The carrier states that the employee has no coverage under 3.A. because Oregon was not added. I think, and the compliance officer concurs, that he is still entitled to Arkansas benefits under 3.A. since that part of the WC policy applies to the workers compensation law of the states listed, namely, Arkansas.

The carrier is also denying coverage for Oregon and New York under Part Three – Other States Insurance, citing section A.4. as the employee was living in Oregon during the effective date of the policy, so coverage is not afforded in Oregon, and therefore when he traveled to other states, he had no coverage in those states either. I read A.4. as the employee can only be denied Oregon benefits and that he has the option of Arkansas benefits under coverage 3.A. or New York under 3.C. Part Three. The manufacturer did not have any employees living or working in New York at the effective date of the policy.

Arkansas Subscriber

The injured worker is entitled to benefits from Arkansas since he is working for an Arkansas company.  As for the other states insurance, your policy has the all states endorsement and that means if an insured is confronted with a claim under a WC law of a state that the insured has not listed in Item 3A, there is coverage for the claim by utilizing the other state section of the policy. If the insured begins work in one of the states that are included in the all states endorsement, the policy applies as if that state were listed in Item 3A for the WC benefits. You do have to make sure that the WC carrier is licensed to operate in the states you mention (OR and NY) because the all states endorsement does not give any insurer the approval to write WC coverage in a particular state if that insurer is not licensed to do so.

Of course, the insurer has a point about the notification clause. If your insured did have work in Oregon and New York on the effective date of the policy, it should have notified the carrier. Coverage would be there for the thirty days but after that, coverage is not afforded for that state. In other words, the other states coverage gives coverage for the insured if an employee is suddenly working in a state where the insured had not fully expected to be working in, but if an employee is working in a state that the insured is fully aware of on the effective date of the policy, the insured has a duty to notify the carrier about this.

So, the carrier may be correct about the lack of WC benefits from OR and NY depending on the circumstances/notification, but the AR benefits are available.