Ask PIA

Waivers

Some states permit an uninsured subcontractor, operating as a sole proprietor or partner with no employees, to waive the right to workers’ compensation benefits. Is the waiver provision applicable in New Jersey?

One risk or two?

I have a New Jersey workers’ compensation risk that is two separate corporations under a common ownership. To be specific, it is a retail store that added a deli. The company indicated that I have to write two separate policies. Are they correct?

Sole proprietors and partners

Since sole proprietors and partners have the option to elect workers’ compensation coverage, how does it affect them when acting as a subcontractor? How will this affect jobs with general contractors and certificates of insurance?

Nonprofits’ Joint Insurance Funds for workers’ compensation

There is a certain religious denomination that has decided that all individual churches in New Jersey will get their workers’ compensation under a single policy. Is this arrangement legal?

Definition of employment

A not-for-profit group oriented toward American history maintains a museum for which we have written a workers’ compensation policy in the past. We recently received a request from the group to nonrenew the policy, based on the premise that they no longer have an employee. In discussing it with them, however, we learned there is a couple living on the premises who receive room and board in return for maintaining the museum. If one of them were injured, wouldn’t they have recourse to the museum under the state’s Workers’ Compensation Law?

Calculating payroll—retirees

We insure a business for workers’ compensation. The company has had a profit-sharing plan for more than 30 years. It has an individual who retired from his former position and collects his benefits under the profit-sharing plan but has returned to work as a part-time employee. The insurer is including as remuneration the retirement (profit-sharing) benefits along with the salary he received for the part-time work. Is this correct?

Rating sole-proprietor contractors

It recently came to our attention that an area competitor has been writing minimum-premium “clerical” workers’ compensation policies for sole-proprietor contractors who have no employees, rather than writing the minimum premium policy for the governing class of business they are in. Consequently, the sole proprietor can supply a certificate of insurance to interested parties, while paying the lowest possible deposit premium on the policy.

The manual does not seem to address this situation. What is the proper way the New Jersey Workers’ Compensation Insurance Plan expects producers to rate a sole proprietor (no employees) who is a contractor?

Two corporations, one risk

We insure two corporations. The same person owns and is an executive officer of both. How should we handle this situation for workers’ compensation purposes; that is, should the executive officer remuneration be included in the rating base of both policies?

Injury reporting deadline

Our client’s workers’ compensation carrier is denying a claim for a hernia because it wasn’t reported within 48 hours. Where does it say they can do this?

‘Unlimited’ employers’ liability

I am confused about the limits of liability afforded under Part Two (Employers’ Liability Insurance) in the workers’ compensation policy. Limits for this coverage are stated in the policy, but someone told me that the coverage is really unlimited. Could you please clarify?

Discounts

Is there a maximum discount for workers’ compensation coverage premiums that can be offered to an employer for selecting a managed-care program?

Contested claims

Where does it say that if a workers’ compensation claim is contested, the state’s disability benefits will apply, subject to a lien against the workers’ compensation benefits?

Concurrent employment benefits

An employee has two employers (A and B). The employee was injured while working for employer A. Will compensation for that injury include wages lost from his job with employer B?

Waivers of subrogation

Are “waiver of subrogation” endorsements permitted in New Jersey on workers’ compensation policies?

Portal-to-portal if paid to travel

We have a carpet installer that is “on the clock” from the time he leaves his house through the last job of the day. There was an accident en route to his first job, and the workers’ compensation carrier is denying coverage. They say he is not considered on the job until he arrives at the first job, even though the company is paying him when he leaves his residence. What are the rules?

Volunteer firefighters—other duties

We write a workers’ compensation policy for a volunteer fire department. Because they cannot get a reasonably priced service to cut the grass, they pay volunteer firefighters to mow their lawn. Does the classification need to be amended to reflect this exposure?

Foreign exposures

For clients who have employees traveling outside of the U.S., at what point does coverage cease (i.e., Canada, Mexico, Israel or England)? Is there a solution? Some companies will not provide international coverage. Would I find this answer in the workers’ compensation manual or actual state law?

