| WORKERS COMPENSATION, WORKERS COMP, CALIFORNIA, WORKERS COMPENSATION INSURANCE, WORKMAN'S COMP, WORKMAN'S COMPENSATION, WORKER'S COMPENSATION INSURANCE, WORKERS COMP, WORKERS' COMPENSATION INSURANCE, Top workers comp law firms Los Angeles, Workers compensation adjuster, Texas workers compensation, California's workers compensation, Workman's comp Service Center, Shop Workers Compensation Insurance, Get a Workers Compensation Quote Today, Provide medical and disability benefits to employees injured on the job, Workers Compensation Insurance in California, Workers compensation is required by law., Arizona, California, Colorado, Florida, GeoAylor Insurancea, Illinois, Iowa, Louisiana, Minnesota, New York, North Carolina, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Wisconsin , workers compensation insurance coverage, workers compensation insurance information, expert loss control, WC Insurance, features of workers compensation insurance, workplace injuries, workers disabilities, workers compensation, rules, statutes, forms, news, information, employees, employers, insurers, medical providers, work safety, injured worker, work comp, quote compensation insurance, workers compensation insurance, workers compensation insurance quotes, workers compensation coverage, workmen's compensation insurance, stop gap insurance, employers liability insurance, Psychiatrist, podiatrist, optometrist, dentist, urologist, obstetrician, pediatrician, oncologist, neurologist, cardiologist, nephrologists, rheumatologist, dermatologist, endocrinologist, gastrologist, family practitioner, physician, surgeon, nurse, Chiropractor, Hospital, Hospitals, Clinic, Clinics, Doctor Office, Professional Office, Emergency room, urgent care, medical office, medical clinic, free clinic | ||||||||||||
![]() |
||||||||||||
|
||||||||||||
WORKERS COMPENSATION, WORKERS COMP, WORKMAN'S COMP, WORKERS COMPENSATION LAWYER, WORKMAN'S COMPENSATION, WORKERS COMPENSATION INSURANCE, WORKERS COMP, WORKERS' COMPENSATION INSURANCE, Top workers comp law firms Los Angeles, Workers compensation adjuster, Texas workers compensation, California's workers compensation, Workman's comp Service Center, Shop Workers Compensation Insurance, Get a Workers Compensation Quote Today, Provide medical and disability benefits to employees injured on the job, Workers Compensation Insurance in California, Workers compensation is required by law., Arizona, California, Colorado, Florida, GeoAylor Insurancea, Illinois, Iowa, Louisiana, Minnesota, New York, North Carolina, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Wisconsin , workers compensation insurance coverage, workers compensation insurance information, expert loss control, WC Insurance, features of workers compensation insurance, workplace injuries, workers disabilities, workers compensation, rules, statutes, forms, news, information, employees, employers, insurers, medical providers, work safety, injured worker, work comp, quote compensation insurance, workers compensation insurance, workers compensation insurance quotes, workers compensation coverage, workmen's compensation insurance, stop gap insurance, employers liability insurance, Psychiatrist, podiatrist, optometrist, dentist, urologist, obstetrician, pediatrician, oncologist, neurologist, cardiologist, nephrologists, rheumatologist, dermatologist, endocrinologist, gastrologist, family practitioner, physician, surgeon, nurse, Chiropractor, Hospital, Hospitals, Clinic, Clinics, Doctor Office, Professional Office, Emergency room, urgent care, medical office, medical clinic, free clinic
|
|
ALL ABOUT WORKERS COMPENSATIONWorkers' compensation (colloquially known as workers' comp in North America or compo in Australia) is a form of insurance that provides compensation medical care for employees who are injured in the course of employment, in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence. The tradeoff between assured, limited coverage and lack of recourse outside the worker compensation system is known as "the compensation bargain." While plans differ between jurisdictions, provision can be made for weekly payments in place of wages (functioning in this case as a form of disability insurance), compensation for economic loss (past and future), reimbursement or payment of medical and like expenses (functioning in this case as a form of health insurance), and benefits payable to the dependents of workers killed during employment (functioning in this case as a form of life insurance). General damages for pain and suffering, and punitive damages for employer negligence, are generally not available in worker compensation plans. Employees' compensation laws are usually a feature of highly developed industrial societies, implemented after long and hard-fought struggles by trade unions. Supporters of such programs believe they improve working conditions and provide an economic safety net for employees. Conversely, these programs are often criticized for removing or restricting workers' common-law rights (such as suit in tort for negligence) in order to reduce governments' or insurance companies' financial liability. These laws were first enacted in Europe and Oceania, with the United States following shortly thereafter. Compensation
prior to statutory law Statutory compensation
law Statutory compensation
in the United States In the United States, most employees who are injured on the job have an absolute right to medical care for that injury, and in many cases, monetary payments to compensate for resulting temporary or permanent disabilities. Most employers are required to subscribe to insurance for workers' compensation, and an employer who does not may have financial penalties imposed. In many states, there are public uninsured employer funds to pay benefits to workers employed by companies who illegally fail to purchase insurance. Insurance policies are available to employers through commercial insurance companies: if the employer is deemed an excessive risk to insure at market rates, it can obtain coverage through an assigned-risk program. In the vast majority of states, workers' compensation is solely provided by private insurance companies. 12 states operate a state fund (which serves as a model to private insurers and insures state employees), and a handful have state-owned monopolies. To keep the state funds from crowding out private insurers, they are generally required to act as assigned-risk programs or insurers of last resort, and they can only write workers' compensation policies. In contrast, private insurers can turn away the worst risks and can write comprehensive insurance packages covering general liability, natural disasters, and so on. Of the 12 state funds, the largest is California's State Compensation Insurance Fund. The federal government pays its workers' compensation obligations for its own employees through regular appropriations. It is illegal in most states for an employer to terminate or refuse to hire an employee for having reported a workplace injury or filed a workers' compensation claim. However, it is often not easy to prove discrimination on the basis of the employee's claims history. To abate discrimination of this type, some states have created a "subsequent injury trust fund" which will reimburse insurers for benefits paid to workers who suffer aggravation or recurrence of a compensable injury. It is also suggested that laws should be made to prohibit inclusion of claims history in databases or to make it anonymous. Employees may not falsely claim benefits. There have been instances where the sub rosa videos recorded by private investigators show employees engaging in sports or other strenuous physical activities, although the employees allegedly suffered disability or injury. Such evidence may not be admissible at a trial, if it is found that the taping infringed on the employees' reasonable expectation of privacy. Some employers vigorously contest employee claims for workers' compensation payments. In any contested case, or in any case involving serious injury, a lawyer with specific experience in handling workers' compensation claims on behalf of injured workers should be consulted. Laws in many states limit a claimant's legal expenses to a certain fraction of an award; such "contingency fees" are payable only if the recovery is successful. In some states this fee can be as high as 40% or as little as 11% of the monetary award recovered, if any. In the vast majority of states, original jurisdiction over workers' compensation disputes has been transferred by statute from the trial courts to special administrative agencies. Within such agencies, disputes are usually handled informally by administrative law judges. Appeals may be taken to an appeals board and from there into the state court system. However, such appeals are difficult and are regarded skeptically by most state appellate courts, because the point of workers' compensation was to reduce litigation. A few states still allow the employee to initiate a lawsuit in a trial court against the employer. Ohio allows appeals to go before a jury. Statutory compensation
in New York state Alternate forms
of statutory compensation in the United States Opposition to
statutory compensation in the United States United States employers can also move some operations to other countries where employee entitlements are much lower than in the US, and where there may be no workers' compensation or other legal remedies at all for workers who are injured or who are exposed to hazardous substances while on the job. Such countries may also have weaker or no legal protections available for employees in areas such as job discrimination, social security, or the right to organize or to join a trade union. Some small business owners complain that the cost of workers’ compensation, which they pay in the form of insurance premiums, places a heavy burden on them. Economists who favor the distributism system of economics cite workers' compensation as an example of how far the modern capitalist economic system approaches what they call the "servile state" or "slavery worker" system. They say that in past times, when ownership of the means of production were more widely distributed, it would not be natural to hold an employer responsible for a worker's injury, since the worker was freely choosing to work for that employer. Distributors assert that in modern times, with the vast majority of people dispossessed of the means of production, requiring employers to have workers compensation shows how much workers really are dependent on being employed and are essentially forced to work for someone else to survive. Some distributors who feel that capitalism is heading in the direction of a slavery system feel that this will come about by workers exchanging their personal freedom for economic benefits like workers' compensation. Workers' Compensation
Cost Containment This field of risk management is a specialized niche called "post loss cost containment," "injury management cost reduction," and several other names. The specialty centers around actions an employer can do to "manage" the processes in the workplace immediately after an injury occurs. There are four stages to the workers' comp cost containment process including: assessment & recommendations, design & development, implementation and rollout. Cost drivers
* building management
