Employers Liability Insurance Form

Information page form wc 00 00 01 b.

Employers liability insurance form. Employers liability insurance proposal form for office use only account code insured code u r warranties endorsements other instructions policy no please complete this proposal with clear capital letters and mark with the appropriate boxes a. Employers liability insurance is also called part 2 of a workers compensation policy. This is the equivalent of the declarations page in other lines of insurance. The following insuring agreements and exclusions are added to section i coverages of the commercial general liability coverage form.

Travel insurance property owners liability medical expenses insurance employers liability insurance summary of cover 1. In most states the standard workers compensation and employers liability policy published by the national council on compensation insurance ncci is the required policy form. Particulars of proposing employer full name of proposer. If any communication relating to this accident is received from or on behalf of the injured employee please pass it to us unacknowledged without delay.

Separate from the workers comp component employers liability insurance provides legal protection for the business. Employer s liability coverage helps pay for lawsuits over employee injuries. Both lawsuits protect business owners from employee lawsuits which can cost your business more than 125 000 however epli is a separate insurance policy that protects your business from allegations of employment. Employers agreeing to and officially signing a liability claim form enforces their financial security and legal protection.

If an employer intentionally causes an employee to receive a job related injury the liability insurance will not cover those expenses and the employee may file a lawsuit against the employer. Employers liability covers the cost of lawsuits involving employees who are injured at work or suffer an occupational illness. Workers comp policy parts. Employers liability claim form with reference to your recent notification of an accident to an employee please complete and return this form to the address shown above as soon as possible.

The basic workers compensation and employers liability insurance policy has two parts. It contains the name of the insurance company providing the coverage as well as the named insured its mailing address other workplaces and the form of business. These lawsuits are often filed by employees family relatives and even other 3rd parties. Employer s liability insurance covers employers against liability claims from their employees from accidents or ill health that they may suffer whilst working and that are due to negligence of their employers.