1 Presented by: Mark R. Hunter, CRIS Summit Risk Management & Insurance Salt Lake City: Phoenix: Disclaimer: The information contained in this presentation is for a general understanding of insurance. Please refer to your specific insurance policy for details regarding your coverage. Summit Insurance Group, LLC. and Summit Risk Management, SIG/SRM, provides risk management ideas, concepts, and tools. We advise that all the risk management concepts, training tools, ideas, theories, programs, software, computer programs, sample and/or actual policies and procedures, sample and/or actual employee handbook information, safety programs or materials or any other consultative advice in which SIG/SRM provides, verbally or in writing, to the company, any of it s employees, or any recipient of this information be reviewed by an appropriate attorney who is a specialist in that which is being reviewed. SIG/SRM does NOT provide legal or tax advice or opinions. 5/4/2015 1
2 Types of Coverage General Liability Insurance Commercial Auto Insurance Inland Marine Coverage Tools and Equipment Builders Risk Workers Compensation Health Insurance (ACA-Obamacare)
3 General Liability Insurance Page 40 in the book
9 Utah Statue of Repose
10 Contract Utah Statue of Repose
11 Utah Statue of Repose 9 years + 2 year tail for discovery
13 Lawsuit and Claim Denial #1
14 Lawsuit and Claim Denial
16 Lawsuit Forensics
20 Contracts and Agreements Owner, GC (upper tier) / and Subcontractor (lower tier)
22 Contracts and Agreements
23 Contract #1 Not proper insurance
24 Contract #2 Not enough insurance
25 Contract #3 No Risk Transfer
29 Best 2 nd Best Blanket Combo Additional Insured
33 Tender defense to Sub 1
34 No Additional Insured
38 DOPL Failure to have insurance (Liability or Workers Comp) R156-55a-401. Minimum Penalty for Failure to Maintain Insurance. (1) A minimum penalty is hereby established for the violation of Subsection R156-55a-501(2) as follows: (a) For a violation the duration of which is less than 90 days, where the licensee at the time a penalty is imposed documents that the required liability and workers compensation insurance have been reacquired, and provided an insurable loss has not occurred while not insured, a minimum of a 30 day suspension of licensure, stayed indefinitely, automatically executable in addition to any other sanction imposed, upon any subsequent violations of Subsection R156-55a-501(2). (b) For a violation the duration of which is 90 days or longer, or where insurable loss has occurred, where the licensee at the time a penalty is imposed documents that the required insurance have been reacquired, a minimum of 30 days suspension of licensure. (c) For a violation of any duration, where the licensee at the time a penalty is imposed fails to document that the required insurance have been reacquired, a minimum of indefinite suspension. A license which is placed on indefinite suspension may not be reinstated any earlier than 30 days after the licensee documents the required insurance have been reacquired. (d) If insurable loss has occurred and licensee has not paid the damages, the license may be suspended indefinitely until such loss is paid by the licensee. (e) Nothing in this section shall be construed to restrict a presiding officer from imposing more than the minimum penalty for a violation of Subsection R156-55a-501(2) and (3). However, absent extraordinary cause, the presiding officer may not impose less than the minimum penalty.
39 General Liability Insurance Purpose Providing protection to companies in the event of a loss, or lawsuit Compliance with licensing/dopl requirements Compliance with Contractual requirements
40 General Liability Insurance General liability insurance provides protection against two types of financial loss arising out of a lawsuit against the company. 1)Bodily Injury/Property Damage damages awarded to a third party because of injury or damage for which the insured is legally responsible, including loss of use of property claims. 2) Defending the insured against the charges alleged in the suit, including attorney fees, investigation costs, and other legal expenses.
41 General Liability Insurance Contractual Liability: Many breach of contract claims are confined to allegations of financial or business loss that are not of a type that are covered under a general liability policy. For example, liability based on the failure to perform the contracted work is usually not insurable. Liability insurance is not designed to warranty the work performed. Other contractual liabilities including the assumption of the other party s legal liability to a third person or organization are often covered. Part B of the WC policy (employer liability).