commitment, Employers should use a "holistic" approach to workers' compensation cost containment by looking at the total problem, rather than focusing only on one area such as reducing medical bills. By taking a "can do" approach, employers focus on controlling procedures within their control rather than the many things they cannot control. For example, employers cannot quickly or easily change the workers' comp laws or eliminate plaintiff's lawyers or the legal system, items that are frequently mentioned as "causes" of high workers' comp costs; however, an employer can implement a "post-injury response procedure" in their own workplace specifying what an employee must do if injured. Employers must "take charge" of those things within their control. Employers should also do after-action reviews (AARs) when an individual claimant's case has cost an extraordinary amount or resulted in extensive litigation to try and determine what went wrong. Often times the biggest driver in costs is a failure to recognize a meritorious claim quickly. Delayed treatment can result in a need for much more extensive treatment and/or the futility of all efforts at healing and eventual return to competitive employment. An injured worker's sense of having been the victim of an unjust litigation process can also lead to increased rates of consequential depression and other mental health conditions which create a complicating "overlay" to an initial physical injury. Policies Some documents and
policies to use are: History In many states today, Workers' Compensation represents a major cost of business for employers, and there is ongoing political maneuvering by both business and labor groups to shift the compromise balance struck by Workers' Compensation statutes (for an example see California's Senate Bill (SBA) 899). In general, business groups seek to limit the cost of Workers' Compensation coverage, while labor groups seek to increase benefits paid to workers. For the commercial insurance market, Workers' Compensation represents a major line of business, although one that is sometimes problematic for the insurance industry. Premiums are large, but many insurers find it difficult to turn a profit in many states, as benefit costs sometimes exceed premiums. This line of insurance is regulated fairly closely by most states, although in recent years many states have allowed insurance companies greater flexibility in pricing this line of coverage. The hope has been that by encouraging price competition among insurers for Workers' Compensation insurance, employers would benefit by being able to obtain lower overall premiums. However, the introduction of competitive pricing for Workers' Compensation insurance has also led to significant swings in cost, as the insurance market moves between 'hard' and 'soft' markets. Employers often benefit from lower premiums in 'soft' insurance markets, only to see their premiums increase exponentially during 'hard' insurance markets. Injured Workers sometimes complain that insurance companies do not treat them fairly or in compliance with the law, while employers often complain about their costs of insurance being driven up by exaggerated or fraudulent claims. Thus, the field engenders a considerable amount of controversy and litigation. These disputed areas include both claims and premium computations The statute of limitations
for filing a compensation claim for an accidental injury varies from
state to state. WORKERS COMPENSATION GLOSSARY OF TERMSAccepted claim: A claim in which the insurance company agrees your injury or illness is covered by workers' compensation. Even if your claim is accepted there may be delays or other problems. Also called admitted claim. ACOEM: American College of Occupational and Environmental Medicine. Until the state Division of Workers' Compensation (DWC) adopts medical treatment guidelines, the guidelines published by ACOEM, called "Occupational Medicine Practice Guidelines," are the guidelines used in most cases to decide the type and amount of treatment you'll receive for a work injury or illness. Agreed medical evaluator (AME): If you have an attorney, an AME is the doctor your attorney and the insurance company agree on to conduct the medical examination that will help resolve your dispute. If you don't have an attorney, you will use a qualified medical evaluator (QME). See QME. Alternative work: A new job with your former employer. If your doctor says you will not be able to return to your job at the time of injury, your employer is encouraged to offer you alternative work instead of supplemental job displacement benefits or vocational rehabilitation benefits. The alternative work must meet your work restrictions, last at least 12 months, pay at least 85 percent of the wages and benefits you were paid at the time you were injured, and be within a reasonable commuting distance of where you lived at the time of injury. American Medical Association (AMA): A national physician's group. The AMA publishes a set of guidelines called "Guides to the Evaluation of Permanent Impairment." If your permanent disability is rated under the 2005 rating schedule, the doctor is required to determine your level of impairment using the AMA's guides. Americans with Disabilities Act (ADA): A federal law that prohibits discrimination against people with disabilities. If you believe you've been discriminated against at work because you're disabled and want information on your rights under the ADA, contact a US Equal Employment Opportunity Commission office. For the EEOC office in your area, call 1-800-669-4000 or 1-800-669-6820 (TTY). AOE/COE (Arising out of and occurring in the course of employment): Your injury must be caused by and happen on the job. Applicant: The party -- usually you -- that opens a case at the local Workers' Compensation Appeals Board (WCAB) office by filing an application for adjudication of claim. Appeals board: A group of seven commissioners appointed by the governor to review and reconsider decisions of workers' compensation administrative law judges. Also called the Reconsideration Unit. See Workers' Compensation Appeals Board. Applicants' attorney: A lawyer that can represent you in your workers' compensation case. Applicant refers to you, the injured worker. Application for adjudication of claim (application or app) : A form you file to open a case at the local Workers' Compensation Appeals Board (WCAB) office if you have a disagreement with the insurance company about your claim. Apportionment: A way of figuring out how much of your permanent disability is due to your work injury and how much is due to other disabilities. Audit Unit: A unit within the DWC that receives complaints against claims administrators. These complaints may lead to investigations of the way the company handles claims. Benefit notice: A required letter or form sent to you by the insurance company to inform you of benefits you may be entitled to receive. Also called notice. Cal/OSHA: A unit within the state Division of Occupational Safety and Health (DOSH). Cal/OSHA inspects workplaces and enforces laws to protect the health and safety of workers in California. California Labor Code section 132a: A workers' compensation law that prohibits discrimination against you because you filed a workers' compensation claim, and against coworkers who might testify in your case. Carve-out: Carve-out programs allow employers and unions to create their own alternatives for workers' compensation benefit delivery and dispute resolution under a collective bargaining agreement. Claim form: The form used to report a work injury or illness to your employer. Claims adjuster: See claims administrator. Claims administrator: The term for insurance companies and others that handle your workers' compensation claim. Most claims administrators work for insurance companies or third party administrators handling claims for employers. Some claims administrators work directly for large employers that handle their own claims. Also called claims examiner or claims adjuster. Claims examiner: See claims administrator. Commission on Health and Safety and Workers' Compensation (CHSWC): A state-appointed body that conducts studies and makes recommendations to improve the California workers' compensation and workplace health and safety systems. Commutation: An order by a workers' compensation judge for a lump sum payment of part or all of your permanent disability award. Compromise and release (C&R): A type of settlement in which you receive a lump sum payment and become responsible for paying for your future medical care. A settlement like this must be approved by a workers' compensation judge. Cumulative injury (CT): An injury that was caused by repeated events or repeated exposures at work. For example, hurting your wrist doing the same motion over and over or losing your hearing because of constant loud noise. Date of injury: When you got hurt or ill. If your injury was caused by one event, the date it happened is the date of injury. If the injury or illness was caused by repeated exposures (a cumulative injury), the date of injury is the date you knew or should have known the injury was caused by work. Death benefits: Benefits paid to surviving dependents when a work injury or illness results in death. Declaration of readiness (DOR or DR): A form used to request a hearing before a workers' compensation judge when you're ready to resolve a dispute. Defendant: The party -- usually your employer or its insurance company -- opposing you in a dispute over benefits or services. Delay letter: A letter sent to you by the insurance company that explains why payments are delayed. The letter also tells you what information is needed before payments will be sent and when a decision will be made about the payments. Denied claim: A claim in which the insurance company believes your injury or illness is not covered by workers' compensation and has notified you of the decision. Description of employee's job duties (RU-91): A form filled out jointly by you and the insurance company that helps your treating physician decide whether you will be able to return to your normal job and working conditions. Determination and order (D&O): A decision by the DWC Rehabilitation Unit on a vocational rehabilitation dispute. Disability: A physical or mental impairment that limits your life activities. A condition that makes engaging in physical, social and work activities difficult. Disability Evaluation Unit (DEU): A unit within the DWC that calculates the percent of permanent disability based on medical reports. See disability rater. Disability management: A process to prevent disability from occurring or to intervene early, following the start of a disability, to encourage and support continued employment. This is done early in the recovery process in severe injury cases such as spinal injuries. Usually a rehabilitation nurse is involved with you and your treating doctor and the progress of your medical treatment is reported to the insurance company. Disability rater: An employee of the DWC Disability Evaluation Unit who rates your permanent disability after reviewing a medical report or a medical-legal report describing your condition. Disability rating: See permanent disability rating. Discrimination claim (Labor Code132a): A petition filed if your employer has fired or otherwise discriminated against you for filing a workers' compensation claim. Dispute: A disagreement about your