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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 00 00 00 C <br />(Ed. 1-15) <br />insurance or self-insurance. Subject to any limits of <br />liability that may apply, all shares will be equal until <br />the loss is paid. If any insurance or self-insurance <br />is exhausted, the shares of all remaining insurance <br />will be equal until the loss is paid. <br />F. Payments You Must Make <br />You are responsible for any payments in excess of <br />the benefits regularly provided by the workers <br />compensation law including those required <br />because: <br />1. of your serious and willful misconduct; <br />2. you knowingly employ an employee in violation <br />of law; <br />3. you fail to comply with a health or safety law or <br />regulation; or <br />4. you discharge, coerce or otherwise discriminate <br />against any employee in violation of the workers <br />compensation law. <br />If we make any payments in excess of the benefits <br />regularly provided by the workers compensation <br />law on your behalf, you will reimburse us promptly. <br />G. Recovery From Others <br />We have your rights, and the rights of persons <br />entitled to the benefits of this insurance, to recover <br />our payments from anyone liable for the injury. You <br />will do everything necessary to protect those rights <br />for us and to help us enforce them. <br />H. Statutory Provisions <br />These statements apply where they are required by <br />law. <br />1. As between an injured worker and us, we have <br />notice of the injury when you have notice. <br />2. Your default or the bankruptcy or insolvency of <br />you or your estate will not relieve us of our <br />duties under this insurance after an injury <br />occurs. <br />3. We are directly and primarily liable to any <br />person entitled to the benefits payable by this <br />insurance. Those persons may enforce our <br />duties; so may an agency authorized by law. <br />Enforcement may be against us or against you <br />and us. <br />4. Jurisdiction over you is jurisdiction over us for <br />purposes of the workers compensation law. We <br />are bound by decisions against you under that <br />law, subject to the provisions of this policy that <br />are not in conflict with that law. <br />5. This insurance conforms to the parts of the <br />workers compensation law that apply to: <br />a. benefits payable by this insurance; <br />b. special taxes, payments into security or <br />other special funds, and assessments <br />payable by us under that law. <br />6. Terms of this insurance that conflict with the <br />workers compensation law are changed by this <br />statement to conform to that law. <br />Nothing in these paragraphs relieves you of your <br />duties under this policy. <br />PART TWO <br />EMPLOYERS LIABILITY INSURANCE <br />A. How This Insurance Applies <br />This employers liability insurance applies to bodily <br />injury by accident or bodily injury by disease. Bodily <br />injury includes resulting death. <br />1. The bodily injury must arise out of and in the <br />course of the injured employee's employment by <br />you. <br />2. The employment must be necessary or <br />incidental to your work in a state or territory <br />listed in Item 3.A. of the Information Page. <br />3. Bodily injury by accident must occur during the <br />policy period. <br />4. Bodily injury by disease must be caused or <br />aggravated by the conditions of your <br />employment. The employee's last day of last <br />exposure to the conditions causing or <br />aggravating such bodily injury by disease must <br />occur during the policy period. <br />5. If you are sued, the original suit and any related <br />legal actions for damages for bodily injury by <br />accident or by disease must be brought in the <br />United States of America, its territories or <br />possessions, or Canada. <br />B. We Will Pay <br />We will pay all sums that you legally must pay as <br />damages because of bodily injury to your <br />employees, provided the bodily injury is covered by <br />this Employers Liability Insurance. <br />The damages we will pay, where recovery is <br />permitted by law, include damages: <br />1. For which you are liable to a third party by <br />reason of a claim or suit against you by that third <br />party to recover the damages claimed against <br />2 of 6 <br />© Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. <br />HORaN <br />o r <br />RiskManagemerdDivisian <br />REVIEWED & APPROVED BY.- <br />f R. VSA44a <br />Risk Management Analyst <br />