42 Construction Liability Exposures Premises and operations liability encompasses liability arising out of conditions in and around the insured s premises as well as its current on and off premises business operations. On-Going operations. Products and completed operations liability refers to just that liability arising out of the insured s products or its completed work. Contractual liability involves the voluntary assumption of obligations that do not exist under common law Independent contractor liability describes liability imposed upon the person who hires an independent contractor to perform work on its behalf.
43 Premises and Operations Risks (In most instances, injuries to employees do not present general liability exposures because of the exclusive remedy of workers compensation. Where exclusive remedy can be circumvented, the workers compensation and employers liability policy will apply, not the general liability policy.) In some cases, the contractor may be liable when someone else s negligence was the cause of the loss such as when it is held liable for injury or damage caused by its subcontractor or when it has contractually agreed to assume another party s liability for such losses.
45 Products & Completed Operations Risks On-going operations Liability Vs. Completed Operations Liability Ongoing operations is the exposure you have while doing the work, but ends when you leave the jobsite.
46 Products & Completed Operations Risks On-going operations Liability Vs. Completed Operations Liability Ongoing operations is the exposure you have while doing the work, but ends when you leave the jobsite. Construction work can fail long after the actual work was performed, resulting in injury or damage years later.
47 Products & Completed Operations Risks On-going operations Liability Vs. Completed Operations Liability Ongoing operations is the exposure you have while doing the work, but ends when you leave the jobsite. Construction work can fail long after the actual work was performed, resulting in injury or damage years later. These long tail liabilities are difficult to estimate and much more difficult to investigate and determine the cause of the loss. Further, with respect to progressive injury or damage, issues often arise over when the actual injury or damage occurred. Different states have different statutes of limitations/repose (often up to 12 years).
48 Products & Completed Operations Risks - Occurrence Basis - It is important to note that it is the occurrence of bodily injury or property damage, not the event (Construction) that produces the bodily injury or property damage, that triggers the policy. - Claims Made - This is when the claim is made, not when the occurrence takes place. These are generally not as good of policies as the Occurrence policy. (Tail coverage)
49 Products & Completed Operations Risks For example, assume that an electrical contractor has a CGL policy written on an occurrence basis with a term of January 1, 2000, to January 1, The contractor makes a mistake in installing an electrical panel on July 1, 2000, and an employee of the project owner is electrocuted as a result of the error on June 1, 2003 but does not make a claim until July 1, 2005.
50 Products & Completed Operations Risks The claim would be covered by the 2003 policy, regardless of the fact the negligent act occurred in 2000 and the claim was made in In other words, the dates on which the negligence occurs or the claim is actually made are irrelevant to the issue of determining coverage. The date on which the injury or damage occurred is the only date that controls the trigger of coverage.
51 Products & Completed Operations Risks In another example, assume that a plumbing contractor has a CGL policy written on an occurrence basis with a term of January 1, 2005 to January 1, This policy was renewed for two consecutive years, with the current policy period being January 1, 2007 to January 1, On September 15, 2005, the contractor makes a mistake in installing a new plumbing unit in a home.
52 Products & Completed Operations Risks On December 8, 2006, the plumbing system malfunctions as a result of the mistake, causing property damage to the home. The claim, however was not made until January 7, The claim would be covered by the 2006 policy, regardless of the fact that the negligent act occurred in 2005 and the claim was made in 2007.
53 Products & Completed Operations Risks
54 2002 The building is built roof collapses under the weight of snow in causing damage to the building and its contents, and injuring five people. The cause of the collapse is determined to be improper spacing of support beams in the roof, in direct noncompliance with the architect s plans. The policy in effect in 2004 when the roof collapsed is triggered. Therefore, if the 2004 policy did not include completed operations coverage, there would be no coverage for this loss.
58 Contractual Liability
59 Indemnify & Hold Harmless Project owners typically require the general contractor to indemnify and hold harmless the owner for third-party liability they incur as a result of the contractor s work for them. General contractors typically do likewise with respect to subcontractors. The notion behind this risk transfer is that the party performing the work should bear responsibility for any injury or damage that is incurred by third parties in connection with that work.
60 Independent Contractor Liability Vicarious liability is liability that attaches even in the absence of direct negligence, due to a specific legal responsibility for the acts of another. That is, in certain circumstances, a contractor can be held liable for the negligence of its subcontractor merely because of the contractual relationship. Strict liability attaches without the need to show any negligence at all. The mere fact that a loss occurs renders the contractor liable. The circumstances under which contractors can be held strictly liable for a loss vary by state but commonly address extra-hazardous operations such as blasting, use of hazardous materials, or work performed above a specified height.
