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