right to payments, services or other benefits. Division of Workers' Compensation (DWC): A division within the state Department of Industrial Relations (DIR). The DWC administers workers' compensation laws, resolves disputes over workers' compensation benefits and provides information and assistance to injured workers and others about the workers' compensation system. Employee: A person whose work activities are under the control of an individual or entity. The term employee includes undocumented workers and minors. Employer: The person or entity with control over your work activities. Ergonomics: The study of how to improve the fit between the physical demands of the workplace and the employees who perform the work. That means considering the variability in human capabilities when selecting, designing or modifying equipment, tools, work tasks and the work environment. Essential functions: Duties considered crucial to the job you want or have. When being considered for alternative work, you must have both the physical and mental qualifications to fulfill the job's essential functions. Fair Employment and Housing Act (FEHA): A state law that prohibits discrimination against people with disabilities. If you believe you've been discriminated against at work because you're disabled and want more information on your rights under the FEHA, contact the state Department of Fair Employment and Housing at 1-800-884-1684. In some cases, the FEHA provides more protection than the federal Americans with Disabilities Act (ADA). Family and Medical Leave Act (FMLA): A federal law that provides certain employees with serious health problems or who need to care for a child or other family member with up to 12 weeks of unpaid, job-protected leave per year. It also requires that group health benefits be maintained during the leave. For more information, contact the US Department of Labor at 1-866-4-USA-DOL. Filing: Sending or delivering a document to an employer or a government agency as part of a legal process. The date of filing is the date the document is received. Final order: Any order, decision or award made by a workers' compensation judge that has not been appealed in a timely way. Findings
& award (F&A): A written decision by a workers' compensation
administrative law judge about your case, including payments and future
care that must be provided to you. The F&A becomes a final order unless
appealed. Future medical: Ongoing right to medical treatment for a work-related injury. Health care organization (HCO): An organization certified by the Department of Industrial Relations to provide managed medical care within the workers' compensation system. Hearings: Legal proceedings in which a workers' compensation judge discusses the issues in a case or receives information in order to make a decision about a dispute or a proposed settlement. In pro per: An injured worker not represented by an attorney. Independent contractor: There is no set definition of this term. Labor law enforcement agencies and the courts look at several factors when deciding if someone is an employee or an independent contractor. Some employers mis-classify employees as an independent contractor to avoid workers' compensation and other payroll responsibilities. Just because an employer says you are an independent contractor and doesn't need to cover you under a workers' compensation policy doesn't make it true. A true independent contractor has control over how their work is done. You probably are not an independent contractor when the person paying you:
Industrial Medical Council (IMC): No longer in existence. See Medical Unit. Information & Assistance Unit (I&A): A unit within DWC that provides information to all parties in workers' compensation claims and informally resolves disputes. Information & Assistance (I&A) officer: A DWC employee who answers questions, assists injured workers, provides written materials, conducts informational workshops and holds meetings to informally resolve problems with claims. Injury and illness prevention program (IIPP): A health and safety program employers are required to develop and implement. This program is enforced by Cal/OSHA. Impairment rating: A percentage estimate of how much normal use of your injured body parts you've lost. Impairment ratings are determined based on guidelines published by the American Medical Association (AMA). An impairment rating is used to calculate your permanent disability rating but is different from your permanent disability rating. Judge: See workers' compensation administrative law judge. Lien: A right or claim for payment against a workers' compensation case. A lien claimant, such as a medical provider, can file a form with the local Workers' Compensation Appeals Board to request payment of money owed in a workers' compensation case. Mandatory settlement conference (MSC): A required conference to discuss settlement prior to a trial. Maximal medical improvement (MMI): Your condition is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. Once you reach MMI, a doctor can assess how much, if any, permanent disability resulted from your work injury. Mediation conference: A voluntary conference held before an I&A officer to resolve a dispute if you are not represented by an attorney. Medical care: See medical treatment. Medical-legal report: A report written by a doctor that describes your medical condition. These reports are written to help clarify disputed medical issues. Medical provider network (MPN): An entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. Medical treatment: Treatment reasonably required to cure or relieve the effects of a work-related injury or illness. Also called medical care. Medical Unit: A unit within the DWC that oversees medical provider networks (MPNs), independent medical review (IMR) physicians, health care organizations (HCOs), qualified medical evaluators (QMEs), panel QMEs, utilization review (UR) plans, and spinal surgery second opinion physicians. Formerly called the Industrial Medical Council (IMC). Modified work: Your old job, with some changes that allow you do to it. If your doctor says you will not be able to return to your job at the time of injury, your employer is encouraged to offer you modified work instead of supplemental job displacement benefits or vocational rehabilitation benefits. Nontransferable voucher: A document you get from the insurance company that must be completed by both you and the insurance company. This is the document used to provide payment for education under the supplemental job displacement benefit program. Notice: See benefit notice. Objective factors: Measurements, direct observations and test results a treating physician, QME or an AME says contribute to your permanent disability. Off calendar (OTOC): A WCAB case in which there is no pending action. Offer of modified or alternative work form (RU-94): A form you get from the insurance company if: you were injured before 2004 and; your treating physician says you probably will never return to your job or one like it and; your employer is offering modified or alternative work instead of vocational rehabilitation benefits. Offer of modified or alternative work (DWC form #AD 10133.53): A form you get from the insurance company if: you were injured in 2004 or later and; your treating physician reports you have a permanent disability and; your employer is offering modified or alternative work instead of a supplemental job displacement benefit. This form also explains how your permanent disability payments may be lowered by 15 percent because your employer is returning you to work. Panel qualified medical evaluator (QME): A list of three independent qualified medical evaluators (QMEs) issued by the DWC Medical Unit. You select any one of the three doctors for your evaluation. If you have an attorney, other rules apply. Party: Normally this includes the insurance company, your employer, attorneys and any other person with an interest in your claim (doctors or hospitals that have not been paid). Permanent and stationary (P&S): Your medical condition has reached maximum medical improvement. Once you are P&S, a doctor can assess how much, if any, permanent disability resulted from your work injury. If your disability is rated under the 2005 schedule you will see the term maximal medical improvement (MMI) used in place of P&S. See also P&S report. Permanent disability (PD): Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached. Permanent disability rating (PDR): A percentage that estimates how much a job injury permanently limits the kinds of work you can do. It is based on your medical condition, date of injury, age when injured, occupation when injured, how much of the disability is caused by your job, and your diminished future earning capacity. It determines the number of weeks you are entitled to permanent disability benefits. Permanent disability rating schedule (PDRS): A DWC publication containing detailed information used to rate permanent disabilities. One of three schedules will be used to rate your disability, depending on when you were injured. Permanent disability (PD) benefits: Payments you receive when your work injury permanently limits the kinds of work you can do or your ability to earn a living. Permanent disability advance (PDA): A voluntary lump sum payment of permanent disability you are due in the future. Permanent disability payments: A mandatory biweekly payment based on the undisputed portion of permanent disability received before and/or after an award is issued. Permanent partial disability award: A final award of permanent partial disability made by a workers' compensation judge or the Workers' Compensation Appeals Board. Permanent partial disability (PPD) benefits: Payments you receive when your work injury partially limits the kinds of work you can do or your ability to earn a living. Permanent total disability (PTD) benefits: Payments you receive when you are considered permanently unable to earn a living. Penalty: An amount of money you receive because something wasn't done correctly in your claim. Paid by your employer or the insurance company, the penalty amount can be an automatic 10 percent for a delay in one payment to you, or a 25 percent penalty -- up to $10,000 -- for an unreasonable delay. Personal physician: A doctor licensed in California with an MD degree (medical doctor) or a D.O. degree (osteopath), who has treated you in the past and has your medical records. Petition for reconsideration (Recon): A legal process to appeal a decision issued by a workers' compensation judge. Heard by the Workers' Compensation Appeals Board Reconsideration Unit, a seven-member, judicial body appointed by the governor and confirmed by the Senate. Physician: A medical doctor, an osteopath, a psychologist, an acupuncturist, an optometrist, a dentist, a podiatrist or a chiropractor licensed in California. The definition of personal physician is more limited. See personal physician. Pre-designated physician: A physician that can treat your work injury if you advised your employer in writing prior to your work injury or illness and certain conditions are met. See pre-designation. Pre-designation: The process you use to tell your employer you want your personal physician to treat you for a work injury. You can pre-designate your personal doctor of medicine (MD) or doctor of osteopathy (D.O.) if: your employer offers group health coverage; the doctor has treated you in the past and has your medical records; prior to the injury your doctor agreed to treat you for work injuries or illnesses and; prior to the injury you provided your employer the following in writing:
