Workers Compensation Insurance Policy Information
Workers Compensation Insurance. It covers the named insured's statutory liability under various state workers compensation laws or acts. It provides defined benefits to employees for injuries they sustain or diseases they contract that arise out of and in the course of their employment. All states have laws that require such protection for workers and those laws prescribe the amount and duration of the benefits provided.
Employers Liability covers an employer's common law or tort liability for employee injuries that fall outside the scope of the state laws or acts. This liability is separate and distinguished from the liability that workers compensation laws impose.
The workers compensation insurance policy provides the mandatory benefits that the various state laws prescribe and require for accidental work-related injuries that occur in the course of employment, subject to its terms and conditions. It must be emphasized that the injury must arise from and be related to the injured worker's job duties. Coverage also applies to the related costs for disease or death that occur as a result of the accident.
There are times when the employed worker's injury is not compensable under workers compensation or occupational disease laws. In those cases, Employers Liability coverage responds to the injured worker's allegations of negligence on the employer's part, subject to its terms, conditions, limitations, and exclusions. The coverage the basic policy provides may be broadened, restricted, clarified, or made to comply with specific state regulatory requirements by using a variety of available endorsements.
Workers compensation insurance protects your business from employee lawsuits for the injuries they sustain or diseases they contract that arise out of and in the course of their employment - with rates as low as $37/mo. Get a fast quote and your worker comp insurance now."
Workers Compensation Insurance 101
The three most basic parts of a workers compensation policy include:
Part One - Workers Compensation Insurance: Part One explains how the insurance provided applies and outlines payments the insurance company is obligated to make. These include benefits required by law, costs to defend suits brought against the named insured for benefits the insurance pays, and additional costs incurred as a result of a claim or legal action.
It explains what happens if other insurance covers the same claim and details payments the named insured must make. It also includes procedures to follow if there are any recoveries from others and summarizes the statutory provisions that apply if there is a loss.
Part Two - Employers Liability Insurance: Part Two explains what employers liability insurance is, how it applies, and outlines payments that are the insurance company's responsibility. It provides a detailed list of exclusions and circumstances where coverage does not apply. It explains when the insurance company defends the insured for suits brought due to damages the insurance pays and details additional costs the company pays as part of any legal action it defends.
It explains what happens if other insurance covers the same claim and defines meanings of the terms and limits that apply to this coverage. It also details the named insured's obligations in case of recoveries from others responsible for a covered loss and summarizes each party's requirements before an action can be brought against the insurance company.
Part Three - Other States Insurance: Part Three explains how this coverage applies when one or more states are entered in the space provided on the Information Page for this coverage. Coverage applies to any state listed on the Information Page. However, coverage does not apply to any other state unless the named insured reports the start of any work in that state within 30 days of the date that the work begins. The named insured must immediately inform the insurance company of operations that begin in any state listed in this section on the Information Page.
What Does Workers Compensation Insurance Cover?
Do you own, operate, or manage a business which includes at least one employee? Are you familiar with the laws of the states where you operate regarding workers compensation insurance coverage?
Workers comp insurance covers bodily injury by accident or bodily injury by disease, including death that results from either. This is subject to the following:
- An Accident - When bodily injury is due to an accident, the bodily injury must occur during the policy period.
- Disease - When bodily injury is due to disease determining the exact policy that must respond becomes more difficult. Because many disease-related bodily injuries are due to cumulative exposure, many different policies could be expected to respond. Because of the need to establish a single policy to respond, the policy explains that the policy in effect when the employee was last exposed to the conditions that either caused or aggravated the bodily injury by disease must respond.
The Workers Compensation and Employers Liability Insurance Policy covers your statutory liability as an employer under state workers compensation laws. It pays for medical treatment because of injuries and indemnity payments for employees disabled by work-related accidents. It also provides tort liability coverage for legal actions brought against you for bodily injuries to your employees that fall outside state workers compensation laws.