61 First, contractors are also responsible to the party that hires them (i.e., the property owner) for any damage to the property constructed that is the result of a subcontractor s work. The basis of this liability is usually some form of direct negligence, such as negligent hiring or supervision of the subcontractor. Second, a contractor can be held liable for losses arising out of the acts of its subcontractors under the theory of vicarious liability or strict liability.
62 Construction Risk and CGL Policy Insurable Risk Vs. Uninsurable Risk
63 Exhibit 1.1 Construction Exposures and CGL Coverage Contractor s Exposure Damage to property under construction The CGL Policy Provides significant coverage with respect to the contractor s liability for damage to the property under construction (sometimes referred to as broad form property damage coverage) On-going ops Completed operations Other third-party bodily injury and property damage Covers third-party bodily injury or property damage that occurs during the policy period in conjunction with completed operations, including damage to the completed project under some circumstances. Coverage applies even if the work that produced the injury or damage was performed many years prior. Covers a broad array of claims for bodily injury or property damage sustained by third parties, including premises and operations liability Completed ops Subs injured Worker Contractual liability Independent contractor liability Covers the insured s assumption of liability in an insured contract, which includes tort liability assumed in a hold harmless or indemnity provision in a construction contract or rental agreement Responds to a contractor s liability arising out of its use of subcontractors CG limitation CG Exclusion
64 Construction Risk and CGL Policy
65 Limits of General Liability Insurance Limits of coverage (split limits) 300,000 Each Occurrence /600,000 Aggregate (annual limit) 500,000/1,000,000 1,000,000/2,000,000 Additional limits may be available through an umbrella policy or an excess coverage limit policy
67 General Liability Premium Rating Premium is developed through applying a factor rate percentage against an exposure (Rate X Exposure) Gross Payroll Gross Sales Subcontracted Cost Square footage Auditable
68 General Liability Insurance Credits: Schedule Credits/Debits (-25% to +25%) Experience Credits Additional Credits (Size, Association, Compliance, etc.)
69 Riders/Endorsements/Addl. Coverage: Employee Benefit Liability: Covers employers for mistakes made on certain employee benefits (eg: Health Insurance) Employment Practices Liability: covers for issues such as: Wrongful termination, failure to hire, failure to promote, retaliation, sexual harassment, hostile work environment, ADA, FMLA, Title VII- discrimination issues, etc.
70 Riders/Endorsements/Addl. Coverage: D&O Directors and Officers: Covers Directors and Officers of an organization against lawsuits brought by the share holders for poor business practices E&O- Errors & Omissions / Professional Liability: Protects against lawsuits brought against a company for it s professionals services (eg: Architects/Engineers). Contractors have this exposure when they draw or change designs Standard Exclusion in a General Liability policy.
71 Riders/Endorsements/Addl. Coverage: Stop Gap Coverage: Provides Employer Liability coverage for employers that do work in monopolistic states (Wyoming, Washington State, Ohio, North Dakota) Fiduciary Liability: Provides Fiduciaries (owners, HR folks, controllers, etc.) coverage in the event they act as the fiduciary relative to employee investments (eg: 401K, employee benefits advice)
76 Soil subsidence/earth movement Residential and/or Tract Housing Condo Townhome Apartment Multi-family EIFS/Synthetic Stucco Mold/fungus Asbestos and/or Lead Exclusions / Coverage Reducing Endorsements Cross Suits Exclusion (eliminates coverage for suits brought by Subcontractors (if GC is AI) employees. *This is not an all inclusive list
77 Bodily injury to contractors or subcontractors limitation Prior work exclusion Exclusions / Coverage Reducing Endorsements Sunset clause (claim must be reported within a time certain 2 yrs of completion) Manifestation Provision (BI or PD first manifests during the policy period) Total pollution exclusion (clean up from hostile fire, BI from building heating equipment) Contractual Liability Limitation CG (Eliminates important contractual liability coverage -see next slide) Independent Contractors Limitation of Coverage (Eliminates coverage if requirements aren t met limits, correct additional insured status, hold-harmless/indemnification agreements) Damage to Work Performed by Subcontractors CG *This is not an all inclusive list
78 Exclusions / Coverage Reducing Endorsements Contractual Liability Limitation CG *This is not an all inclusive list
79 Exclusions / Coverage Reducing Endorsements Contractual Liability Limitation CG Indemnification agreement = insured contract Under the definitions Section 9.f. an indemnification agreement would be considered an insured contract. The CG simply deletes sections 9.f. from the definitions of an insured contract. The result is that a subcontractor can now be on the hook to pay for the legal expenses and liability of the general contractor in the event of a loss. So, before you sign your life away on an indemnification agreement, check your insurance policy for a CG
80 Damage to Your Work Exclusion While several CGL exclusions pertain to completed operations losses, the damage to your work exclusion is by far the most important in defining the scope of completed operations coverage, including damage arising out of construction defects. This exclusion specifically states that it applies only to liability arising out of the products-completed operations hazard, which limits its application to completed work. The damage to property exclusion, discussed above, addresses coverage for damage to work in progress. Insurance is not a warranty.
