	39	(1)
Ohio	40	(2)
Washington	42	(1)
West Virginia	43	(2)
Wyoming	45	(1)
Residual Markets	46	(1)
Federal Workers Compensation Coverage	47	(14)
Introduction	47	(1)
The Longshore and Harbor Workers Compensation Act	48	(5)
Scope of Coverage	48	(1)
Employer's Liability	49	(1)
Third Party Actions	50	(1)
Compensation	51	(1)
The L&HWCA and the Workers Compensation Policy	51	(1)
State vs. Federal Coverage	52	(1)
The Jones Act	53	(4)
Scope of Coverage	53	(2)
Definition of ``Seaman''	55	(1)
Jurisdiction of the Jones Act	56	(1)
Federal Workers Compensation Endorsements	57	(4)
Defense Base Act Coverage Endorsement WC 00 01 01 A	57	(1)
Federal Coal Mine Health and Safety Act Coverage Endorsement WC 00 01 02	58	(1)
Federal Employers Liability Act Coverage Endorsement WC 00 01 04	58	(1)
Longshore and Harbor Workers Compensation Act Coverage Endorsement WC 00 01 06 A	58	(1)
Nonappropriated Fund Instrumentalities Act Coverage Endorsement WC 00 01 08 A	59	(1)
Outer Continental Shelf Lands Act Coverage Endorsement WC 00 01 09 A	59	(1)
Maritime Coverage Endorsement WC 00 02 01 A	60	(1)
Premium	61	(10)
Manuals	61	(1)
Classifications	61	(1)
Remuneration	62	(1)
Premium Payments	62	(1)
Final Premium	62	(1)
Records	63	(1)
Audit	63	(1)
Workers Compensation Bureaus	64	(1)
Classification of Exposures	64	(2)
Premium Basis	66	(1)
Payroll Limitation	66	(1)
Rates	67	(1)
Other Factors	67	(1)
Limits of Liability	68	(1)
Sample Premium Calculation	68	(1)
Extension of Information Page	69	(2)
Experience Rating	71	(12)
Introduction	71	(1)
General Points	71	(5)
The Mod	72	(1)
Anniversary Rating Date	73	(1)
The Mod Formula	74	(1)
Unit Statistical Plan	75	(1)
Making the Calculation	76	(1)
Applying the Mod	76	(1)
Recalculation and Revisions	77	(1)
One Risk or Two?	78	(1)
Experience Rating Summary	79	(1)
Schedule Rating	80	(1)
Why is This Important?	81	(2)
Financial Plans	83	(24)
Introduction	83	(2)
Type of Financial Plans	85	(6)
Guaranteed Cost Plans	87	(1)
Dividend Plans	87	(1)
Standard Dividend Plans	88	(1)
Sliding Scale Dividends	89	(2)
Estimated Dividend Display	91	(1)
Retrospective Rating Plans	91	(12)
Retrospective Rating Formula	93	(1)
Excess Loss Premium	94	(1)
How a Retro Works	95	(2)
Optional Retro Premium Components	97	(1)
Audit vs. Retro Calculation	98	(1)
Retro Policy Cancellation	98	(1)
Retrospective Rating Forms	99	(1)
Incurred Loss vs. Paid Loss Plans	99	(1)
Deductible Plans	100	(3)
Option Evaluation Form	103	(4)
Cost Management Issues	107	(10)
Introduction	107	(1)
Managing Loss Reserves	108	(4)
A Typical Claims Review	109	(1)
Location Coding	110	(2)
Return to Work Programs	112	(1)
ADA Implications	112	(1)
Integrated Disability Management	113	(1)
Loss Prevention Incentive Programs	113	(1)
Premium Allocation Systems	114	(1)
Financial Impact	115	(2)
Issues in Workers Compensation	117	(30)
Introduction	117	(1)
Exclusive Remedy	117	(6)
Dual Capacity	118	(1)
Intentional Tort	118	(2)
Third-Party-Over	120	(1)
Other Possible Doctrines	120	(3)
Mental Stress Claims	123	(2)
In the Course of Employment	125	(2)
Relationship to Employment	126	(1)
Employment of Minors	127	(3)
Principals and Contractors	130	(2)
Leased Employees	132	(3)
Stop Gap Coverage	135	(1)
Workers Compensation and Volunteers	136	(2)
Various Workers Compensation Doctrines	138	(4)
The Positional Risk Doctrine	138	(1)
Odd Lot Doctrine	139	(1)
Usual Exertion Doctrine	140	(1)
Last Injurious Exposure Rule	140	(1)
Peculiar Risk Doctrine	141	(1)
Personal Comfort Doctrine	141	(1)
Successive Injury Cases	142	(5)
Appendix A: NCCI WC Policy Information Page	147	(8)
NCCI Workers Compensation and Employers Liability Policy Form	149	(6)
Appendix B: Sample Experience Modification Worksheet	155	(4)
Confidential Request for Information Form ERM-14	157	(2)
Appendix C: Application of Workers Compensation Laws by State	159	(16)
Residual Markets	161	(2)
Successive Injury Funds by State	163	(10)
Type of WC Law by State	173	(2)
Index	175