The coverages provide the benefits that the law requires for injuries employees sustain that arise out of and in the course of their employment, including resulting disease or death, subject to certain policy terms and conditions. In addition, if the employee injury is not compensable under applicable state workers compensation laws or occupational disease acts, Employers Liability Insurance responds to the employee's allegation of negligence by you, again subject to certain policy terms, conditions, and exclusions.
- Workers compensation insurance applies to bodily injury by accident that occurs during the policy term. It also includes bodily injury by disease, including resulting death, caused or aggravated by employment conditions. The worker's last day of last exposure to the conditions that cause or aggravate the bodily injury by disease must occur during the policy term.
- The insurance company pays benefits the named insured is required to pay when they are due.
- The insurance company has the right and duty to defend any legal action filed against the named insured but only for benefits this coverage insures. It also has the right to investigate and settle claims and lawsuits and pay other described reasonable expenses and costs related to those legal actions.
- The insurance company also pays the following:
- Reasonable expenses the named insured incurs at its request, except for lost earnings
- Premiums for appeal bonds and bonds to release attachments for amounts up to the amount this insurance pays
- The named insured's share of litigation costs
- Legally required interest on judgments until it offers the amount due
- All expenses it incurs
- If other insurance or self-insurance applies to the same loss, the insurance company pays only its share. Unless there are specific limits, all shares are equal until the loss is paid. If payments use up any insurance or self-insurance, the remaining insurance pays in equal shares until the loss is paid.
- The named insured is responsible for payments that exceed the benefits the workers compensation law requires, as well as certain other payments. Examples are those required due to willful misconduct, illegal employment, not complying with health or safety laws, and employment-related practices that violate the law.
- The insurance company obtains the named insured's rights to recover from others who may be liable for an injury as a result of the payments it makes. The named insured must do everything possible to preserve those rights.
- The insurance company is subject to all statutory provisions of the workers compensation law. Any conflicts between policy terms and such provisions are changed to conform to those laws. However, nothing in the policy relieves the named insured of its duties and obligations under the policy.
What Is Experience Rating In Workers Compensation?
Experience rating in workers comp is a calculation that either increases or decreases your premium based on your company's claims (loss history).
Experience rate factors are actually credits or debits that reflect the specific risk's loss experience. They are applied to the premium developed by using manual rates. The National Council on Compensation Insurance, Inc. (NCCI) or another rating organization that has jurisdiction calculates these factors. Experience rating is mandatory for all risks that meet certain eligibility requirements. For example, a risk must be in business under the same ownership for at least two years. Minimum premium eligibility thresholds also apply and vary by state.
Each risk pays its "fair share" of the average annual rate for the class or classes involved based on its own loss experience. The experience may be better or worse than average and the factor determined and applied reflects it. One of the most important consequences of experience rating is that it encourages the named insured to implement loss control, safety, and hazard reduction initiatives that control or reduce losses.
The experience rating factor is calculated using the latest three years of loss experience prior to the current policy period. It excludes the most recent full year. It is recalculated annually by adding the experience for the latest eligible year and dropping the oldest year. The problem with this approach is that it applies historical loss experience to the current policy period in order to predict future losses and results in a time lag in being applied. Effective loss control or safety initiatives implemented today will not impact the premium until at least two years following implementation.
'Real Life' Court Cases Involving Workers Comp:
Midwestern Indemnity Company v. David Rich and Paul Savage
Midwestern Indemnity Company (Midwestern) had issued a commercial general liability policy, which included workers compensation coverage, to Paul Savage. While working as an employee of Savage, David Rich was seriously and permanently injured. He received workers compensation benefits but then filed an action for damages, alleging that his employer knew, or should have known, that the job assigned to him would place him in a hazardous situation that probably would result in serious injuries. Savage referred the action to Midwestern, which denied liability and refused to defend. (A consent judgment of $1.3 million was entered in favor of Rich against Savage.) Midwestern then filed this action for declaratory judgment.
The policy excluded coverage of claims for bodily injury "expected or intended from the standpoint of the insured," and "bodily injury to an employee arising out of or in the course of (a) employment by the insured, or (b) performing duties relating to the conduct of the insured's business."
