Term
| Workers' Compensation is a |
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Definition
| system of benefits mandated by law for most workers who suffer job-related injuries or diseases. These benefits are paid regardless of fault, and the amount of benefits is limited by law. |
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Term
| Worker's compensation laws eliminated |
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Definition
| the common law defenses of contributory negligence, fellow-servant rule, and assumption of risk. |
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Term
| A workers' compensation insurance policy is |
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Definition
| one means an employer can use to meet the requirements of workers' compensation laws. |
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Term
| Workers' compensation is an exclusive _______ insurance program. This means that an injured employee can seek ____ for his loss _____ from the workers' compensation policy. |
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Definition
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Term
| If the employer fails to carry workers' compensation, the employee may seek _____ through the courts, and the employer has ____ _______ _________. |
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Definition
| restitution, no insurable protection |
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Term
| Workers' compensation coverage is |
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Definition
| a type of no-fault insurance for employee injuries, and employers liability coverage, which covers an employer's liability for common lawsuits brought by employees to recover damages for job-related injuries. |
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Term
| Employer's liability is necessary because |
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Definition
| a court may award damages to an injured employee (or survivor) in addition to, or in lieu of, compensation benefits. |
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Term
| Texas employers except for public entities, |
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Definition
| can choose whether or not to provide Workers' Compensation insurance coverage for their employees. |
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Term
| Workers' Compensation provides |
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Definition
| covered employees with income and medical benefits if they are injured on the job or have a work related injury or illness. |
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Term
| Workers' Compensation is regulated |
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Definition
| by the Texas Department of Insurance, Division of Workers' Compensation (the Division). |
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Term
| Partcipation in the workers' compensation system in Texas is ________ for most employers. |
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Definition
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Term
| Employers who choose to have workers' compensation insurance may: |
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Definition
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Purchase a workers' compensation insurance policy from a private insurance company
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Self-insure, if the employer can meet the requirement to self-insure under the Texas Workers' Compensation Act and is certified through the Division
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Self- insure through the Texas Department of Insurance with a group of same or similar private employers
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Term
| An employer must report the following to its insurance carrier within either (8) days of the date: |
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Definition
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An employee misses more than (1) day of work because of a work-related injury
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An employer knows about an occupational disease or illness even if the employee has not missed any work
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An employee dies because of a work-related injury or illness.
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Term
| An employer may report the injury or illness to its insurance carrier by |
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Definition
| mail, fax, telephone, or electronic transmission and should keep a record of the date each injury is reported to its carrier. |
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Term
| Employee Rights in the Texas Workers' Compensation System |
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Definition
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The employee has the right to receive benefits. You may receive benefits regardless of who was at fault for your injury with certain exceptions, such as:
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You were intoxicated at the time of the injury
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You injured yourself on purpose or while trying to injure someone else
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You were injured by another person for personal reasons
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You were injured by an act of God
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Your injury occured during horseplay
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Your injury occured while voluntarily participating in a off-work activity
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The employee has the right to receive medical care to treat their workplace injury or illness. There is no time limit for this medical care.
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The employee has the right to choose their treating doctor. If they are in a Workers' Compensation Health Care Network, they can choose their doctor from the network's treating doctor list. If they are not in a network, they can choose a doctor from the Approved Doctor List kept by the Division of Workers' Compensation.
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The employee has the right to hire an attorney at any time to help with their claim.
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The employee has the right to receive information and assistance from the Office of Injured Employee Counsel at no cost.
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The employee has the right to receive ombudsman assistance if they do not have an attorney and a dispute resolution proceeding about their claim has been scheduled.
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The employee has the right for their claim information to be kept confidential. In most cases, the contents of their claim file cannot be obtained by others. Some parties have a right to know what is in their claim file, such as their employers or their employer's insurance carrier.
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Term
| Employee Responsibilites in the Texas Workers' Compensation System: |
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Definition
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The employee has the responsibility to tell their employer if they have been injured at work or in the scope of their employment. They must tell their employer within 30 days of the date they were injured or first know their injury or illness might be work related.
