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4. liability for any consequence, whether <br />of America necessarily incurred as a direct result <br />direct or indirect, of war, invasion, act of <br />of bodily injury. <br />Foreign enemy, hostilities (whether war <br />Our reimbursement shall be limited as follows: <br />be declared or not), civil war, rebellion, <br />revolution, insurrection or military or <br />1. to the amount by which such expenses <br />usurped power. No endorsement now or <br />exceed the normal cost of returning the <br />subsequently attached to this policy shall <br />officer or employee if in good health, or <br />be construed as overriding or waiving <br />2. in the event of death, to the amount by which <br />this limitation unless specific reference is <br />such expenses exceed the normal cost of <br />made thereto. <br />returning the officer or employee if alive and <br />D. <br />Before We Pay <br />in good health. <br />Before we reimburse you for the benefits to <br />In no event shall our reimbursement exceed the <br />the persons entitled to them, you must have <br />bodily injury by accident limit shown in Item 3.B. <br />them: <br />of the Information Page as respects any one <br />such officer or employee whether dead or alive. <br />1. release you and us, in writing, of all <br />responsibility for the injury or death, <br />H. Endemic Disease <br />2. transfer to us their right to recover from <br />The word "disease" includes any endemic <br />others who may be responsible for their <br />diseases. <br />injury or death, <br />The coverage applies as if endemic diseases <br />3. cooperate with us and do everything <br />were included in the provisions of the workers' <br />necessary to enable us to enforce the <br />compensation law. <br />right to recover from others. <br />5. Longshore and Harbor Workers' Compensation <br />If the persons entitled to the benefits paid fail <br />Act Coverage <br />to do these things, our duty to reimburse <br />General Section C. Workers' Compensation Law <br />ends at once. If they claim damages from us <br />is replaced by the following: <br />for the injury or death, our duty to reimburse <br />C. Workers' Compensation Law <br />ends at once. <br />Workers' Compensation Law means the workers <br />E. <br />Recovery From Others <br />or workers' compensation law and occupational <br />If we make a recovery from others, we will <br />disease law of each state or territory named in <br />keep an amount equal to our expenses of <br />Item 3.A. of the Information Page and the <br />recovery and the benefits we reimbursed. <br />Longshore and Harbor Workers' Compensation <br />We will pay the balance to the persons <br />Act (33 USC Sections 901-950). It includes any <br />entitled to it. If persons entitled to the <br />amendments to those laws that are in effect <br />benefits make a recovery from others, they <br />during the policy period. It does not include any <br />must repay us for the amounts that we have <br />other federal workers or workers' compensation <br />reimbursed you. <br />law, other federal occupational disease law or the <br />F. <br />Reimbursement for Actual Loss <br />provisions of any law that provide <br />Sustained <br />nonoccupational disability benefits. <br />This endorsement provides only for <br />Part Two (Employers' Liability Insurance), C. <br />reimbursement for the loss you actually <br />Exclusions, exclusion 8, does not apply to work <br />sustain. In order for you to recover loss or <br />subject to the Longshore and Harbor Workers' <br />expenses under this reimbursement you <br />Compensation Act. <br />must: <br />This coverage does not apply to work subject to <br />1. actually sustain and pay the loss or <br />the Defense Base Act, the Outer Continental <br />expense in money after trial, or <br />Shelf Lands Act, or the Nonappropriated Fund <br />Instrumentalities Act. <br />2. secure our consent for the payment of <br />the loss or expense. <br />G. <br />Repatriation <br />Our reimbursement includes the additional <br />expenses of repatriation to the United States <br />oR,N F RiskMougementDMsian <br />a� REVIEWED & APPROVED BY. <br />t-I f7Le1J� <br />— J Risk Management Specialist <br />Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) <br />Page 5 of 6 <br />