The trial court granted Midwestern's motion for summary judgment and Rich appealed.
The higher court pointed out that Rich was injured while working for Savage and was performing duties assigned to him by the insured. The policy issued to the insured excluded injuries such as those Rich sustained.
The judgment entered in the trial court holding that the policy did not cover the injuries sustained by the employee was affirmed.
(Midwestern Indemnity Company v. David Rich and Paul Savage, Appellant-No. 02CA1584-Court of Appeals of Ohio, Second District, Darke County-October 18, 2002-778 North Eastern Reporter 2d 141)
Tony Moncus, Deceased, Appellant v. Billingsley Logging and American Interstate Insurance Company
Tony Moncus (Moncus) worked cutting logs for Billingsley Logging (Billingsley). The owner, Mitchell Billingsley (Mitchell), had the entire logging crew meet at a centrally located service station one morning so he could lead them to a new location they could not find on their own. This was standard practice when starting work on a new tract and occurred a few times each year.
Moncus had to drive his own vehicle that day and not ride with the others on a company truck because he had to leave early to run a personal errand. Moncus was killed in a head-on motor vehicle accident before arriving at the logging site. His vehicle contained no tools or equipment belonging to Billingsley. Since he was paid based on the number of tons of wood that he cut, Moncus was paid nothing on the day of his death because he had not yet cut any wood.
A claim was filed for workers' compensation benefits on behalf of Moncus. The administrative law judge (ALJ) held that Moncus did not sustain a compensable fatal injury due to his not performing an employment-related service at the time of the accident. The ALJ found that the preponderance of evidence disproved the death resulting from an injury compensable under the Workers Compensation Act. The Arkansas Workers' Compensation Commission (Commission) affirmed and adopted the ALJ's decision.
This was based on the "coming and going" rule that ordinarily precludes recovery for an injury sustained while the claimant is going to or returning from work. The rationale behind the rule is that the claimant is not within the scope of his employment while traveling to and from his job and is subject to the recognized hazards of travel to and from work in a vehicle. The rule is subject to exceptions in cases where the employee is injured when in close proximity to the employer's premises, where the employer furnishes the transportation, where the employee is a traveling salesperson, where the employee is injured on a special mission or errand or when the employee is paid from the moment he leaves home until he returns home.
The appellant acknowledged the "coming and going" rule but argued that the day in question was not a normal workday because the employees were ordered to meet Mitchell and follow him to the tract. It was asserted that Moncus was performing employment-related services when he was killed driving to the job site because of Mitchell's orders and that Billingsley would have benefited because the day's business could be conducted successfully.
The rationale of the ALJ, adopted by the Commission, was that Moncus was not performing an employment-related service at the time of the accident. Employees of Billingsley were ordinarily required to provide their own transportation to and from the logging tracts of land. Meeting at a central location to drive to a new tract occurred regularly, although infrequently.
It was determined that such meetings and driving to a new tract as a group did not advance Billingsley's purpose or interest on those days any more than any other day when employees traveled to the logging tract on their own. While meeting in this manner was not customary, it was done at least a few times each year when commencing work at a new site.
In either case, Moncus was required to travel to the actual job site where his work would begin and this case did not fall into one of the recognized exceptions to the "coming and going" rule. For these reasons, the claim was not compensable. The court of appeals affirmed the decision of the ALJ.
(Tony Moncus, Deceased, Appellant v. Billingsley Logging and American Interstate Insurance Company, Appellees. No CA 05-264. 93 Ark. App 402, 219 S.W. 3d 680.)
Small Business Economic Data & Insurance Regulations
Perhaps you have the next great idea for a product or service that you know will appeal to your local area. Maybe you want to contribute to the economic growth of your community. Whatever the reason is, if you're thinking about starting a small business, it's important to understand pertinent information relating to small businesses in the United States; namely economic information and insurance regulations. After all, if you want your small business to succeed, you have to understand the economic trends organizations of a similar size in your area.