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The employee has the responsibility to know if they are in a Workers' Compensation Health Care Network. If they do not know whether they are in a network, they should ask their employer at the time of the injury. If they are in a network, they have the responsibility to follow the network rules. Their employer must give them a copy of the Texas Department Insurance network rules.
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The employee has the responsibility to tell their docotr how they were injured and whether the injury is work-related.
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The employee has the responsibility to send a completed claim form to the Division of Workers' Compensation. They have one year to send the form after they were injury or first knew that their illness might be work related. The employee may lose their right to benefits if they do not send the completed form to the Division of Workers' Compensation.
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The employee has the responsibility to provide their current address, telephone number, and employer information to the Division of Workers' Compensation and the insurance carrier.
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The employee has the responsibility to tell the Division of Workers' Compensation and the insurance carrier any time there is a change in their employment status or wages. Examples include:
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Term
| Under Workers Compensation law, there are ____ types of disability: |
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Definition
four
- permanent total
- permanet partial
- temporary total
- temporary partial
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Term
| A Permanent Total Disablility usually results |
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Definition
| in a complete and permanent loss of earning power, with no ability to perform any type of gainful employment. Many state compensation laws specify that certain injuries, such as the total loss of sight or loss of both hands or feet, consititute permanent total disability regardless of the insured's capacity to do some form of work. |
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Term
| A Permanent Partial Disability |
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Definition
| generally refers to a permanent physical impairment that leaves the individual incapable of performing his or her original job, but results in only partial loss of earning ability since other jobs can still be performed. |
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Term
| A Temporary Total Disability usually refers to |
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Definition
| a total disability that lasts for a short period, after which the employee is fully able to return to work. For example, an individual strains his back while lifting a heavy box at work. After undergoing treatment for 2 months, he's able to resume his former job. |
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Term
| A Temporary Partial Disability usually refers to |
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Definition
| a temporary disablement that allows the employee to continue in the same job, but with a reduced capability. If the worker in the above example had only twisted his ankle, he would likely still be able to perform some of his regular duties at work. |
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Term
| Workers' Compensation laws incorporate ____ categories of benefits: |
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Definition
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Term
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Definition
| provide compensation for the loss of income or earning capacity suffered by an individual who's injured in his or her occupation. How and in what amounts benefits are paid depend upon the severity and permanency of the injury. Payments can be made on a weekly- or lump-sum basis, or some combination of the two. |
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Term
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Definition
| compensate for the cost of medical treatment resulting from a job-related injury. In most cases, Workers Comp pays for the full cost of the treatment. |
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Term
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Definition
| attempt to recompense the widowed spouse or other survivor of an employee whose death result from a work-related injury. The amount of the benefit would depend upon deceased employee's earnings (subject to fixed minimum and maximum amounts), and the number of surviving dependents. A fixed amount is also available for burial expenses. Benefits would normally continue until the surviving spouse remarries or until the children reach adulthood. |
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Term
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Definition
| are not specifically named in some state Workers Compensation laws. Nevertheless, rehabilitation is provided in every state since all accept the provisions of the federal Vocational Rehabilitation Act, which provides federal aid toward the benefit costs incurred. |
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Term
| State Workers Compensation laws are either _______ or _______, with most being _________. This means that the employer must _____ and ______ with all of the provisions of the law. |
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Definition
| compulsory, elective, compulsory, accept, comply |
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Term
| Conversely, if the state law is _______, then both the employer and employee have the option of either accepting or rejecting the law. |
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Definition
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Term
| Some state Workers Compensation laws are _______ ______ for some specific types of work and _______ for others. |
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Definition
| deemed compulsory, elective |
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Term
| Certain workers fall under _______ __________ no matter where they work. |
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Definition
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Term
| ______________ are available so the policy will pay the benefits required by federal law. |
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Definition
