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4. Bodily injury by accident must occur <br />keep an amount equal to our expenses of <br />during the policy period. <br />recovery and the benefits we paid. We will <br />5. Bodily injury by disease must be caused <br />pay the balance to the persons entitled to it. If <br />or aggravated by the conditions of the <br />the persons entitled to the benefits of this <br />officer's or employee's employment. The <br />insurance make a recovery from others, they <br />officer's or employee's last day of last <br />must reimburse us for the benefits we paid <br />exposure to the conditions causing or <br />them. <br />aggravating such bodily injury by disease <br />F. Employers' Liability Insurance <br />must occur during the policy period. <br />Part Two (Employers' Liability Insurance) <br />B. We Will Pay <br />applies to bodily injury covered by this <br />We will pay an amount equal to the benefits <br />endorsement as though the State of <br />that would be required of you as if you and <br />Employment was shown in Item 3.A. of the <br />your employees were subject to the workers' <br />Information Page. <br />compensation law of any state shown in Item <br />This provision 6. does not apply in New Jersey or <br />3.A. of the Information Page. We will pay <br />Wisconsin. <br />those amounts to the persons who would be <br />EMPLOYERS' LIABILITY STOP GAP COVERAGE <br />entitled to them under the law. <br />7. Employers' Liability Stop Gap Coverage <br />C. Exclusion <br />A. This coverage only applies in Montana, North <br />This insurance does not cover: <br />Dakota, Ohio, Washington, West Virginia and <br />1. any obligation imposed by workers' <br />Wyoming. <br />compensation or occupational disease law <br />B. Part One (Workers' Compensation Insurance) <br />or any similar law. <br />does not apply to work in states shown in <br />2. bodily injury intentionally caused or <br />Paragraph A above. <br />aggravated by you. <br />C. Part Two (Employers' Liability Insurance) <br />3. officers or employees who have elected <br />applies in the states, shown in Paragraph A., <br />not to be subject to the state workers' <br />as though they were shown in Item 3.A. of the <br />compensation law. <br />Information Page. <br />4. partners or sole proprietors not covered <br />D. Part Two, Section C. Exclusions is changed <br />under the Standard Sole Proprietors, <br />by adding these exclusions. <br />Partners, Officers and Others Coverage <br />This insurance does not cover; <br />Endorsement. <br />5. bodily injury intentionally caused or <br />D. Before We Pay <br />aggravated by you or in Ohio bodily injury <br />Before we pay benefits to the persons entitled <br />resulting from an act which is determined <br />to them, they must: <br />by an Ohio court of law to have been <br />1. Release you and us, in writing, of all <br />committed by you with the belief than an <br />responsibility for the injury or death. <br />injury is substantially certain to occur. <br />However, the cost of defending such <br />2. Transfer to us their right to recover from <br />claims or suits in Ohio is covered. <br />others who may be responsible for the <br />injury or death. <br />13. bodily injury sustained by any member of <br />the flying crew of any aircraft. <br />3. Cooperate with us and do everything <br />necessary to enable us to enforce the right <br />14. any claim for bodily injury with respect to <br />to recover from others. <br />which you are deprived of any defense or <br />defenses or are otherwise subject to <br />If the persons entitled to the benefits of this <br />penalty because of default in premium <br />insurance fail to do those things, our duty to <br />under the provisions of the workers' <br />pay ends at once. If they claim damages from <br />compensation law or laws of a state <br />you or from us for the injury or death, our duty <br />shown in Paragraph A. <br />to pay ends at once. <br />E. This insurance applies to damages for which <br />E. Recovery From Others <br />you are liable under West Virginia Code Annot. <br />If we make a recovery from others, we will <br />S 23-4-2. <br />Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) <br />o Nye RiskMwaganadDMsian <br />z <br />REVIEWED & APPROVED BY.- <br />-��" Risk Management Analyst <br />