Lesson 10: Workers Comp and Employers Liability Flashcards
Occupational Safety and Health Act of 1970 (OSH Act)
passed to prevent workers from being killed or otherwise harmed at work. The law requires employers to provide their employees with working conditions that are free of known dangers.
What does workers comp provide
medical benefits and wages to employees suffering from job-related injuries or diseases during employment in exchange for a mandatory waive of the employee’s right to sue the employer for negligence under tort law.
What is workers comp
a form of accident insurance paid by employers. No payroll deductions are taken out of employees’ salaries for workers’ comp.
Workers comp policy format
policy has an information page, general section, coverages, liabilities, other states’ insurance, premiums, and conditions. It provides coverage for every type of employer and occupation with specific exclusions.
What does workers comp cover
employees excluding injuries sustained while intoxicated, committing or attempting to commit suicide, failure to use safety devices they are trained to use, and injury to a worker while employed in violation of the law with the insured’s knowledge
Workers comp - Part I (Workers Comp)
only applies to statutory benefits. Workers’ Compensation includes a ‘Miscellaneous Provision Section’ with the following information:
1) Premiums: (a) Payroll and classification/experience determines the rate. (b) An audit will determine the final premium at the end of the policy period.
2) The insurer has the right to inspect the workplace.
3) Cancellation: (a) The insured can cancel the policy at any time. (b) Under GA law, the insurer must give 75-days notice before cancellation.
Workers comp - Part II (Employers Liability)
covers the basic limits, which are $100,000 per accident for injuries; $100,000 per employee for disease; and $500,000 aggregate (annually) for the disease. For example, think of the medical costs associated with a coal miner developing black lung due to exposure.
Employer duty
legally obligated to take reasonably care to ensure workplaces are safe
Risk pool
Insurance companies acn form a pool which can provide insurance against catastrophic risk such as a chemical fire
Exclusive remedy doctrine
a worker gives up his or her rights to sue and can legally pursue damages.
Medical treatment benefit
If an employee is injured or becomes ill due tot heir work/workplace, he can file a workers’ comp claim to help pay for treatment, including: doctor’s appointments; hospital and ER visits; medications; therapy and rehab; recovery equipment
Disability benefit
usually 4 categories
Temporary total disability
injured employee is completely unable to work for a certain amount of time but will return to work at full capacity
Temporary partial disability
injured employee can work at a reduced capacity without needing time off; i.e. employee with broken wrist may be partially disabled and be able to work for half days until it heals
Permanent Total Disability
leaves an employee completely unable to work, never returning to their previous role
Permanent partial disability
employee can return to work but will never work the same capacity as before the injury
Does workers comp provide lost income?
if a disabled employee has to take time away to recover, workers’ comp can help the employee recover some of their lost income until they return. If the employee has a permanent disability, workers’ comp can give disability benefits for life
Physical or vocational rehab benefit
Workers comp can assist w/ ongoing care, including physical therapy, vocational rehab, and can cover the cost of new training or certifications
Death and funeral services benefit
if an employee dies due to a work related injury or illness, workers comp can provide benefits tot he family/beneficiary for funeral expenses and lost income
Right to inspect
Insurer has right to inspect workplace
Typical occupations exempt from workers’ comp
1) employers with fewer than 3 employees
2) agricultural workers
3) railroad workers
4) casual, part-time employees (someone paid to cut grass, load furniture on a truck)
5) domestic employees
6) real estate brokers
federal govt employees also exempt
Other workers Comp exclusions
The Merchant Marine Act of 1920 (Jones Act)
This coverage provides seamen with a negligence remedy for on-the-job injury without having to overcome fellow servant liability. Employers can obtain coverage under a workers’ compensation policy by purchasing a maritime coverage endorsement.
The United States Longshore and Harbor Workers Compensation Act (USL&H)
The Longshore and Harbor Workers’ Compensation Act (USL&H) is a federal workers’ compensation act providing benefits for particular maritime employees and civilian employees on military bases.
Workers Comp - Employers Liability
coverage for the legal liability of employers arising out of injuries or disease to cover claims, which are not subject to compensation loss.
Who can sue an employer?
Exempt employees.
Spouses & children of Injured workers.
Spouses sue for loss of consortium.
Elements of employers’ liability claim
Covers claims if the original suit is brought in the United States, its territories, possessions or Canada. Gross Negligence must be proven.
Employers Liability is needed to fill gaps in the compensation coverage and covers claims which are not subject to compensation laws.
Workers’ comp second injury funds
remove disincentives for hiring disabled people; help pay the additional loss resulting from combined injuries; and relieve an employer from some of the burden for multiple injuries
How are benefits calculated?
for employees with partial disabilities, a benefits table is used to calculate benefits
