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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C <br /> (Ed. 1-15) <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> In return for the payment of the premium and PART ONE <br /> subject to all terms of this policy, we agree with you WORKERS COMPENSATION INSURANCE <br /> as follows: A. How This Insurance Applies <br /> GENERAL SECTION This workers compensation insurance applies to <br /> A. The Policy bodily injury by accident or bodily injury by disease. <br /> Bodily injury includes resulting death. <br /> This policy includes at its effective date the <br /> Information Page and all endorsements and Bodily injury by accident must occur during the <br /> schedules listed there. It is a contract of insurance policy period. <br /> between you (the employer named in Item 1 of the 2. Bodily injury by disease must be caused or <br /> Information Page)and us(the insurer named on the aggravated by the conditions of your <br /> Information Page). The only agreements relating to employment. The employee's last day of last <br /> this insurance are stated in this policy. The terms of exposure to the conditions causing or aggravating <br /> this policy may not be changed or waived except such bodily injury by disease must occur during <br /> by endorsement issued by us to be part of this the policy period. <br /> policy. <br /> B. We Will Pay <br /> B. Who is Insured We will pay promptly when due the benefits required <br /> You are insured if you are an employer named in of you by the workers compensation law. <br /> Item 1 of the Information Page. If that employer is a <br /> partnership, and if you are one of its partners, you C.We Will Defend <br /> are insured, but only in your capacity as an We have the right and duty to defend at our expense <br /> em-ployer of the partnership's employees. any claim, proceeding or suit against you for benefits <br /> C. Workers Compensation Law payable by this insurance.We have the right to <br /> investigate and settle these claims, proceedings or <br /> Workers Compensation Law means the workers or suits. <br /> workmen's compensation law and occupational We have no duty to defend a claim, proceeding or <br /> disease law of each state or territory named in Item suit that is not covered by this insurance. <br /> 3.A. of the Information Page. It includes any <br /> amendments to that law which are in effect during D.We Will Also Pay <br /> the policy period. It does not include any federal We will also pay these costs, in addition to other <br /> workers or workmen's compensation law, any federal amounts payable under this insurance, as part of any <br /> occupational disease law or the provisions of any claim, proceeding or suit we defend: <br /> law that provide nonoccupational disability benefits. <br /> 1. reasonable expenses incurred at our request, but <br /> D. State <br /> not loss of earnings; <br /> State means any state of the United States of <br /> America, and the District of Columbia. 2. premiums for bonds to release attachments and <br /> for appeal bonds in bond amounts up to the <br /> amount payable under this insurance; <br /> E. Locations 3. litigation costs taxed against you; <br /> This policy covers all of your workplaces listed in 4. interest on a judgment as required by law until <br /> Items 1 or 4 of the Information Page; and it covers we offer the amount due under this insurance; <br /> all other workplaces in Item 3.A. states unless you and <br /> have other insurance or are self-insured for such <br /> workplaces. 5. expenses we incur. <br /> E. Other Insurance <br /> We will not pay more than our share of benefits and <br /> costs covered by this insurance and other <br /> 5 of 24 <br /> Ed.1-15 <br /> ©Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. <br />