Primary treating physician (PTP): The doctor having overall responsibility for treatment of your work injury or illness. This physician writes medical reports that may affect your benefits. Also called treating physician or treating doctor. Proof of service: A form used to show that documents have been sent to specific parties. P&S report: A medical report written by a treating physician that describes your medical condition when it has stabilized. See also permanent and stationary. Qualified injured worker (QIW): Entitled to vocational rehabilitation benefits. This benefit applies only if you were injured before Jan. 1, 2004. Qualified medical evaluator (QME): An independent physician certified by the DWC Medical Unit to perform medical evaluations. Qualified rehabilitation representative (QRR): A person trained and able to evaluate, counsel, and place disabled workers in new jobs. Also called rehabilitation counselor. Rating: See permanent disability rating. Reconsideration: See petition for reconsideration. Reconsideration of a summary rating: A process used when you don't have an attorney and you think mistakes were made in your permanent disability rating. Reconsideration Unit: See appeals board. Regular work: Your old job, paying the same wages and benefits as paid at the time of an injury and located within a reasonable commuting distance of where you lived at the time of your injury. Rehabilitation consultant: A DWC employee who oversees vocational rehabilitation procedures, makes decisions about vocational rehabilitation benefits and helps resolve disputes. Rehabilitation counselor: See qualified rehabilitation representative (QRR). Rehabilitation Unit: A unit within DWC that resolves vocational rehabilitation disputes, approves potential settlements of vocational rehabilitation services, and reviews and approves vocational rehabilitation plans for injuries that happened before Jan. 1, 2004. Restrictions: See work restrictions. Schedule for rating permanent disabilities: See permanent disability rating schedule. Settlement: An agreement between you and the insurance company about your workers' compensation payments and future medical care. Settlements must be reviewed by a workers' compensation judge to make sure they are adequate. Serious and willful misconduct (S&W): A petition filed if your injury is caused by the serious and willful misconduct of your employer. Social Security disability benefits: Long-term financial assistance for totally disabled persons. These benefits come from the US Social Security Administration. They are reduced by workers' compensation payments you receive. Specific injury: An injury caused by one event at work. Examples: hurting your back in a fall, getting burned by a chemical splashed on your skin, getting hurt in a car accident while making deliveries. State average weekly wage: The average weekly wage paid in the previous year to employees in California covered by unemployment insurance, as reported by the US Department of Labor. Effective 2006, temporary disability benefit increases are tied to this index. State disability insurance (SDI): A partial wage-replacement insurance plan paid out to California workers by the state Employment Development Department (EDD). SDI provides short-term benefits to eligible workers who suffer a loss of wages when they are unable to work due to a non work-related illness or injury, or a medically disabling condition from pregnancy or childbirth. Workers with job injuries may apply for SDI when workers' compensation payments are delayed or denied. Call 1-800-480-3287 for more information on SDI. Stipulated rating: Formal agreement on your permanent disability rating. Must be approved by a workers' compensation judge. Stipulation with award: A settlement of a case where the parties agree on the terms of an award. This is the document the judge signs to make the award final. Stipulations with request for award (Stips): A settlement in which the parties agree on the terms of an award. It may include future medical treatment. Payment takes place over time. This document is provided to the judge for final review. Subjective factors: The amount of pain and other symptoms described by an injured worker that a doctor reports as contributing to a worker's permanent disability. Subjective factors are given very little weight under the 2005 rating schedule as the schedule relies mainly on objective measurements. Subpoena: A document that requires a witness to appear at a hearing. Subpoena Duces Tecum (SDT): A document that requires records be sent to the requester. Summary rating: The percentage of permanent disability calculated by the DWC Disability Evaluation Unit. Summary rating reconsideration: A procedure used if you object to the summary rating issued by the DWC Disability Evaluation Unit. Supplemental job displacement benefit (SJDB): A workers' compensation benefit. If you were injured in 2004 or later, and have a permanent partial disability that prevents you from doing your old job, and your employer does not offer other work, you qualify for this benefit. It is in the form of a voucher that promises to help pay for educational retraining or skill enhancement, or both, at state-approved or state-accredited schools. Also called voucher. Temporary disability (TD or TTD): Payments you get if you lose wages because your injury prevents you from doing your usual job while recovering. Temporary partial disability (TPD) benefits: Payments you get if you can do some work while recovering, but you earn less than before the injury. Temporary total disability (TTD) benefits: Payments you get if you cannot work at all while recovering. Transportation expenses: A benefit to cover your out-of-pocket expenses for mileage, parking and toll fees related to a claim. Usually a reimbursement. Treating doctor: See primary treating physician. Treating physician: See primary treating physician. Uninsured Employers Fund (UEF): A fund, run by the DWC, through which your benefits can be paid if your employer is illegally uninsured for workers' compensation. Utilization review (UR): The process used by insurance companies to decide whether to authorize and pay for treatment recommended by your treating physician or another doctor. Vocational & return to work counselor (VRTWC): If you have a permanent disability, this is the person or entity that helps you develop a return to work strategy. They evaluate you, provide counseling and help you get ready to work. A VRTWC must have at least an undergraduate degree in any field and three or more years of full time experience. Vocational rehabilitation (VR): A workers' compensation benefit. If you were injured before 2004 and are permanently unable to do your usual job, and your employer does not offer other work, you qualify for this benefit. It includes job placement counseling to help you find another job. It may also include retraining and a vocational rehabilitation maintenance allowance. Vocational rehabilitation maintenance allowance (VRMA): Payments to help you with living expenses while participating in vocational rehabilitation. See vocational rehabilitation. Voucher: See supplemental job displacement benefit and nontransferable voucher. Wage loss (temporary partial disability): See temporary partial disability benefits. Workers' Compensation Appeals Board (WCAB): Consists of 24 local offices throughout the state where disagreements over workers' compensation benefits are initially heard by workers' compensation judges. The WCAB Reconsideration Unit in San Francisco is a seven-member, judicial body appointed by the governor and confirmed by the Senate that hears appeals of decisions issued by local workers' compensation judges. Workers' Compensation Insurance Rating Bureau (WCIRB): An agent of the state Department of Insurance and funded by the insurance industry, this private entity provides statistical and rating information for workers' compensation insurance and employer's liability insurance, and collects and tabulates information to develop pure premium rates. Work restrictions: A doctor's description of the work you can and cannot do. Work restrictions help protect you from further injury. Workers' compensation administrative law judge: A DWC employee who makes decisions about workers' compensation disputes and approves settlements. Judges hold hearings at local Workers' Compensation Appeals Board (WCAB) offices, and their decisions may be reviewed and reconsidered by the Reconsideration Unit of the WCAB. Also called workers' compensation judge. Workers' compensation judge: See workers' compensation administrative law judge.
ALL
ABOUT INSURANCE Principles
of insurance A large number of homogeneous exposure units. The vast majority of insurance policies are provided for individual members of very large classes. Automobile insurance, for example, covered about 175 million automobiles in the United States in 2004. The existence of a large number of homogeneous exposure units allows insurers to benefit from the so-called “law of large numbers,” which in effect states that as the number of exposure units increases, the actual results are increasingly likely to become close to expected results. There are exceptions to this criterion. Lloyd's of London is famous for insuring the life or health of actors, actresses and sports figures. Satellite Launch insurance covers events that are infrequent. Large commercial property policies may insure exceptional properties for which there are no ‘homogeneous’ exposure units. Despite failing on this criterion, many exposures like these are generally considered to be insurable. Definite Loss. The event that gives rise to the loss that is subject to insurance should, at least in principle, take place at a known time, in a known place, and from a known cause. The classic example is death of an insured on a life insurance policy. Fire, automobile accidents, and worker injuries may all easily meet this criterion. Other types of losses may only be definite in theory. Occupational disease, for instance, may involve prolonged exposure to injurious conditions where no specific time, place or cause is identifiable. Ideally, the time, place and cause of a loss should be clear enough that a reasonable person, with sufficient information, could objectively verify all three elements. Accidental Loss. The event that constitutes the trigger of a claim should be fortuitous, or at least outside the control of the beneficiary of the insurance. The loss should be ‘pure,’ in the sense that it results from an event for which there is only the opportunity for cost. Events that contain speculative elements, such as ordinary business risks, are generally not considered insurable. Large Loss. The size of the loss must be meaningful from the perspective of the insured. Insurance premiums need to cover both the expected cost of losses, plus the cost of issuing and administering the policy, adjusting losses, and supplying the capital needed to reasonably assure that the insurer will be able to pay claims. For small losses these latter costs may be several times the size of the expected cost of losses. There is little point in paying such costs