Note: This analysis is
of WC 00 00 00 C. This edition is effective 01/01/15. The changes from the
prior edition are in bold print.
The policy opens
by explaining that the insurance company agrees to provide the coverages
indicated in return for the named insured paying the premium. This is subject
to all of the policy’s terms and conditions.
GENERAL
SECTION
A.
The Policy
The policy
includes the Information Page and all endorsements and schedules that are
listed on it as of its inception date. It is an insurance contract between the
named insured employer and the insurance company identified on the Information
Page. The only agreements that affect the insurance coverage provided are the
ones stated in the policy. Policy terms and conditions cannot be changed or
waived unless the insurance company does so by issuing written endorsements.
Note: Waiver means
intentionally or voluntarily relinquishing a known right. As a result, this
provision states that a written endorsement is needed to confirm that either
party is surrendering a known right. The intent of this language is to prevent
any oral agreements or unauthorized written agreements from being considered or
treated as part of the insurance policy.
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Example: Linda copies a brochure in the human resources office
about Employers Liability coverage that describes the coverage the policy
provides. She notices several statements to the effect that the brochure only
describes the coverage. Linda wants to know exactly what coverage is provided
and asks her human resources manager for a copy of the company’s actual
policy to review.
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B.
Who Is Insured
The employer
identified in Item 1. on the Information Page is the named insured. If the form
of business is a partnership and the named insured is the partnership, an
individual partner is considered an insured but only to the extent of being the
employer of the partnership's employees.
Note: Unlike many
liability coverage forms and policies, the spouse of an individual, partner,
member, or manager of a joint venture is not automatically included and covered
as an insured. If the spouse is an employer, the spouse must be either named or
have a separate policy that covers the operations for which the spouse is the
employer.
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Example: A partner in a law firm is an insured with respect to
the employees of the law firm. However, he is not an insured for injuries to
his household employees.
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Note: WC 00 03 05–Joint
Venture as Insured Endorsement makes each member of the joint venture an
insured under a policy where the joint venture is a named insured. Similar to the partner as an insured, the member is an
insured only with respect to the joint venture's employees.
Related Article: Workers
Compensation and Employers Liability Insurance Policy Available Endorsements
and Their Uses
C.
Workers Compensation Law
The term
"workers compensation law" means the workers compensation law(s) and
the occupational disease law(s) of each state and/or territory listed under
Item 3. A. on the Information Page. When those laws change during the policy
period, those changes are incorporated into this policy. This is for state and
territory law only so does not include any federal workers compensation or
occupational disease law(s). It also does not apply to any non-occupational
disability benefits law(s).
Note: Because this
paragraph specifically excludes federal workers compensation, occupational
disease, or similar laws, special endorsements are available when such coverage
is required.
Related Article: Workers
Compensation and Employers Liability Insurance Policy Available Endorsements
and Their Uses
D.
State
When the term
"state" is used anywhere in the policy, it means any state of the
United States of America plus the District of Columbia.
Note: Item C. above
states that territories can be listed under Item 3 and be covered. However,
this section does not broaden the definition of state to include territories.
E.
Locations
Coverage applies
to workplaces that are listed under Item 1 or Item 4 on the Information Page.
It also covers all other workplaces in states listed under Item 3 unless other
insurance or self-insurance covers those workplaces.
Notes:
This policy
covers the named insured's total liability as any state workers compensation
law establishes it. Some states have laws that require insuring this total
liability under one policy. In states that do not have this requirement, it is
possible to "carve out" certain workplaces and exclude them from
coverage. An example of this is when a project uses a wrap-up program and all
contractors that work within that wrap-up are covered under the wrap-up workers
compensation program. WC 00 03 02–Designated Workplaces Exclusion Endorsement
is used to carve out the coverage for the wrap-up project from the
subcontractor’s policy.
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Example: Big Boy Builders subcontracts with Joe’s Flooring
Installations to install laminate floors in living/dining rooms in new homes
it builds in an exclusive subdivision. All workers on this Big Boy
construction project are covered under a wrap-up workers compensation
program. Joe does not include any individual workers compensation premium in
his costs because the wrap-up covers all workers compensation injuries. Joe
can remove the project payroll from his policy by attaching WC 00 03
02–Designated Workplaces Exclusion Endorsement.
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Multiple policies
issued to insure various employers engaged in large construction projects can
be combined for premium discount purposes where the law permits. The same
insurance company or group must issue them and they
must be limited to the applicable employer's work at the construction site.
Similar coordinated policies are also permitted to address other related cases
and circumstances.
Related Articles:
Workers Compensation
and Employers Liability Insurance Policy Available Endorsements and Their Uses
Premium Discount
Endorsement
Overview of
Wrap-up Programs
