Workers Compensation and Employers Liability (Lecture 13)

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1 Workers Compensation and Employers Liability (Lecture 13) Overview of Lecture 13 (Chapter 9, CPCU 4) I. Introduction II. III. IV. Employers Liability Under Common Law State Workers Compensation Laws Workers Compensation and Employers Liability Policy I. Introduction - workers compensation is a comprehensive term used to refer to the statutes that provide for fixed awards and medical reimbursement to employees or their dependents in cases of employment related injuries and diseases II. Employers Liability Under Common Law - prior to workers comp law, common law was applied to occupational injury and disease - when a worker does not fall under workers comp law, the employee retains the right to sue under common law A. Employer s duty of care

2 B. Common law defenses 1. assumption of risk - employee knows of the risk and has an appreciation of the danger 2. contributory negligence - if employee is partly at fault, then employer is in no way liable 3. negligence of a fellow employee III. State Workers Compensation Law A. Principles of workers comp law specific objectives of workers compensation law - prompt payment of adequate benefits according to a predetermined schedule - promote safety in the workplace by holding employers absolutely liable

3 B. Common features 1. choice of law - laws of several states may apply to one loss (i.e. state of hire, state where the injury occurred, state where business in normally conducted) 2. employees covered - generally speaking, all employees of employers with more than 3 to 5 employees (depending upon the state) are covered 3. injuries and diseases covered - those injuries that are as a result of an accident which arose out of employment (incidental to employment) and in the course of employment (refers to time, place and circumstances) - those illnessess that normally result from the nature of employment and the exposure to the disease arose out of employment 4. benefits provided a. indemnity payments for time lost from work - disability classified as temporary/permanent and partial/total (varying levels of benefits for each)

4 b. payments for medical services c. rehabilitation services - some workers compensation laws have been amended to require more extensive benefits d. death benefits - benefits vary from state to state and typically depend on whether there are minor children and/or a surviving spouse 5. methods of financing workers comp a. b. assigned risk plans - state run workers comp coverage that is available to firms who are unable to obtain coverage in the private market c. state funds - competitive state funds - monopolistic state fund d. self-insurance

5 e. excess insurance 6. procedure for obtaining benefits - notice of occurrence must be made to the employer in a reasonable time (normally 30 days) C. Third-party claims - in the event that the injury was caused by a third party, the employee has one of three options accept compensation under workers comp 3. accept compensation under workers comp and sue the third party IV. Workers Compensation and Employers Liability Policy - combines coverage for obligations imposed by workers compensation statutes and for damages that an employer becomes legally obligated to pay because of bodily injury by accident or disease to an employee - because the policy does not contain specific references to state specific benefits, the same policy could be written for firms in different states A. Information page

6 B. Policy form 1. General section 2. Part One - Workers Compensation Insurance - obligates the insurer to pay all compensation and other benefits required by law 3. Part Two - Employers Liability Insurance - examples of need for employers liability coverage a. b. c. d. e. - exclusions a. b.

7 c. d. damages arising out of employment practices such as demotion, harassment, discrimination e. - limits are stated in the policy 4. Part Three - Other States Insurance - allows for other states where business might be conducted to be included as covered by the policy 5. Part Four - Your Duties If Injury Occurs 6. Part Five - Premium - premium can be adjusted at the end of the policy period to reflect actual payroll of the employer during the policy period 7. Part Six - Conditions - insurer is allowed to inspect the business practices of the insured - first named insured is responsible for rights and duties specified in the policy

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