unless the protection offered has real value to a buyer. Affordable Premium. If the likelihood of an insured event is so high, or the cost of the event so large, that the resulting premium is large relative to the amount of protection offered, it is not likely that anyone will buy insurance, even if on offer. Further, as the accounting profession formally recognizes in financial accounting standards, the premium cannot be so large that there is not a reasonable chance of a significant loss to the insurer. If there is no such chance of loss, the transaction may have the form of insurance, but not the substance. Calculable Loss. There are two elements that must be at least estimable, if not formally calculable: the probability of loss, and the attendant cost. Probability of loss is generally an empirical exercise, while cost has more to do with the ability of a reasonable person in possession of a copy of the insurance policy and a proof of loss associated with a claim presented under that policy to make a reasonably definite and objective evaluation of the amount of the loss recoverable as a result of the claim. Limited risk of catastrophically large losses. The essential risk is often aggregation. If the same event can cause losses to numerous policyholders of the same insurer, the ability of that insurer to issue policies becomes constrained, not by factors surrounding the individual characteristics of a given policyholder, but by the factors surrounding the sum of all policyholders so exposed. Typically, insurers prefer to limit their exposure to a loss from a single event to some small portion of their capital base, on the order of 5 percent. Where the loss can be aggregated, or an individual policy could produce exceptionally large claims, the capital constraint will restrict an insurers appetite for additional policyholders. The classic example is earthquake insurance, where the ability of an underwriter to issue a new policy depends on the number and size of the policies that it has already underwritten. Wind insurance in hurricane zones, particularly along coast lines, is another example of this phenomenon. In extreme cases, the aggregation can affect the entire industry, since the combined capital of insurers and re-insurers can be small compared to the needs of potential policyholders in areas exposed to aggregation risk. In commercial fire insurance it is possible to find single properties whose total exposed value is well in excess of any individual insurer’s capital constraint. Such properties are generally shared among several insurers, or are insured by a single insurer who syndicates the risk into the reinsurance market. Indemnification The technical definition of "indemnity" means to make whole again. There are two types of insurance contracts; 1) an "indemnity" policy and 2) a "pay on behalf" or "on behalf of" policy. The difference is significant on paper, but rarely material in practice. An "indemnity" policy will never pay claims until the insured has paid out of pocket to some third party; i.e. a visitor to your home slips on a floor that you left wet and sues you for $10,000 and wins. Under an "indemnity" policy the homeowner would have to come up with the $10,000 to pay for the visitor's fall and then would be "indemnified" by the insurance carrier for the out of pocket costs (the $10,000). Under the same situation, a "pay on behalf" policy, the insurance carrier would pay the claim and the insured (the homeowner) would not be out of pocket for anything. Most modern liability insurance is written on the basis of "pay on behalf" language. An entity seeking to transfer risk (an individual, corporation, or association of any type, etc.) becomes the 'insured' party once risk is assumed by an 'insurer', the insuring party, by means of a contract, called an insurance 'policy'. Generally, an insurance contract includes, at a minimum, the following elements: the parties (the insurer, the insured, the beneficiaries), the premium, the period of coverage, the particular loss event covered, the amount of coverage (i.e., the amount to be paid to the insured or beneficiary in the event of a loss), and exclusions (events not covered). An insured is thus said to be "indemnified" against the loss events covered in the policy. When insured parties experience a loss for a specified peril, the coverage entitles the policyholder to make a 'claim' against the insurer for the covered amount of loss as specified by the policy. The fee paid by the insured to the insurer for assuming the risk is called the 'premium'. Insurance premiums from many insureds are used to fund accounts reserved for later payment of claims—in theory for a relatively few claimants—and for overhead costs. So long as an insurer maintains adequate funds set aside for anticipated losses (i.e., reserves), the remaining maAylor Insurancen is an insurer's profit. Insurer’s business model Profit = earned premium + investment income - incurred loss - underwriting expenses. Insurers make money in two ways: (1) through underwriting, the process by which insurers select the risks to insure and decide how much in premiums to charge for accepting those risks and (2) by investing the premiums they collect from insureds. The most complicated aspect of the insurance business is the underwriting of policies. Using a wide assortment of data, insurers predict the likelihood that a claim will be made against their policies and price products accordingly. To this end, insurers use actuarial science to quantify the risks they are willing to assume and the premium they will charge to assume them. Data is analyzed to fairly accurately project the rate of future claims based on a given risk. Actuarial science uses statistics and probability to analyze the risks associated with the range of perils covered, and these scientific principles are used to determine an insurer's overall exposure. Upon termination of a given policy, the amount of premium collected and the investment gains thereon minus the amount paid out in claims is the insurer's underwriting profit on that policy. Of course, from the insurer's perspective, some policies are winners (i.e., the insurer pays out less in claims and expenses than it receives in premiums and investment income) and some are losers (i.e., the insurer pays out more in claims and expenses than it receives in premiums and investment income). An insurer's underwriting performance is measured in its combined ratio. The loss ratio (incurred losses and loss-adjustment expenses divided by net earned premium) is added to the expense ratio (underwriting expenses divided by net premium written) to determine the company's combined ratio. The combined ratio is a reflection of the company's overall underwriting profitability. A combined ratio of less than 100 percent indicates underwriting profitability, while anything over 100 indicates an underwriting loss. Insurance companies also earn investment profits on “float”. “Float” or available reserve is the amount of money, at hand at any given moment, that an insurer has collected in insurance premiums but has not been paid out in claims. Insurers start investing insurance premiums as soon as they are collected and continue to earn interest on them until claims are paid out. In the United States, the underwriting loss of property and casualty insurance companies was $142.3 billion in the five years ending 2003. But overall profit for the same period was $68.4 billion, as the result of float. Some insurance industry insiders, most notably Hank Greenberg, do not believe that it is forever possible to sustain a profit from float without an underwriting profit as well, but this opinion is not universally held. Naturally, the “float” method is difficult to carry out in an economically depressed period. Bear markets do cause insurers to shift away from investments and to toughen up their underwriting standards. So a poor economy generally means high insurance premiums. This tendency to swing between profitable and unprofitable periods over time is commonly known as the "underwriting" or insurance cycle. Property and casualty insurers currently make the most money from their auto insurance line of business. Generally better statistics are available on auto losses and underwriting on this line of business has benefited greatly from advances in computing. Additionally, property losses in the US, due to natural catastrophes, have exacerbated this trend. Finally, claims and loss handling is the materialized utility of insurance. In managing the claims-handling function, insurers seek to balance the elements of customer satisfaction, administrative handling expenses, and claims overpayment leakage. As part of this balancing act, fraudulent insurance practices are a major business risk that must be managed and overcome. History of insurance In some sense we can say that insurance appears simultaneously with the appearance of human society. We know of two types of economies in human societies: money economies (with markets, money, financial instruments and so on) and non-money or natural economies (without money, markets, financial instruments and so on). The second type is a more ancient form than the first. In such an economy and community, we can see insurance in the form of people helping each other. For example, if a house burns down, the members of the community help build a new one. Should the same thing happen to one's neighbor, the other neighbor must help. Otherwise, neighbor will not receive help in the future. This type of insurance has survived to the present day in some countries where modern money economy with its financial instruments is not widespread (for example countries in the territory of the former Soviet Union). Turning to insurance in the modern sense (i.e., insurance in a modern money economy, in which insurance is part of the financial sphere), early methods of transferring or distributing risk were practiced by Chinese and Babylonian traders as long ago as the 3rd and 2nd millennia BC, respectively. Chinese merchants traveling treacherous river rapids would redistribute their wares across many vessels to limit the loss due to any single vessel's capsizing. The Babylonians developed a system which was recorded in the famous Code of Hammurabi, c. 1750 BC, and practiced by early Mediterranean sailing merchants. If a merchant received a loan to fund his shipment, he would pay the lender an additional sum in exchange for the lender's guarantee to cancel the loan should the shipment be stolen. Achaemenian monarchs of Iran were the first to insure their people and made it official by registering the insuring process in governmental notary offices. The insurance tradition was performed each year in Norouz (beginning of the Iranian New Year); the heads of different ethnic groups as well as others willing to take part, presented gifts to the monarch. The most important gift was presented during a special ceremony. When a gift was worth more than 10,000 Derrik (Achaemenian gold coin) the issue was registered in a special office. This was advantageous to those who presented such special gifts. For others, the presents were fairly assessed by the confidants of the court. Then the assessment was registered in special offices. The purpose of registering was that whenever the person who presented the gift registered by the court was in trouble, the monarch and the court would help him. Jahez, a historian and writer, writes in one of his books on ancient Iran: " Whenever the owner of the present is in trouble or wants to construct a building, set up a feast, have his children married, etc. the one in charge of this in the court would check the registration. If the registered amount exceeded 10,000 Derrik, he or she would receive an amount of twice as much."