Flashcards in Workers Comp Deck (30)
What are 3 defenses to wc?
Assumption of risk
Fellow servant rule
Who is exempt from compulsory wc?
Farm workers, casual employees, domestic servants
How many years does an entity have to be in business to self insure for wc?
When an injured employee has lost five days of work how long doses employer have to notify DIA?
7 calendar days
Which coverages fall under part I?
Medical expense (no limit)
Income ( 66 2/3 total permanent, 60 partial or temporary)
Dependent/funeral expense ($4000 burial, survivor if fatally injured - children to age
18 or no longer in college)
Rehab/restoration (max 104 weeks)
Is there coverage of contributory negligence exists, injury results from another employee or injured employee violated a safety warning?
How long are benefits paid for total incapacity?
Is there wc coverage if employee violated the law or injury was self-inflicted?
What is covered under part II?
Employers liability (3rd party suits against employer by
1) non/employees people not subject to wc law)
2) covered employee dependents
Legal defense expenses in addition to
What are basic wc limits?
$100 accident $100 occupational disease $500 aggregate for occupational disease
This type of suit occurs when employee sues employer in other capacity. Ex. Suing safety over auto claim.
Suit where employee is injured by faulty machinery sues manufacturer of machinery an manufacturer alleges the employer installed incorrectly.
Third party over
Covers injury to family member due to injured employee. Ex. Heart attack finding out about injury, loss of consortium.
Covers employer if an employees family member sues due to loss of consortium, companionship or affection.
Care and loss of services.
What is part III of a wc?
Other states insurance ... Optional. Must itemize each state.
Which states are monopolistic states?
ND, OH, WA, WY
What are parts IV V and VI?
When can an employer make a payment?
Can only make at own expense except can pay for emergency medical treatment.
When does employer have to report to DIA?
Within 7 days if employee lost 5 days of work.
How are wc premiums set?
1) classification of job
2) payroll ($100s of payroll - audit at end)
3) claims experience
Wc plan where employer pays claims up to large amount ... $100k or $250k. Insurer pays beyond.
Large deductible plan.
Used by some wc programs , premium is based on actual loss experience and calculate at end
Retrospective rating plan
Which employees are exempt from wc?
1) masters and seamen in interstate commode covered by federal law
2) athletes with contracts providing disability
3) commision paid salespeople (contractors)
4) independent taxi drivers
5) domestic servants less than 16 hours per week.
Adds wc coverage for employees normally not eligible.
Extends wc to us citizens working in other countries. May cover cost of repatriating for treatment of diseases.
What are some additional coverages normally not covered by a wc that are afforded when the foreign coverage endorsement is attached?
Repatriating injure employee, treatment of endemic diseases.
This fund is set up as an encouragement for employers to hire previously injured persons. It pays all or part of compensation resulting from the prior injury when a partially disabled employee is hired. 1/4% tax on wc on all insurers who write wc insurance.
Subsequent injury fund
Law that allowed employee or family to take legal action against (interstate) railroad as result of injury or death. Excl usps
Federal Employers Liability Act
Compensation by federal government to employees/family to people working on or around ships. Crew of ship not covered.
Us longshoreman and harbor workers' comp