2017-413-E Aging - Senior Care of Orange County Inc. for adult day health care services

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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) F. Other Insurance 2. The amount you owe has been determined with We will not pay more than our share of damages our consent or by actual trial and final judgment. and costs covered by this insurance and other This insurance does not give anyone the right to add insurance or self-insurance. Subject to any limits of us as a defendant in an action against you to liability that apply, all shares will be equal until the determine your liability. The bankruptcy or insolvency foss is paid. If any insurance or self-insurance is of you or your estate will not relieve us of our exhausted,the shares of all remaining insurance obligations under this Part. and self-insurance will be equal until the loss is paid. G, Limits of Liability PART THREE OTHER STATES INSURANCE Our liability to pay for damages is limited. Our limits A. How This Insurance Applies of liability are shown in Item 3.B. of the Information Page. They apply as explained below. 1. This other states insurance applies only if one or 1 Bodily Injury by Accident. The limit shown for more states are shown in Item 3.C. of the "bodily injury by accident-each accident" is Information Page. the most we will pay for all damages covered 2. If you begin work in any one of those states after by this insurance because of bodily injury to the effective date of this policy and are not one or more employees in any one accident. insured or are not self-insured for such work, all A disease is not bodily injury by accident provisions of the policy will apply as though that unless it results directly from bodily injury by state were listed in Item 3.A. of the Information accident. Page. 2. Bodily Injury by Disease. The limit shown for 3. We will reimburse you for the benefits required by "bodily injury by disease policy limit"is the the workers compensation law of that state if we most we will pay for all damages covered by are not permitted to pay the benefits directly to this insurance and arising out of bodily injury persons entitled to them. by disease, regardless of the number of 4. If you have work on the effective date of this employees who sustain bodily injury by policy in any state not listed in Item 3.A. of the disease. The limit shown for"bodily injury by Information Page, coverage will not be afforded disease-each employee"is the most we will for that state unless we are notified within thirty pay for all damages because of bodily injury by days. disease to any one employee. Bodily injury by disease does not include B. Notice disease that results directly from a bodily injury Tell us at once if you begin work in any state listed in by accident. Item 3.C. of the Information Page. 3. We will not pay any claims for damages after we have paid the applicable limit of our PART FOUR liability under this insurance. YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered H. Recovery From Others by this policy, Your other duties are listed here. We have your rights to recover our payment from anyone liable for an injury covered by this 1. Provide for immediate medical and other insurance.You will do everything necessary to services required by the workers compensation protect those rights for us and to help us enforce law. them. 2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other I. Actions Against Us information we may need. There will be no right of action against us under this 3. Promptly give us all notices, demands and legal insurance unless: papers related to the injury, claim, proceeding or 1. You have complied with all the terms of this suit. policy; and 8 of 24 Ed.1-15 ®Copyright 2013 National Council on Compensation Insurance,Inc,All Rights Reserved.