[1] A thousand years later, the inhabitants of Rhodes invented the concept of the 'general average'. Merchants whose goods were being shipped together would pay a proportionally divided premium which would be used to reimburse any merchant whose goods were jettisoned during storm or sinkage. The Greeks and Romans introduced the origins of health and life insurance c. 600 AD when they organized guilds called "benevolent societies" which cared for the families and paid funeral expenses of members upon death. Guilds in the Middle Ages served a similar purpose. The Talmud deals with several aspects of insuring goods. Before insurance was established in the late 17th century, "friendly societies" existed in England, in which people donated amounts of money to a general sum that could be used for emergencies. Separate insurance contracts (i.e., insurance policies not bundled with loans or other kinds of contracts) were invented in Genoa in the 14th century, as were insurance pools backed by pledges of landed estates. These new insurance contracts allowed insurance to be separated from investment, a separation of roles that first proved useful in marine insurance. Insurance became far more sophisticated in post-Renaissance Europe, and specialized varieties developed. Toward the end of the seventeenth century, London's growing importance as a canter for trade increased demand for marine insurance. In the late 1680s, Mr. Edward Lloyd opened a coffee house that became a popular haunt of ship owners, merchants, and ships’ captains, and thereby a reliable source of the latest shipping news. It became the meeting place for parties wishing to insure cargoes and ships, and those willing to underwrite such ventures. Today, Lloyd's of London remains the leading market (note that it is not an insurance company) for marine and other specialist types of insurance, but it works rather differently than the more familiar kinds of insurance. Insurance as we know it today can be traced to the Great Fire of London, which in 1666 devoured 13,200 houses. In the aftermath of this disaster, Nicholas Barbon opened an office to insure buildings. In 1680, he established England's first fire insurance company, "The Fire Office," to insure brick and frame homes. The first insurance company in the United States underwrote fire insurance and was formed in Charles Town (modern-day Charleston), South Carolina, in 1732. Benjamin Franklin helped to popularize and make standard the practice of insurance, particularly against fire in the form of perpetual insurance. In 1752, he founded the Philadelphia Contributionship for the Insurance of Houses from Loss by Fire. Franklin's company was the first to make contributions toward fire prevention. Not only did his company warn against certain fire hazards, it refused to insure certain buildings where the risk of fire was too great, such as all wooden houses. In the United States, regulation of the insurance industry is highly Balkanized, with primary responsibility assumed by individual state insurance departments. Whereas insurance markets have become centralized nationally and internationally, state insurance commissioners operate individually, though at times in concert through a national insurance commissioners' organization. In recent years, some have called for a dual state and federal regulatory system (commonly referred to as the Optional Federal Charter (OFC)) for insurance similar to that which oversees state banks and national banks. Types of insurance Any risk that can be quantified can potentially be insured. Specific kinds of risk that may give rise to claims are known as "perils". An insurance policy will set out in detail which perils are covered by the policy and which are not. Below are (non-exhaustive) lists of the many different types of insurance that exist. A single policy may cover risks in one or more of the categories set forth below. For example, auto insurance would typically cover both property risk (covering the risk of theft or damage to the car) and liability risk (covering legal claims from causing an accident). A homeowner's insurance policy in the US typically includes property insurance covering damage to the home and the owner's belongings, liability insurance covering certain legal claims against the owner, and even a small amount of health insurance for medical expenses of guests who are injured on the owner's property. Business insurance can be any kind of insurance that protects businesses against risks. Some principal subtypes of business insurance are (a) the various kinds of professional liability insurance, also called professional indemnity insurance, which are discussed below under that name; and (b) the business owners policy (BOP), which bundles into one policy many of the kinds of coverage that a business owner needs, in a way analogous to how homeowners insurance bundles the coverages that a homeowner needs. Health
Insurance Disability
Insurance Casualty
Insurance Life
Insurance Property
Insurance * Automobile insurance, known in the UK as motor insurance, is probably the most common form of insurance and may cover both legal liability claims against the driver and loss of or damage to the insured's vehicle itself. Throughout the United States auto insurance policy is required to legally operate a motor vehicle on public roads. In some jurisdictions, bodily injury compensation for automobile accident victims has been changed to a no-fault system, which reduces or eliminates the ability to sue for compensation but provides automatic eligibility for benefits. Credit card companies insure against damage on rented cars. o Driving School Insurance provides cover for any authorized driver whilst under going tuition, cover also unlike other motor policies provides cover for instructor liability where both the pupil and driving instructor are both equally liable in the event of a claim. * Aviation insurance insures against hull, spares, deductible, hull wear and liability risks. * Boiler insurance (also known as boiler and machinery insurance or equipment breakdown insurance) insures against accidental physical damage to equipment or machinery. * Builder's risk insurance insures against the risk of physical loss or damage to property during construction. Builder's risk insurance is typically written on an "all risk" basis covering damage due to any cause (including the negligence of the insured) not otherwise expressly excluded. * Crop insurance "Farmers use crop insurance to reduce or manage various risks associated with growing crops. Such risks include crop loss or damage caused by weather, hail, drought, frost damage, insects, or disease, for instance." * Earthquake insurance is a form of property insurance that pays the policyholder in the event of an earthquake that causes damage to the property. Most ordinary homeowners insurance policies do not cover earthquake damage. Most earthquake insurance policies feature a high deductible. Rates depend on location and the probability of an earthquake, as well as the construction of the home. * A fidelity bond is a form of casualty insurance that covers policyholders for losses that they incur as a result of fraudulent acts by specified individuals. It usually insures a business for losses caused by the dishonest acts of its employees. * Flood insurance protects against property loss due to flooding. Many insurers in the US do not provide flood insurance in some portions of the country. In response to this, the federal government created the National Flood Insurance Program which serves as the insurer of last resort. * Home insurance or homeowners insurance: See "Property insurance". * Marine insurance and marine cargo insurance cover the loss or damage of ships at sea or on inland waterways, and of the cargo that may be on them. When the owner of the cargo and the carrier are separate corporations, marine cargo insurance typically compensates the owner of cargo for losses sustained from fire, shipwreck, etc., but excludes losses that can be recovered from the carrier or the carrier's insurance. Many marine insurance underwriters will include "time element" coverage in such policies, which extends the indemnity to cover loss of profit and other business expenses attributable to the delay caused by a covered loss. * Surety bond insurance is a three party insurance guaranteeing the performance of the principal. * Terrorism insurance provides protection against any loss or damage caused by terrorist activities. * Volcano insurance is an insurance that covers volcano damage in Hawaii. * Windstorm insurance is an insurance covering the damage that can be caused by hurricanes and tropical cyclones. Liability
Insurance Credit
Insurance Other types of Insurance * Collateral
protection insurance or CPI, insures property (primarily vehicles) held
as collateral for loans made by lending institutions. Insurance
financing vehicles Insurance
Companies General
insurance companies can be further divided into these sub categories.
In most countries, life and non-life insurers are subject to different regulatory regimes and different tax and accounting rules. The main reason for the distinction between the two types of company is that life, annuity, and pension business is very long-term in nature — coverage for life assurance or a pension can cover risks over many decades. By contrast, non-life insurance cover usually covers a shorter period, such as one year. In the United States, standard line insurance companies are your "main stream" insurers. These are the companies that typically insure your auto, home or business. They use pattern or "cookie-cutter" policies without variation from one person to the next. They usually have lower premiums than excess lines and can sell directly to individuals. They are regulated by state laws that can restrict the amount they can charge for insurance policies. Excess line insurance companies (AKA Excess and Surplus) typically insure risks not covered by the standard lines market. They are broadly referred as being all insurance placed with non-admitted insurers. Non-admitted insurers are not licensed in the states where the risks are located. These companies have more flexibility and can react faster than standard insurance companies because they are not required to file rates and forms as do the "admitted" carriers do. However, they still have substantial regulatory requirements placed upon them. State laws generally require insurance placed with surplus line agents and brokers to not be available through standard licensed insurers. Insurance companies are generally classified as either mutual or stock companies. This is more of a traditional distinction as true mutual companies are becoming rare. Mutual companies are owned by the policyholders, while stockholders (who may or may not own policies) own stock insurance companies. Other possible forms for an insurance company include reciprocals, in which policyholders 'reciprocate' in sharing risks, and Lloyds organizations. Insurance companies are