Worker’s Compensation insurance Flashcards
Workers compensation insurance
State mandated benefits are paid for on the job injuries
 payments are made regardless of the negligence of the employer or employee
Each state determines
Whether insurance is compulsory or elective, what workers are subject to statute, Who may provide insurance, benefit levels
Types of laws
Employers common law defenses if employee tried to sue them
Assumption of risk-does defense placed all the risk on the employee as being responsible for knowing the work conditions prior to employment
Fellow servant rule-remove the employers negligence if a fellow employee contributed in any way to the loss
Contributory negligence-used to argue that the employee was partially at fault and therefore was not eligible to recover benefits from the employer
 exclusive Remedy
Exclusive Remedy means that the employer assumes absolute liability for injuries to the employee. Under Worker’s Compensation , If the employees injured, employee may not:
- Collect benefits and then sue the employer for negligence or liability
- refuse to accept compensation benefits in order to sue the employer for a larger award
Compulsory coverage
All California employers that employ one or more employees are required by law to provide Worker’s Compensation benefits to their employees by purchasing Worker’s Compensation insurance from an any admitted insure offering coverage or the state compensation insurance fund. Employers who can demonstrate the financial capacity to manage Worker’s Compensation claims without insurance must first obtain a certificate of self insurance from the department of industrial relations in order to be self insured
Covered insured
The purpose of this insurance is to protect employer regarding legal obligations arising out of work related loss of a covered employee. The insured under this employee is the employer, who may be an individual, partnership, corporation, or other legal entity. The employer is responsible for paying the premium. Injured employees are entitled to benefits, but not considered the insureds
Exclusive remedy
Prevents an injured worker from suing for a larger word then will be paid through Worker’s Compensation
Independent contractors
The worker is an independent contractor if they pass the ABC test, meaning they meet all the following conditions:
- The worker is free from the control and direction of the hiring entity in connection with performance of the work
- The worker performs worth that is outside of the usual course of hiring entitys business
- The worker is customarily engaged in an independently establish trade, or business of the same nature as that involved in the work performed
Independent contractors
Independent contractors are not eligible for Worker’s Compensation and must purchase their own liability insurance
Miss classified workers
Worker misclassification is a form of fraud. Was classification occurs when an employer inaccurately classifies an employee as an independent contractor in order to avoid paying payroll taxes, minimum wage or overtime, or to avoid compliance with wage and hour law requirements, such as meal periods and breaks.
Medical benefits
California provides unlimited coverage for all necessary medical expenses related to cover injury and illness without time or dollar limitations
Disability income benefits
There are two types of temporary disabilities, which are most common disabilities:
Temporary total disability Dash describes an injury from which an employee is expected to recover and return to work, but which prevents the employee from doing any work while recovering
Temporary partial disability – describes an injury that allows an employee to do some work, but prevents them from performing the regular duties until full recovery
Temporary total disability
Temporary total disability benefits are 2/3 of the employees pretax weekly wage prior to the injury, and they are not subject to any federal, state, or local income tax
Temporary partial disability
Temporary partial disability benefits are 2/3 of the employers lost weekly wages. For example, if the disability results and employees weekly wage being decreased by $90, the employee is entitled to $60 per week
Temporary total disability benefits are subject to waiting a period of how many days
3 days
Permanent disability
Permanent total disability Dash describes an injury that prevents an employee from being able to do any work for the rest of their life. These disabilities are rated at 100%
Permanent partial disability
Permanent partial disability describes an injury with which an employee is able to do some work, but never fully recover. These disabilities are rated at 1% - 99%
Death and survivor benefits
Death on survivor benefits are paid to the spouse, children, or other dependent of an employee who died from a work related injury or illness. Benefits are paid at The temporary total disability rate, 2/3 of the employees weekly wages, not less than a set minimum weekly amount, and up to the maximum total limit based on the number of total and partial dependence or until the youngest minors 18th birthday. Include reasonable burial expenses up to $10,000$
Second injury fund
The second and refund pays compensation to an employee who has already suffered a prior disabling injury, and then sustained a subsequent injury, when the combination of the two injuries creates a greater disability than the second injury would have created by itself. The employer is responsible only for that compensation that would have been paid had the second injury occurred without the existence of the prior injury, and the fund pays the difference.
Employers liability insurance
Employer‘s liability insurance covers the gap between the workers compensation policy and the commercial general liability policy. It provisions include coverage for:
- Injuries sustained by non-employees that arise out of covered employment
- A spouses loss of consortuim
- damages under the doctrine of dual capacity, which applies when an employee is injured by the product of the employer manufactures
- consequential bodily injury when another party suffers injury resulting from the employees injury.
