Workers Compensation Policy Does Not Respond to Nonoccupational Twenty-Four Hour Coverage
State workers compensation laws require an employer to provide benefits for an employee who is injured on the job. Does any state have a twenty-four hour coverage law, and if so, would the workers compensation policy pick up coverage?
Texas Subscriber
The standard NCCI workers compensation policy states the following:
Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, and federal occupational disease law or the provisions of any law that provides nonoccupational disability benefits.
Given this wording, the current policy would not respond to the portion of twenty-four hour coverage that pertained to nonoccupational benefits.
In the recent past (perhaps continuing in at least some states and perhaps for larger corporations), there was a push for integrated disability benefits that would combine occupational and nonoccupational health and disability coverage under the one umbrella of integrated disability management (IDM). The problems that arose, among others, were that workers compensation is a state-regulated coverage, and health insurance (employee benefits) is typically federally regulated.
Frequently, the nonoccupational and occupational losses are handled by different departments within an insurance company, which creates problems. There were several tests a few years back that attempted to merge the two; for example, the California legislature enacted California Labor Code section 4612, which authorized three-year pilot programs for twenty-four hour healthcare in that state.
Because of these issues, most integration has gravitated toward integration of nonoccupational benefits alone without workers compensation being included.
If a state came up with a workers compensation law that successfully combined occupational and nonoccupational exposures, there might be a response from carriers to amend the NCCI workers compensation form to address those. This has not happened as of this writing, although some carriers may have tried to piece together coverage by dovetailing a workers compensation policy with an accident/health policy, but that would not be a single workers compensation policy.
This premium content is locked for FC&S Coverage Interpretation Subscribers
Enjoy unlimited access to the trusted solution for successful interpretation and analyses of complex insurance policies.
- Quality content from industry experts with over 60 years insurance experience, combined
- Customizable alerts of changes in relevant policies and trends
- Search and navigate Q&As to find answers to your specific questions
- Filter by article, discussion, analysis and more to find the exact information you’re looking for
- Continually updated to bring you the latest reports, trending topics, and coverage analysis
Already have an account? Sign In Now
For enterprise-wide or corporate access, please contact our Sales Department at 1-800-543-0874 or email [email protected]