rated by various agencies such as A. M. Best. The ratings include the company's financial strength, which measures its ability to pay claims. It also rates financial instruments issued by the insurance company, such as bonds, notes, and securitization products. Reinsurance companies are insurance companies that sell policies to other insurance companies, allowing them to reduce their risks and protect themselves from very large losses. The reinsurance market is dominated by a few very large companies, with huge reserves. A re-insurer may also be a direct writer of insurance risks as well. Captive insurance companies may be defined as limited-purpose insurance companies established with the specific objective of financing risks emanating from their parent group or groups. This definition can sometimes be extended to include some of the risks of the parent company's customers. In short, it is an in-house self-insurance vehicle. Captives may take the form of a "pure" entity (which is a 100 percent subsidiary of the self-insured parent company); of a "mutual" captive (which insures the collective risks of members of an industry); and of an "association" captive (which self-insures individual risks of the members of a professional, commercial or industrial association). Captives represent commercial, economic and tax advantages to their sponsors because of the reductions in costs they help create and for the ease of insurance risk management and the flexibility for cash flows they generate. Additionally, they may provide coverage of risks which is neither available nor offered in the traditional insurance market at reasonable prices. The types of risk that a captive can underwrite for their parents include property damage, public and products liability, professional indemnity, employee benefits, employers liability, motor and medical aid expenses. The captive's exposure to such risks may be limited by the use of reinsurance. Captives
are becoming an increasingly important component of the risk management
and risk financing strategy of their parent. This can be understood against
the following background: There are also companies known as 'insurance consultants'. Like a mortgage broker, these companies are paid a fee by the customer to shop around for the best insurance policy amongst many companies. Similar to an insurance consultant, an 'insurance broker' also shops around for the best insurance policy amongst many companies. However, with insurance brokers, the fee is usually paid in the form of commission from the insurer that is selected rather than directly from the client. Neither insurance consultants nor insurance brokers are insurance companies and no risks are transferred to them in insurance transactions. Third party administrators are companies that perform underwriting and sometimes claims handling services for insurance companies. These companies often have special expertise that the insurance companies do not have. The financial stability and strength of an insurance company should be a major consideration when purchasing an insurance contract. An insurance premium paid currently provides coverage for losses that might arise many years in the future. For that reason, the viability of the insurance carrier is very important. In recent years, a number of insurance companies have become insolvent, leaving their policyholders with no coverage (or coverage only from a government-backed insurance pool or other arrangement with less attractive payouts for losses). A number of independent rating agencies, such as Best's, Fitch, Standard & Poor's, and Moody's Investors Service, provide information and rate the financial viability of insurance companies. LIST
OF US INSURANCE COMPANIES LIST
OF DISABILITY INSURANCE COMPANIES LIST OF EXPATRIATE INSURANCE COMPANIES: * Clements International LIST OF GENERAL LIABILITY INSURANCE COMPANIES: * American Family Insurance LIST OF HEALTH INSURANCE COMPANIES: * American National Insurance Company * Aetna * Aflac * American Family Insurance * American Medical Security Life Insurance Company * Anthem * Assurant * Asuris Northwest Health * Blue Cross and Blue Shield Association * Celtic Insurance Co. * CIGNA * community first * Continental General * Fortis * Golden Rule Insurance Company * Group Health Inc. * Group Health Cooperative * Harvard Community Health Plan * HealthMarkets * Health Net of Arizona * Health Net of Oregon * HealthPartners * Health Plan of Nevada * Humana Inc. * Insurance Services of America * Intermountain Health Care * Kaiser Permanente * LifeWise Health Plan of Arizona * LifeWise Health Plan of Oregon * LifeWise Health Plan of Washington * Medica of Minnesota * Medical Mutual * Oxford Health Plans, Inc. * Principal Financial Group * Shelter Insurance Companies * UNICARE * UnitedHealthCare (UnitedHealth recently purchased Pacificare) * Vista Healthplan of South Florida * Wellpoint * College Health IPA * Acordia National LIST OF LIFE INSURANCE COMPANIES: * AAA d.b.a. Western United * AAA Life Insurance Company * Aetna * AIG American General * Alfa Life Insurance * Allstate Insurance Company * American Family Insurance * American Farmers and Ranchers * American International Group * American National Insurance Company * Aon Corporation, formerly known as Combined Insurance Company of America * Auto-Owners Insurance * AXA * Bankers Life and Casualty Company * Banner Life * The Chesapeake Life Insurance Company * Farm Bureau Insurance * Farmers Insurance * First United American Life Insurance Company * Foresters * Garden State Life Insurance Company * Globe Life And Accident Insurance Company * Guardian Life Insurance Company * Jackson National Life * John Hancock Insurance, now a unit of Manulife Financial * The Hartford * Kansas City Life Insurance Company, Inc. * Lafayette Life Insurance Company * Liberty NationalLife Insurance Company * Mass Mutual Financial Group * MEGA Life and Health Insurance * Metropolitan Life Insurance Company * Minnesota Life Insurance Company * Modern Woodmen of America * Nationwide Insurance * New York Life * Northwestern Mutual Life Insurance Company * Old Mutual * Pacific Life Insurance * Primerica Life Insurance Company * Principal Financial Group * Protective Life Corporation * Prudential Financial * RBC * Sagicor USA, Inc., formerly known as American Founders Life * Shenendoah * The Standard (Also known as Standard Insurance Company) * Shelter Life Insurance Company * State Farm Insurance * Thrivent Financial for Lutherans, product of merger between Lutheran Brotherhood & Aid Association for Lutherans * Travelers Group, now somewhat part of Citigroup, other parts belong to The St. Paul Travelers Companies, Inc. * USAA * West Coast * Western & Southern * Western Reserve Life LIST OF PET INSURANCE COMPANIES: * ASPCA Pet Health Insurance * Pets Health Plan * Hartville Pet Insurance * PetCare * Global Pet Insurance * Pets Best Pet Insurance * Veterinary Pet Insurance * Embrace Pet Insurance * Petplan USA Pet Insurance * PetFirst Healthcare Pet Insurance * Trupanion Pet Health Insurance LIST OF PROPERTY AND CASUALTY INSURANCE COMPANIES: * ACE USA * Acuity * Allstate * Alfa Mutual Insurance * American Family Insurance * American National Property and Casualty * American International Group * Assurant Specialty Property * Argonaut Group, Inc. * Auto-Owners Insurance * BISYS Commercial Insurance Services, Inc. * Bliss & Glennon, Inc. * Chubb Corporation * Church Mutual * Cincinnati Financial Corporation * Commerce Insurance Group * CNA Financial Corporation * Farm Bureau Insurance * Farmers Insurance * Fireman's Fund Insurance Company * FM Global * Frankenmuth Mutual Insurance Company * Great American Insurance Company * Hanover Insurance * The Hartford * Hastings Mutual Insurance Company * Harleysville Insurance Company * HomeInsurance.com * Infinity Property & Casualty * Liberty Mutual * Manulife Financial * Markel Corporation * Nationwide Insurance * NLC Insurance Companies * OneBeacon Insurance Group * Penn National Insurance * Philadelphia Insurance * The St. Paul Travelers Companies, Inc. * Safeway Insurance Group * Secura * Sentry Insurance * Shelter Insurance Companies * State Auto Insurance Companies * State Farm Insurance * Southern Farm Bureau * Union Standard Insurance * United Automobile Insurance Company * USAA * Wausau Insurance Companies * West Bend Mutual Insurance Company * Westfield Insurance * Zenith Insurance Company * Zurich Insurance Services * Island Insurance * The Phoenix Group LIST OF RENTER INSURANCE COMPANIES: * American Family Insurance * American Bankers Insurance Company of Florida * Assurant Specialty Property * Balboa Insurance * State Farm Insurance LIST OF TRAVEL INSURANCE COMPANIES: * American Family Insurance * ASSIST-CARD LIST OF WORKERS' COMPENSATION INSURANCE COMPANIES: * ACE * Amerisafe * Liberty Mutual * Missouri Employers Mutual * Penn National Insurance * State Accident Insurance Fund (Oregon) * State Compensation Insurance Fund (California) * Zenith Insurance
The State of California is a state located in the western Pacific region of the United States and was the 31st admitted to the Union. It is the most populous state of the United States. It is bordered by Oregon to the north, Nevada to the east, and Arizona to the southeast in the United States, as well as Baja California in Mexico to the south. California's capital city is Sacramento, with the four largest cities being Los Angeles, San Diego, San Jose, and San Francisco. California is known for its diverse climate and geography, as well as ethnically diverse population. The state has 58 counties. Before becoming a part of the United States, Alta California was colonized by the Spanish Empire in 1769. After Mexican independence in 1821, Alta California remained as part of Mexico until 1846, when it was the independent California Republic for one brief week. Following the conclusion of the Mexican-American war of 1848, California was annexed by the United States and was admitted to the Union as the thirty-first state on September 9, 1850. California is the third largest state by area in the US; its size gives it a diverse geography, which ranges from sandy and rocky beaches of the Pacific coast, to the rugged snowcapped Sierra Nevada mountains in the east, to desert areas in the southeast and the forests of the northwest. The center portion of the state is dominated by the Central Valley, one of the most productive agricultural areas in the world and the largest of any US state. The Sierra Nevada mountains contain Yosemite Valley, famous for its glacially-carved domes, and Sequoia National Park, home to the giant sequoia trees, the largest living organisms on Earth. The state is home to Mount Whitney, the highest point in the contiguous United States,[2] as well as the second lowest and hottest place in the Western Hemisphere, Death Valley. Many of the trees located in the California White Mountains are the oldest in the world; one Bristlecone pine has an age of 4,700 years. The
California Gold Rush began in 1848, dramatically changing California to
accommodate an influx of population and an economic boom. The early 20th
century was marked by Los Angeles becoming the center of the entertainment
industry, in addition to the growth of a large tourism sector in the state.
Along with California's prosperous agricultural industry, other industries
include aerospace, petroleum, and computer and information technology.