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Term
| The US Longshoremen's and Harbor Workers Compensation Act |
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Definition
| is a federal law protecting workers in occupations related to the maritime industry. People typically associate this protection with longshorement and ship builders, but the people and occupations covered are quite broad and extend to those who support the longshorement and ship building operations. |
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Term
| The Federal Black Lung Benefits Act |
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Definition
| provides compensation to coal miners who are totally disabled by pneumoconiosis arising out of coal mine employment, and to survivors of coal miners whose deaths are attributable to the disease. |
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Term
| The Federal Employees Compensation Act |
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Definition
| provides federal employees injured in the performance of duty with workers' compensation benefits, which include wage-loss benefits for total or partial disability, monetary benefits for permanent loss of use of a schedule member, medical benefits, and vocational rehabiliation. This Act also provides survivor benefits to eligible dependents if the injury causes the employee's death. |
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Term
| The Federal Employers Liability Act |
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Definition
| Is a U.S. federal law that was enacted in 1908 to protect and compensate railroad workers injured on the job, if the worker can prove that the railroad was at least partly legally negligent in causing the injury. It is based upon the federal government's power over interstate commerce, granted by the commerce clause in the Constitution. Prior to its inception, there was no remedy for injured railroad workers. |
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Term
| The FELA (Federal Employers Liability Act) is a ______ _______ system. |
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Definition
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Term
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Definition
| are based on the type of business (work or job classification), the number of employees, and the total payroll. Rates are developed for each work (job) classification that best describes the activites of the insured. Rates also reflect the relative value of pure workers' compensation loss amounts expected to be paid out per $100 unit of payroll. These determinations are based on statistical analysis of past loss experience. |
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Term
| Rates for each work classification |
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Definition
| are developed and administered by the National Council on Compensation Insurance. |
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Term
| Total remuneration (payroll or bonuses) |
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Definition
| is used for premium determination because it is considered the best measure of exposure to the risks of employee injury. The more payroll developed, the more employees exposed and the great the risk of injury. |
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Term
| Premium for each work classification |
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Definition
| is determined by multiplying the rate by the premium basis (total remuneration). Premium discounts that reflect the lower expense in the handling of larger risks are applied if the premium exceeds a stipulated amount. An experience modification factor is applied as a method of rewarding those employers with better-than-average loss experience and penalizing those with poorer experience. An insured with a good loss record pays a lower premium than an insured with a bad record. |
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Term
| The premium charged at policy inception is an _______. |
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Definition
| estimate; The final premium is determined at the end of the policy period using actual remuneration and proper work classifications that applied during the policy term. All payroll records and other relevant documents must be made available to the insurer for audit. |
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Term
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Definition
| This rating plan is available only to operations with a large premium volume. It is used in conjunction with experience rating and adjusts the insured's premium after expiration of the policy to reflect the loss experience during the policy. It attempts to charge a premium that reflects the actual cost of risk and the costs of insuring it. |
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Term
| Participation (dividend) plans |
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Definition
| These plans are used to provide dividends to insureds whose loss results, even after application of experience modications, are lower than anticipated by manual rates. As loss ratios decline and premiums increase, divident amounts increase. |
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Term
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Definition
- The insurer retains the rights to inspect the insured's workplace for insurability at any time. The insurer is looking for existing or potential hazards.
- The insured's rights and duties under the policy may not be transferred without the insurer's written consent.
- The insured may cancel the policy at any time by providing written notice to the insurer; the insurer may cancel by providing written notice to the insured 10 days in advance.
- The first-name insured acts on behalf of all insureds to change the policy, receive return premium, and give or receive notice of cancellation.
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Term
| Types of Employment Covered by Workers' Compensation Laws |
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Definition
- Covered employment- The majority of workers' compensation laws cover most employment situations.
- Employment exemptions, which are below
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Term
| In some states, workers' compensation laws ________ employers with fewer than a specified number of employees. |
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Definition
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