Stopgap insurance

Could you explain “stopgap” insurance? How is it provided?

Workers’ compensation—Florida domestic employees

We’re not sure where to turn to obtain workers’ compensation for a domestic employee who will be coming into our clients’ Florida home to care for the husband. Their homeowners carrier says we have to go through the Florida state plan. The state plan says it will provide coverage only if there are four or more employees. What should we do?

Bogus workers' compensation plans

One of my commercial insureds has entered into an unconventional arrangement that purports to provide workers' compensation insurance. Its rates are much lower than the insured's classification would warrant. Is this legal?

Covering workers’ compensation exposures in the Virgin Islands

We need to cover a possible workers’ compensation exposure in St. Thomas, Virgin Islands. Does St. Thomas require workers’ compensation and how can I provide it?

Temporary work in Canada

Our client will be doing well drilling in Ontario, Canada. How do I cover the workers’ compensation exposure?

Audit time frames

According to the company, the wrong rates were used to rate workers’ compensation coverage for a construction business back in 2018-2019. In 2021, after a third audit, the company discovered the rate discrepancy. They are just now suing the business for the difference. Can they do this?

Employee vs. independent contractor

All of our producers are incorporated and their corporation has an independent contractor relationship with our agency. We believe these producers should not be rated on our policy because they are not employees of our corporation, but employees of their own corporations; unless, of course, they are not insured by their corporation. Do you agree? If not, please explain why.

Contingent liability for uninsured contractors

A subcontractor’s employee is injured on the job and it is discovered that the subcontractor’s policy is not in force. The general contractor’s policy pays the subcontractor’s employee the workers’ compensation benefits. Can the employee of the subcontractor sue the general contractor for negligence and collect, or is he or she barred by statute because the general contractor now becomes the employer?

Unsafe workplace

Can an employee sue an employer for an unsafe workplace?

Florida traveling salesperson

Our insured is opening a Florida sales office. The salesperson will be based in Florida but traveling 50% of the time. Do you know if a Florida Joint Underwriting Association Workers’ Compensation Policy would cover the salesperson while traveling?

Executive officers workers’ compensation coverage

In New Jersey, can a stockholder of a corporation reject workers’ compensation coverage if only two stockholders own the corporation?

Class change upon audit

Can a carrier add a new class to a workers’ compensation policy upon audit?

Workers’ compensation fines

Can members of a limited liability company or officers of a corporation be held personally responsible for workers’ compensation fines when the employer has failed to comply with the insurance requirements?

Workers’ compensation assessments

My client just received an assessment for his workers’ compensation policy. However, it also appears that there is another assessment included with it for a different program. Is it legal to combine assessments on The Workers’ Compensation and Employers’ Liability Insurance Policy, and can they take action on the policy if it does not get paid?

Form 154 requirements for out-of-state businesses when operating in Massachusetts

What workers’ compensation insurance requirement applies to a business domiciled in another state, but operating in Massachusetts?

Workers’ compensation, balance billing

My client, who is currently out on workers’ compensation leave, has recently started to receive bills from his medical provider in excess of the amount for treatment that the workers’ compensation carrier has already paid. Is this an accepted practice? Does my client have to pay the amounts the provider is billing him for?

Contractor lending money for purchase of workers’ compensation coverage

A client of ours is a contractor who works with a number of subcontractors. For various reasons, he is strongly encouraging these subcontractors to carry their own workers’ compensation insurance. Because of the cost involved, many cannot purchase the coverage up front. Accordingly, the contractor has offered to loan the subcontractors the money for the policies, to be repaid later. Is this OK?

Workers’ compensation—unpaid premium on a previous policy

I understand that you can’t place business in the New Jersey Workers’ Compensation Plan if money is owed to the Plan, but what if they are insured with a voluntary carrier and they owe money to the voluntary carrier? Can they be placed with the Plan?

Occupational Safety and Health Administration—COVID-19  

Are COVID-19 illnesses recordable to OSHA?

Overtime wages on workers’ compensation premiums

How should my client calculate overtime wages when it comes to workers’ compensation premiums?