California ranks among the top ten largest economies in the world, and
were it a separate country, it would be 34th amongst the most populous
countries, just behind Poland, as well as the 6th World's largest economy. About 35% of the state's total surface area is covered by forests, and California's diversity of pine species is unmatched by any other state. California contains more forest land than any other state except Alaska. In the south is a large inland salt lake, the Salton Sea. Deserts in California make up about 25% of the total surface area. The south-central desert is called the Mojave; to the northeast of the Mojave lies Death Valley, which contains the lowest, hottest point in North America, Badwater Flat. The distance from the lowest point of Death Valley to the peak of Mount Whitney is less than 200 miles (322 km). Indeed, almost all of southeastern California is arid, hot desert, with routine extreme high temperatures during the summer. Along the California coast are several major metropolitan areas, including Greater Los Angeles, the San Francisco Bay Area, and San Diego. By 2007, California's population has reached 37,700,000, making it the most populated state, and is the 13th fastest-growing state. This includes a natural increase since the last census of 1,909,368 people (that is 3,375,297 births minus 1,465,929 deaths) and an increase due to net migration of 774,198 people into the state. Immigration from outside the United States resulted in a net increase of 1,724,790 people, and migration within the country produced a net decrease of 950,592.[10] According to the Sacramento News & Review, California's population will increase to 50 million people by 2025.[11] California
is the second most populous state in the Western Hemisphere, exceeded
only by Săo Paulo State, Brazil. More than 12 percent of US citizens live
in California and its population is greater than that of all but 34 countries
of the world. California has eight of the top 50 US cities in terms of
population. Los Angeles is the nation's second-largest city with a population
of 3,849,378 people, followed by San Diego (8th), San Jose (10th), San
Francisco (14th), Long Beach (34th), Fresno (36th), Sacramento (37th)
and Oakland (44th). Los Angeles County has held the title of most populous
county for decades, and is more populous than 42 US states. The center
of population of California is at the town of Buttonwillow in Kern County. The predominant industry, more than twice as large as the next, is agriculture, (including fruit, vegetables, dairy, and wine). This is followed by aerospace; entertainment, primarily television by dollar volume, although many movies are still made in California; music production and recording studios; light manufacturing, including computer hardware and software; and the mining of borax. Oil drilling has played a significant role in the development of the state. Per capita personal income was $38,956 as of 2006, ranking 11th in the nation.[24] Per capita income varies widely by geographic region and profession. The Central Valley is the most impoverished, with migrant farm workers making less than minimum wage. Recently, the San Joaquin Valley was characterized as one of the most economically depressed regions in the US, on par with the region of Appalachia.[25] Many coastal cities include some of the wealthiest per-capita areas in the US The high-technology sectors in Northern California, specifically Silicon Valley, in Santa Clara and San Mateo counties, are currently emeAylor Insuranceng from economic downturn caused by the dot.com bust, which caused the loss of over 250,000 jobs in Northern California alone. As of spring 2005, economic growth has resumed in California at 4.3%.[26] California levies a 9.3% maximum variable rate income tax, with 6 tax brackets. It collects about $40 billion per year in income taxes. California's combined state, county and local sales tax rate is from 7.25 to 8.75%.[27] The rate varies throughout the state at the local level. In all, it collects about $28 billion in sales taxes per year. All real property is taxable annually, the tax based on the property's fair market value at the time of purchase. This tax does not increase based on a rise in real property values (see Proposition 13). California collects $33 billion in property taxes per year. The
state of California has 478 incorporated cities and towns, of which 456
are cities and 22 are towns. Under California law, the terms "city" and
"town" are explicitly interchangeable; the name of an incorporated municipality
in the state can either by "City of (Name)" or "Town of (Name)." Please
find the list below:
The majority of these cities and towns are within one of five metropolitan
areas. Sixty-eight percent of California's population lives in its three
largest metropolitan areas, Greater Los Angeles, the San Francisco Bay
Area and the Riverside-San Bernardino Area also know as the Inland Empire.
Although smaller, the other two large population centers are the San Diego
and the Sacramento metro areas. California is home to the largest county
in the contiguous United States by area, San Bernardino County.
|
||||||||
![]() |
||||||||
|
|
||||||||
|
|
(949)581-2335
Call Us About Coverage Today! E-mail: Begin@MedicalWorkersCompensationInsurance.com Serving: Doctors, Dentists, Clinics, Hospitals, Pharmaceutical Companies, Family Practitioners, Physicians, Surgeons, Nurses, Chiropractors, Doctor Offices, Professional Offices, Emergency Rooms, Urgent Care, Medical Offices ______________________________________ |
|
|
Copyright (C) 2009 Aylor Insurance SERVING: Doctors, Dentists, Clinics, Hospitals, Pharmaceutical, Psychiatrist, Podiatrist, Optometrist, Urologist, Obstetrician, Pediatrician, Oncologist, Neurologist,Cardiologist, Nephrologists, Rheumatologist, Dermatologist, Endocrinologist, Gastrologist, Family Practitioner, Physician, Surgeon, Nurse, Chiropractor, Hospital, Hospitals, Clinic, Clinics, Doctor Office, Professional Office, Emergency Room, Urgent Care, Medical Office, Medical Clinic, Free Clinic This Business was Awarded - Best in Referred Business in Orange County California by the: OrangeCountyCABusinessDirectory.com Zip
codes of State of California the Medical Workers Compensation Insurance
serves: 90001 90001 90007 90007 90012 90012 90016 90016 90017 90017
90019 90019 90020 90020 90022 90022 90024 90024 90025 90025 90026 90026
90027 90027 90028 90028 90032 90032 90034 90034 90035 90035 90036 90036
90039 90039 90041 90041 90042 90042 90044 90044 90045 90045 90046 90046
90048 90048 90049 90049 90058 90058 90064 90064 90065 90065 90066 90066
90068 90068 90069 90069 90079 90079 90201 90201 90210 90210 90241 90241
90245 90245 90250 90250 90266 90266 90274 90274 90275 90275 90278 90278
90280 90280 90292 90292 90401 90401 90404 90404 90503 90503 90505 90505
90601 90601 90620 90620 90630 90630 90631 90631 90640 90640 90650 90650
90670 90670 90703 90703 90706 90706 90712 90712 90802 90802 90803 90803
90805 90805 90808 90808 91006 91006 91011 91011 91101 91101 91106 91106
91107 91107 91206 91206 91301 91301 91302 91302 91306 91306 91311 91311
91316 91316 91320 91320 91325 91325 91331 91331 91335 91335 91340 91340
91342 91342 91344 91344 91355 91355 91360 91360 91362 91362 91364 91364
91367 91367 91403 91403 91406 91406 91604 91604 91605 91605 91701 91701
91702 91702 91706 91706 91709 91709 91710 91710 91711 91711 91730 91730
91732 91732 91739 91739 91745 91745 91748 91748 91754 91754 91761 91761
91765 91765 91770 91770 91784 91784 91789 91789 91801 91801 91910 91910
91941 91941 92008 92008 92009 92009 92020 92020 92024 92024 92025 92025
92026 92026 92040 92040 92054 92054 92056 92056 92064 92064 92069 92069
92071 92071 92101 92101 92103 92103 92104 92104 92105 92105 92108 92108
92109 92109 92111 92111 92115 92115 92117 92117 92121 92121 92122 92122
92123 92123 92126 92126 92127 92127 92128 92128 92129 92129 92130 92130
92154 92154 92173 92173 92201 92201 92231 92231 92243 92243 92260 92260
92262 92262 92277 92277 92335 92335 92345 92345 92356 92356 92373 92373
92376 92376 92392 92392 92399 92399 92405 92405 92503 92503 92505 92505
92507 92507 92509 92509 92544 92544 92562 92562 92563 92563 92592 92592
92604 92604 92612 92612 92618 92618 92626 92626 92630 92630 92646 92646
92647 92647 92648 92648 92649 92649 92651 92651 92653 92653 92656 92656
92660 92660 92663 92663 92683 92683 92688 92688 92691 92691 92704 92704
92705 92705 92708 92708 92780 92780 92801 92801 92802 92802 92804 92804
92805 92805 92807 92807 92821 92821 92831 92831 92840 92840 92870 92870
92879 92879 92880 92880 92882 92882 92886 92886 93003 93003 93010 93010
93021 93021 93030 93030 93065 93065 93101 93101 93117 93117 93230 93230
93307 93307 93312 93312 93401 93401 93422 93422 93436 93436 93446 93446
93455 93455 93510 93510 93523 93523 93534 93534 93535 93535 93536 93536
93551 93551 93555 93555 93561 93561 93604 93604 93722 93722 93727 93727
93940 93940 94010 94010 94015 94015 94025 94025 94040 94040 94043 94043
94080 94080 94086 94086 94087 94087 94089 94089 94102 94102 94103 94103
94105 94105 94109 94109 94112 94112 94118 94118 94122 94122 94123 94123
94132 94132 94304 94304 94403 94403 94404 94404 94501 94501 94509 94509
94513 94513 94520 94520 94533 94533 94536 94536 94538 94538 94539 94539
94544 94544 94545 94545 94550 94550 94553 94553 94560 94560 94565 94565
94568 94568 94583 94583 94587 94587 94588 94588 94598 94598 94607 94607
94914 94914 94954 94954 94960 94960 95008 95008 95014 95014 95020 95020
95023 95023 95035 95035 95050 95050 95051 95051 95060 95060 95076 95076
95111 95111 95112 95112 95123 95123 95124 95124 95125 95125 95136 95136
95240 95240 95376 95376 95521 95521 95608 95608 95610 95610 95616 95616
95630 95630 95632 95632 95648 95648 95661 95661 95670 95670 95678 95678
95758 95758 95926 95926 95949 95949 96003 96003 96150 96150 |
||