81 Damage to Your Work Exclusion The definition of your work includes work performed by subcontractors; therefore, the first part of the exclusion reaches both self-performed and subcontracted work. However, the subsequent sentence states that the exclusion does not apply if the damaged work or the work out of which the damage arises was performed by a subcontractor. Coverage is thus preserved for damage to a subcontractor s work and damage caused by a subcontractor s work.
82 Sub-contractor Exclusion (Major Exclusion) As each insurance policy may contain certain exclusions, it is important to read each policy carefully. This illustration is not a guarantee of coverage.
86 Certificate of Insurance Often contractors sub-contracting work out to others require a certificate of insurance as evidence that the sub-contractor has insurance coverage. This should reflect coverage for at least the following: General Liability Insurance Commercial Auto Insurance (including non-owned/hired auto) Workers Compensation Insurance (including coverage for any State the contractor performs work) Other coverage that should be considered as a requirement (not an exhaustive list): Professional Liability (coverage is needed for engineers/architects, and any contractor who does any type of design work more common than one might think) Inland Marine (Tools/Equipment, materials in transit or while on job site before installed, and/or builders risk coverage) Performance Bond (a type of insurance that protects against failure to perform the work As each insurance policy may contain certain exclusions, it is important to read each policy carefully. This illustration is not a guarantee of coverage.
87 Certificate of Insurance Certificates of insurance do NOT tell the whole story Page 34
88 Certificate of Insurance Issues to consider -Type of insurance company (AM Best rating, Size, Admitted vs. Non-admitted) -Coverage type: CGL, Auto (including non-owned/hired), Workers compensation, Umbrella/Excess, Inland Marine/Builders Risk, Pollution Liability, & Professional Liability. -Limits of coverage -CGL: Claims Made vs. Occurrence, General Aggregate by POLICY, LOCATION, OR PROJECT -Ensuring the umbrella actually covers ALL underlying coverage
89 Certificate of Insurance Issues to consider -Waiver of Subrogation (CGL, Auto, Umbrella, WC) -Additional Insured Status (CGL, Auto, Umbrella - see next slide for different versions of AI) -Listing Owner and Contractor as AI, job description, etc.
90 Best 2 nd Best Blanket Combo Additional Insured
91 Additional Insured / Hold Harmless-Indemnification Agreements Often contractors sub-contracting work out to others will want to be listed as an additional insured on the subs insurance policy. This is a good use of a risk management tool, however, most insurance companies who insure contractors only add the additional insured based upon the language of the contract between the two parties. In other words, if there is no contract, or if the contract is insufficient to address the issues, there is no coverage afforded on an additional insured basis to the contractor who is hiring the subcontractor even though they may have received a certificate of insurance indicating additional insured status. This should include primary and non-contributory language AND a waiver of subrogation in favor of the certificate holder. Subsequently, a well written agreement between contractors including, but not limited to language that includes: Hold harmless & indemnification in favor of the contractor hiring the sub-contractor. As each insurance policy may contain certain exclusions, it is important to read each policy carefully. This illustration is not a guarantee of coverage.
