Workers Comp [ALL QUESTIONS]

Monopolistic State Funds

Must buy from the state.

Competitive State Funds

Can buy privately or from the state.

Compulsory

Employers must comply.

Elective

Employers can opt out but risk lawsuits.

Massachusetts Workers' Compensation Act

Ensures injured workers get medical and financial support.

Exclusive Remedy

Workers' comp is the only option for work injuries.

Employers REQUIRED to Cover Workers' Comp

Almost all employers.

Employers Who Can VOLUNTARILY Cover Workers' Comp

Small businesses, certain directors, sole proprietors.

Covered Injuries

Most work-related injuries, except minor mental/emotional stress. Must cause 5+ days of incapacity.

Occupational Disease

Covers work-related infectious diseases.

Workers' Comp Benefits

Medical, disability, survivor, rehab, cost-of-living adjustments, special case benefits.

Subsequent Injury Fund

Helps insurers pay when a pre-existing condition worsens due to a new injury.

Large Deductible Programs

Must meet state regulations to qualify.

Subrogation

Insurers recover costs from third-party lawsuits before paying workers.

Federal Employers Liability Act (FELA)

Covers railroad workers with larger payouts than state laws.

U.S. Longshore & Harbor Workers' Compensation Act

Covers maritime workers.

The Jones Act

Allows ship crews to sue owners for injuries.

General Section

Defines terms and conditions of the policy.

Part One – Workers' Compensation Insurance

Pays required benefits with no dollar limit.

Part Two – Employers' Liability Insurance

Covers lawsuits outside workers' comp.

Part Three – Other States Insurance

Covers workers' comp in listed states.

Part Four – Your Duties if Injury Occurs

Employer's obligations after an injury.

Part Five – Premium

Explains how cost is calculated.

Part Six – Conditions

Covers policy rules like cancellation and inspections.

Voluntary Compensation Endorsement

Adds coverage for excluded workers.

Job Classification – Rates

Groups jobs by risk to set rates.

Job Classification – Payroll

Premiums based on every $100 of payroll.

Experience Modification Factor

Adjusts premium based on past claims.

Premium Discounts

Based on total premium amount.

Assigned Risk Plan

Ensures coverage for high-risk employers.

Self-Insured Employers & Groups

Allows self-insurance if financial requirements are met.

Massachusetts Workers' Compensation Trust Fund

Pays claims involving uninsured employers.