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Coverage Limitations Under Workers' Compensation Insurance

By: Dan Gilbert, ARM, M.B.A.

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This article will briefly consider coverage for claims afforded under the Employers' Liability section of the standard Workers' Compensation policy as well as employment-related claims for which no coverage may be available under the Workers' Compensation policy.

By way of background, the standard Workers' Compensation policy is divided into two parts:

  • Part One provides statutory workers' compensation wage and medical payments coverage without any limit of liability.
  • Part Two provides employers' liability for bodily injury from accident or disease that do not fall under the workers' compensation act subject to a maximum limit.


In return for the payment of workers' compensation premiums, most organizations generally believe they are protected from tort liability civil claims arising from employment-related injuries. However, the "exclusive remedy" of workers' compensation does not always apply. In some cases, employers may be held liable under civil liability statutes for injuries to their employees. Employers' Liability (Part Two) is designed to address such claims.

Examples of claims not covered for statutory workers' compensation benefits under Part One include:

  • Employees excluded from the act (such as domestic employees).
  • Dual capacity claims when an employee alleges an injury arises from a non-work related cause.
  • Suits by a spouse for loss of consortium, companionship or affection.


Coverage for these claims is provided for under the Employers' Liability section (Part Two) of the Workers' Compensation policy. Unlike the unlimited statutory workers' compensation benefits provided under Part One, coverage under the Employers' Liability section is subject to a limit of liability. In placing excess/umbrella, care should be taken to schedule the Workers' Compensation policy as underlying insurance to make certain that the higher limits of the excess liability program apply to Employers' Liability coverage (Part Two).

In addition, organizations should be aware that they might have no coverage under either Part One or Part Two of the Workers' Compensation policy in some situations. More specifically, Florida statutes permit employees to sue their employer when:

  • The employer commits an intentional and deliberate act or engages in conduct that is certain to result in injury or death;
  • An employee sexually harasses another employee;
  • The employer violates provisions, which prohibit firing, coercing or intimidating an employee due to a WC claim;
  • The employer has violated federal law regarding housing and transportation of migrant workers; or
  • The accident is excluded from the WC law (such as mental or nervous injury due to stress without any physical injury).


For the most part, the Workers' Compensation policy provides very broad and comprehensive coverage for employment related injuries and illnesses. However, organizations should be aware of the foregoing restrictions when giving consideration to the development and implementation of HR policies and safety and loss control programs.







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