92 Helpful Solutions Two helpful solutions: Summit Risk Management & Insurance Construction Risk Transfer program AND GotMyCerts.com (Free Tool) / GotMyContracts.com / GotMySafety.com
98 State of Utah Requirements for Contractors The state of Utah requires contractors to carry specific insurance to protect the public. The state verifies policy types and amounts by requiring a certificate of insurance. The Division of Professional Licensing is tasked with oversight of contractor insurance. Specific detail on what is required and the penalty for noncompliance can be found in the Utah Construction Trades Licensing Act Rule R156-55a. This rule can be located through the state of Utah s administrative rules web site, or through DOPL s web site: Section 302d states: R156-55a-302d. Qualifications for Licensure - Proof of Insurance and Registrations. In accordance with the provisions of Subsection (2)(b), an applicant who is approved for licensure shall submit proof of public liability insurance in coverage amounts of at least $100,000 for each incident and $300,000 in total by means of a certificate of insurance naming the Division as a certificate holder. NOTE: Most insurance companies will not sell/provide this low of a limit.
99 State of Utah Requirements for Contractors In addition to spelling out the requirements for insurance, the rule also defines failure to continuously maintain insurance as unprofessional conduct and provides the following penalties: R156-55a-401. Minimum Penalty for Failure to Maintain Insurance. (1) A minimum penalty is hereby established for the violation of Subsection R156-55a-501(2) as follows: (a) For a violation the duration of which is less than 90 days, where the licensee at the time a penalty is imposed documents that the required liability and workers compensation insurance have been reacquired, and provided an insurable loss has not occurred while not insured, a minimum of a 30 day suspension of licensure, stayed indefinitely, automatically executable in addition to any other sanction imposed, upon any subsequent violations of Subsection R156-55a-501(2). (b) For a violation the duration of which is 90 days or longer, or where insurable loss has occurred, where the licensee at the time a penalty is imposed documents that the required insurance have been reacquired, a minimum of 30 days suspension of licensure.
100 State of Utah Requirements for Contractors (c) For a violation of any duration, where the licensee at the time a penalty is imposed fails to document that the required insurance have been reacquired, a minimum of indefinite suspension. A license which is placed on indefinite suspension may not be reinstated any earlier than 30 days after the licensee documents the required insurance have been reacquired. (d) If insurable loss has occurred and licensee has not paid the damages, the license may be suspended indefinitely until such loss is paid by the licensee. (e) Nothing in this section shall be construed to restrict a presiding officer from imposing more than the minimum penalty for a violation of Subsection R156-55a- 501(2) and (3). However, absent extraordinary cause, the presiding officer may not impose less than the minimum penalty.
101 Purpose Commercial Auto Page 34 in the book Providing liability protection in the event of a claim or lawsuit resulting from an accident Providing physical damage coverage to protect the value of the vehicle Compliance with State Law (Minimum limits of liability) Provide coverage for medical bills incurred due to an accident for driver and passengers
102 Commercial Auto The state of Utah requires all automobiles to be insured with a No-Fault policy for the entire registration period. The state has crafted exemptions for owner/operators who do not reside in the state. Businesses are required to carry the standard No-Fault policy, and it is recommended they consult an insurance agent to explore a commercial or business policy. These policies can be tailored to cover business-owned vehicles. Business owners can be liable for bodily injury, lost wages, and damage if an employee is involved in an accident. The policy should include Bodily Injury Liability coverage for damages that involve bodily injury to others for which you become responsible under law. Property Damage Liability coverage for damage to property of others for which you become responsible under law.
103 Commercial Auto Medical Payment coverage for reasonable and necessary medical expense and funeral services for those who are accidently injured while in your automobile or while getting into or out of your automobile. Uninsured Motorist Coverage allows you to recover bodily injury damages due to an accident where the other party does not have insurance and is found legally liable. Underinsured Motorist Coverage allows you to recover bodily injury damages due to an accident where the other party is found legally liable and does not have adequate liability limits. Hired Auto Liability covers liability for automobiles hired under contract on behalf of or loaned to the named insured. Non-Owned Liability liability coverage for an automobile used in the business by any of your employees that is not owned by the business.
