Workers' Compensation is a “no fault” system. An injured employee does not have to prove the employer was negligent for the accident to be compensated for his or her injury.

The “no fault” aspect of the Workers' Compensation System benefits both the employer and the employee. The employee receives compensation for his or her work related injuries. Even though the employer must compensate their employees for work related injuries the Workers' Compensation system's benefit structure allows the cost of employee injuries to be predictable. When properly applied and managed the Workers' Compensation System is intended to stabilize the workplace and allow a better opportunity for economic growth.

 Workers' Compensation insurance is required by the laws of the State of Utah to protect employees from the adverse effects of disabling injuries and occupational diseases.

The purpose of the Workers' Compensation contract is to insure employers against claims for injuries to their employees that are compensable under compensation acts, for diseases contracted by employees, which are compensable under occupational disease acts and for liability imposed upon them by law for injuries to employees that are not compensable.

 The currently prescribed benefits provided by Workers' Compensation insurance are as follows:

1.  Medical Care: The employee is entitled to all medical and surgical care that may be required to cure or relieve injury, at no cost to the employee.

2.  Temporary Total Disability Benefits: If the employee misses work due to an industrial injury, he may be entitled to compensation for the time missed from work.

3.  Permanent Disability Benefits: A determination is made based on a) degree of disability, b) earnings, c) age, and d) occupation.  This is either made or approved by the State Industrial Accident Commission.

4.   The Death Benefit is paid as an income benefit for the surviving spouse and children. There is a Burial Allowance.

5.  Vocational Rehabilitation Benefits: Certain qualifying employees are eligible for vocational rehabilitation benefits. The goal is to return the injured employee to work. If the injured employee can no longer perform his or her previous duties, and the employer does not provide or offer them a new position, then they may qualify for these benefits.
 

 Workers Compensation Costs – How rates
are determined 
(Eligibility Requirements must be met for this section to apply)

  . . . THE EXPERIENCE MODIFICATION . . .

Experience Modification (ex-mod) is a merit rating system that operates in such a way that past loss experience is a determining factor in present and future Workers' Compensation costs.  It is expressed in terms of a percentage, which is computed under the experience modification formula.  That percentage is then applied to your premium, adjusting it accordingly.

Experience rating begins with a Unit Statistical Filing. Every insurance company must report the individual experience of each policy to the NCCI. The first filing is made 18 months after the inception of the policy. Two additional filings are made at 12-month intervals to reflect any change in open or closed reported claims.

THE RATING PERIOD

A period of three years is used for the rating, beginning four years and 9 months before the rating date. The most recent year is omitted to permit open or late reported claims to close or develop more stable reserves. To simplify, the experience period is the first three of the past four years.  
To be eligible for Experience Rating, the account must develop $7,000 over the Experience Rating period to qualify for experience rating consideration (this eligibility amount is recalculated annually).

Simplified Example:

An Explanation of Workers Compensation Coverage:

Compensable Injury – for an injury to be compensable in must meet the following three criteria:

1).    It must be accidental.

2).     It must arise out of the workers’ employment.

3).     It must arise in the course of the workers employment.

Accidental means that the injury, from the injured employee’s point of view, was not intended to happen (example: an accidental fall versus a conscious jump).

Arising out of the workers’ employment means the workers employment must be the source of the accident (example: injury that takes place at work and not at home unrelated to work).

Arising in the course of employment indicates the need to consider time, place and circumstances when determining whether an injury is compensable. Time is relevant because the injury must occur during the time work is being performed for the purposes of the worker’s employment. Place is relevant because identical injuries can occur at the site of employment, as well as a worker’s residence. Circumstances are relevant because an injury can be compensable even when it does not tale place at a regular employment site or during normal business hours. The measure in this case is that the worker is performing employment duties and the injury would not have otherwise occurred.
 

COVERAGE PART ONE:  This Workers' Compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death.

I.      Bodily injury by accident must occur during the policy period.

II.     Bodily injury by disease must be caused or aggravated by conditions of employment.

The Insurer agrees to assume the liability imposed by the Workers' Compensation law or laws of the state(s) listed in the policy.
 

COVERAGE PART TWO: Employers Liability Insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death.

I.       The bodily injury must arise out of and in the course of the injured employee’s employment by you.

II.      The employment must be necessary or incidental to your work in a state or territory listed in item 3A of the information page.

III.     Bodily injury by accident must occur during the policy period.

This section protects you against liability imposed by law to employees injured in the course of employment that is not compensable under the Workers' Compensation section.  Pays damages for third party over actions; care and loss of services; consequential bodily injury; and dual capacity actions.

Farmers...Gets you back where you belong.

Serving all of the Utah with our office location at
55 West Main Street, Lehi, UT 84043.

Anywhere in the USA call us at (877) 501-8470

Salt Lake County Call (801) 501-8470 
Utah County Call (801) 766-8476

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