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What is the difference between Part 1 & 2 of the workers’ comp policy?

Learn the differences between Workers' Comp Policy Parts, major exclusions under Part 2, and how claims are filed and managed. Understand the classification of injuries, incurred loss components, and benefit limits. Find out about modification factors, guaranteed cost policy premiums, and state-specific regulations.

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What is the difference between Part 1 & 2 of the workers’ comp policy?

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  1. What is the difference between Part 1 & 2 of the workers’ comp policy? • Part 1 is for liability other then worker’s benefits • Part 2 is for liability other then worker’s benefits • Part 3 is for liability other then worker’s benefits • There is only a part 1

  2. In your state, how does the limit of liability work for Part 2 and what is the minimum attachment point for the umbrella? • In most states it is unlimited • In most states they set a defined limit • In most states they set a defined limit and you have to have a minimum to have scheduled on umbrella • There is no limit

  3. What is a major exclusion under Part 2 of the workers’ comp that could be covered under the GL policy? • Contractual injury to an owner of a building. • Intentional act • Impaired property • Contractual injury to an employee.

  4. What do you do if you are not sure of these exposures; that is, they may develop during the policy period? • Schedule them on the policy • Schedule them at the time • Schedule them on an if any basis • Don’t worry they will be picked up

  5. What form does an employer have to file in order to make a claim? • C-8 • Incident Form • First Report of Injury • Worker’s comp web site form

  6. What form does an employer have to file in order to make a claim? • C-8 • Incident Form • First Report of Injury • Worker’s comp web site form

  7. What is the assumption of compensability? • Innocent until proven guilty • Guilty until proven innocent • Lost Wages • Medical payment for reason of an accident

  8. What is a schedule loss of use? • An amount of money for loss of a job • A PIR • Lost Wages • Medical payment for reason of an accident

  9. What is the maximum benefit for a back injury? • Depends on State • 10 Years • Depends on injury • No Maximum

  10. How are injuries classified? • Based on prognosis and ability to work • Determined by a Dr. • Determined by the comp board • Depends on the state

  11. What are the different components of an incurred loss? • Paid and Reserved • Expenses such as Lawyers • Only Paid • Paid, Reserved and Expenses

  12. What are reserves? How are they set and by whom? • Guesses set by underwriters at the time of the loss • Guesses set by adjusters at the time of the loss • Actuarial calculation set by underwriters at the time of the loss • Depends on the state

  13. How do you calculate a guaranteed cost policy premium? Provide an example, include all components. • Class Codes, Rates, discounts, assessments, mod and premium discount. • The carrier does this • Determined by the comp board • Depends on the state

  14. How does your state set rates? • NCCI • Open rating • Closed rating • Loss Cost State

  15. What is the purpose of a modification factor? • Charge more premiums • Charge less premium • Reward or penalize performance • Depends on the state

  16. Is your state an NCCI state? • Based on prognosis and ability to work • Determined by a Dr. • Determined by the comp board • Depends on the state

  17. What is a monopolistic state and what states are monopolistic? • The state handles comp • The state has one carrier • The carrier handles it for the state • There is no such thing

  18. Are heart attacks covered? • Based on prognosis and ability to work • Determined by a Dr. • Determined by the comp board • Depends on casual relationship to work.

  19. Is it covered if an employee is injured coming and going from work? • Based on prognosis and ability to work • Determined by a Dr. • Depends on facts • Depends on the state

  20. How do comp carriers deal with subcontracted employees? • They must have comp or your insured pays for them • They do not care • They charge you a lower rate • Depends on the county you are in

  21. How are companies classified? • On each job • On the type of business • Determined by the comp board • Depends on the state

  22. An employee in your home state is injured while traveling to another state. Which state law would apply to the employee? • Where they live • Where there home office is • What ever they want • Depends on the state

  23. An employee has a heart attack at work, is it covered? • Based on prognosis and ability to work • Determined by a Dr. • Determined by the comp board • Depends on the state

  24. How does a wrap up affect an Insured’s Mod? • Same as any other job • Not at all • Determined by the comp board • Depends on the state

  25. Two employees are fooling around at work and one is injured. Is the injury covered? • Yes if it happened at work • Determined by a Dr. • Determined by the comp board • No

  26. Explain how a back injury is finalized in your state as well as what conditions must be met before it is finalized. Compare and contrast this claim to carpal tunnel. • Based on prognosis and ability to work • Determined by a Dr. • Determined by the comp board • Depends on the state

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