104 Common Mistakes Commercial Auto Too low of liability limits Trailers (<2,000 GVW vs. >2,000 GVW) Non-owned auto coverage Hired auto coverage Insurable interest Drive other car coverage Making small claims (eg: Glass claims)
105 Commercial Auto Pricing Liability: Limit of coverage, radius, GVW, type of use (Commercial, Service, Retail), territory PIP, UM, UIM: Limit of coverage, territory Comprehensive: Value of vehicle, type of vehicle, deductible amount Collision: Value of vehicle, type of vehicle, deductible amount Towing and Rental Car: Limit of coverage **There are credits available on commercial auto insurance
106 Inland Marine Purpose Page 39 in the book Protect the assets of the company Complying with loan requirements and agreements on property or equipment
107 Inland Marine Types of coverage Equipment Scheduled Equipment (Usually valued over $500 per item and listed out on the policy) Unscheduled Equipment (Usually valued under $500 each item and lump summed on the policy) Builders Risk Covers a building while under construction Usually protects against: Fire, Wind, Hail, Vandalism, Theft of material, Lost Profits, Soft Cost (Interest, Permits, etc.)
108 Inland Marine Types of coverage Property in Transit Covers materials as they are being delivered to the job site Installation Floater Covers materials while at the job site PRIOR to being installed on the project. (eg: lumber that burns in a fire while sitting at the job site, theft of piping before it is installed, etc.)
109 Workers Compensation -Evolution Page in the book Prior to the coming of the industrial age in the United States, there was little reason for the development of workers compensation statutes. Sailors were entitled to wages, transportation, maintenance, and cure if they fell sick or were injured in the service of a ship and could also bring an action against the ship itself under general maritime law if their illness was caused by the unseaworthiness of the vessel. Injuries to agricultural workers, who enjoyed little in the way of civil rights, were not considered to be a problem by the American public. Injuries to trade workers were infrequent since virtually all of their work was performed slowly and meticulously by hand.
110 Workers Compensation -Evolution This all changed with the advent of the industrial revolution. High-speed machinery and mass-production techniques, combined with very poor working conditions, led to a startling increase in work-related injury, disease, and death. An injured employee s only recourse was to sue the employer based on the employer s failure to meet one or more of its common-law obligations to the employee. According to common law, an employer had five obligations to its employees. 1. To provide a safe place to work 2. To provide an employee with a sufficient number of competent fellow employees 3. To provide safe tools and equipment 4. To develop and enforce safety rules 5. To warn employees of inherent work-related dangers of which employees could not reasonably be expected to be aware
111 Workers Compensation Purpose To provide the employee protection in the event of an industrial injury, illness, or death Provides employees, or their dependents, payment of Medical Bills, Lost Wages, and Death Benefit Designed to be the Exclusive Remedy To provide the employer protection in the event of gross negligence, and third party claims
112 Exclusive Remedy Every state s workers compensation law contains an exclusive remedy provision that stipulates that the benefits prescribed in the act are the sole remedy against the employer for covered injuries sustained on the job. (Most states allow suits against the employer if the employer has failed to either purchase workers compensation insurance or obtain authorization to self-insure as required by the law. See the discussion of penalties below.) Many states also allow suits against the employer when the injury was intentionally caused by the employer (Insurance = employer liability coverage). Under these circumstances, most states deprive employers of the normal common-law defenses (assumption of risk, fellow-servant liability, and contributory negligence) against such allegations. The majority of states also shield fellow employees of compliant employers from tort liability when their negligence results in an injury to another employee. A few specifically allow suits against a fellow employee when that employee intentionally caused the injury.
113 Utah Requirement Workers compensation Insurance. The Dept of Professional Licensing (DOPL) requires all contractors to carry workers compensation insurance. Failure to do so results in a penalty. (See ) R156-55a-401. Minimum Penalty for Failure to Maintain Insurance. (1) A minimum penalty is hereby established for the violation of Subsection R156-55a- 501(2) as follows: (a) For a violation the duration of which is less than 90 days, where the licensee at the time a penalty is imposed documents that the required liability and workers compensation insurance have been reacquired, and provided an insurable loss has not occurred while not insured, a minimum of a 30 day suspension of licensure, stayed indefinitely, automatically executable in addition to any other sanction imposed, upon any subsequent violations of Subsection R156-55a-501(2). (b) For a violation the duration of which is 90 days or longer, or where insurable loss has occurred, where the licensee at the time a penalty is imposed documents that the required insurance have been reacquired, a minimum of 30 days suspension of licensure.