Likewise, you want to ensure that your small business is well protected with the right business insurance and that you are in compliance with the rules and regulations that pertain to commercial insurance in your region.
Read up on economic statistics and insurance information that relates to small business owners in the United States.
Small Business Economic Data In The United States
Here's a look at some information that was compiled by the Small Business Association (SBA) regarding the economic data that pertains to small businesses in the United States:
- In 2015, small businesses in the United States employed an estimated 58.9 million American workers, or 47.5 percent of the nation's private workforce.
- Largest shares = fewer than 100 employees. The small businesses that employed 100 people or less had the largest share of employment amount small businesses.
- Employment increased by nearly 2 percent. In 2018, employment amongst small businesses increased by 1.8 percent, which is an increase of 1 percent from the prior year.
- Increase in proprietors. In 2016, the number of small business proprietors increased by 2.3 percent.
- In 2015, small businesses were responsible for creating 1.9 million net jobs. Organizations that employed 20 people or less had the largest gains, as they added an estimated 1.1 million net jobs.
- There were 5.7 million loans that were value less than $100,000 issued by lenders in the United States in 2016. These loans were issued under the Community Reinvestment Act.
- Small business owners that were self-employed at the incorporated businesses that they owned reported a median income of $50,347 in 2016.
- Small business owners that were self-employed at the unincorporated businesses that they owned reported a median income of $23,060 in 2016.
Small Business Insurance Information
In the business world, there are many risks faced by company's every day. The best way that business owners can protect themselves from these perils is by carrying the right insurance coverage.
The The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight.
Commercial insurance is particularly important for small business owners, as they stand to lose a lot more. Should a situation arise - a lawsuit, property damage, theft, etc. - small business owners could end up facing serious financial turmoil.
According to the SBA, having the right insurance plan in place can help you avoid major pitfalls. Your business insurance should offer coverage for all of your assets. It should also include liability and casual coverage. The SBA recommends the following insurance plans for small business owners:
- Commercial Property Insurance: In the case of an unplanned disaster - fire, flood, vandalism, theft, etc. - this type of coverage will help you avoid paying for the damage out of your own pocket. Even if you rent the property, you should still carry commercial property insurance.
- Commercial Liability Insurance: In the event that a legal situation arises - a negligence lawsuit, for example - commercial liability coverage will provide financial protection. It will cover the cost of legal defense fees, court fees, and even moneys that may be awarded.
- Commercial Auto Insurance: If you operate a vehicle for any activities that are related to your business - transporting and/or delivering goods, or meeting with clients - commercial auto insurance is legally required for businesses of all sizes, including small businesses.
Additional Resources For Small Business Insurance
Protect your company and employees with the right commercial insurance policies. Read informative articles on small business insurance coverages - and how they can help shield your company from legal liabilities.
- Small Business
- Business General Liability
- Business Liability
- Business Owners Policy (BOP)
- Certificate of Insurance
- Commercial Auto
- Commercial Umbrella
- Comprehensive General Liability
- Directors and Officers Liability
- Cyber Liability
- Employers Liability
- Employment Practices Liability
- General Liability
- Home Based Business
- Independent Contractor
- Liability Insurance Certificate
- Liability Insurance
- Professional Liability
- Workers Compensation Insurance
Your small business faces many potential disasters including: fire, floods, theft, equipment breakdown, lawsuits from clients or customers and current & former employees. Any many other risks you haven't even thought about.
A small business commercial insurance program should provide protection for both larger and smaller disasters. The obvious things like fire, flood and theft most business owners think about... but what if a hacker infects your computers with a virus - and files containing private customer information like credit card and Social Security numbers are stolen?
Who is going to pay to fix your customers credit rating etc...? Will your insurance pay for the cost? You need to know that.
Your commercial insurance program should cover events that can close down your company, or cause it to lose revenue. Anything less than that is not enough coverage. Commmercial insurance doesn't cover everything, and all policies have exclusions and limits.
You need a written plan that allows you to get your operations back up and running as quick as possible.