114 Utah Requirement (cont) (c) For a violation of any duration, where the licensee at the time a penalty is imposed fails to document that the required insurance have been reacquired, a minimum of indefinite suspension. A license which is placed on indefinite suspension may not be reinstated any earlier than 30 days after the licensee documents the required insurance have been reacquired. (d) If insurable loss has occurred and licensee has not paid the damages, the license may be suspended indefinitely until such loss is paid by the licensee. (e) Nothing in this section shall be construed to restrict a presiding officer from imposing more than the minimum penalty for a violation of Subsection R156-55a-501(2) and (3). However, absent extraordinary cause, the presiding officer may not impose less than the minimum penalty. R156-55a-501. Unprofessional Conduct. (2) failing to continuously maintain insurance and registration as required by Subsection (2), in coverage amounts and form as implemented by this chapter; and (3) failing, upon request by the Division, to provide proof of insurance coverage within 30 days. Can lose your license under unprofessional conduct.
115 Penalty for Failing to Purchase WC The Labor Commission may impose a penalty against the employer of $1,000 or three times the amount of the premium the employer would have paid for WC during the period of noncompliance (whichever is greater). An uninsured employer may also be sued for personal injury in a court of law by an injured employee. This is $1,000 per day penalty because each day without coverage is a violation of the law.
119 Workers Compensation Pricing Premium is developed by applying a factor against gross payroll Base rate factor is determined by the job classification, and statistical data gathered by state on claims for each classification Limits of coverage (Employer Liability) Experience Modification Factor (Actual losses divided by expected losses, including a stabilizing value) Schedule Credits or Debits Supplemental Credits (Association) Premium Discount (Size or Volume Credit) Terrorism
120 Workers Compensation Pricing controls (Employer) Type of work performed Limit of coverage Controlling Experience Mod. Factor Hiring practices Drug testing Loss prevention (Reduction of exposure through: Engineering, Safety -Training, Inspections, & JSA, and PPE) Medical Management (Designated Medical Provider, post accident drug test, attractive light duty-communicated to the medical provider & employees) Claims Management (Timely reporting of claims, light dutycommunicated to the claims adjuster, claim reserves, closing claims before unit stat is reported to NCCI)
121 Are you covered for out of state jobs? Employers extra-territorial coverage and reciprocal agreements. Extra-territorial coverage is defined as coverage extended to Utah employees who work outside of Utah for a temporary period. This coverage is available when a reciprocal agreement exists between Utah and another state. Reciprocal agreements vary by state and may have exclusions. These agreements allow a Utah workers compensation policy to cover Utah based employees while temporarily working in another state. The Industrial Accidents Division issues extra-territorial certificates of insurance on a case by case basis, for a maximum of six months and is non-renewable. This certificate notifies the other state that Utah has authorized the employer to temporarily work in that state. List of states that have reciprocity agreements with Utah: California Idaho Maryland Montana - excludes construction work Nevada - excludes construction work North Dakota Ohio Oregon South Dakota Texas Washington - Maximum 30 days. For specific rules, please go to: West Virginia Wyoming
122 Health Insurance - ACA Page 38 in the book
123 Individuals 123
125 Employers 125
126 Health Insurance - ACA Exchange Notice (a) In General- In accordance with regulations promulgated by the Secretary, an employer to which this Act applies, shall provide to each employee at the time of hiring (or with respect to current employees, not later than March 1, 2013), written notice (1) informing the employee of the existence of an Exchange, including a description of the services provided by such Exchange, and the manner in which the employee may contact the Exchange to request assistance; (2) if the employer plan's share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs, that the employee may be eligible for a premium tax credit under section 36B of the Internal Revenue Code of 1986 and a cost sharing reduction under section 1402 of the Patient Protection and Affordable Care Act if the employee purchases a qualified health plan through the Exchange; and (3) if the employee purchases a qualified health plan through the Exchange, the employee will lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes. (b) Effective Date- Subsection (a) shall take effect with respect to employers in a State beginning on March 1, 2013.
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