TACO Workers Comp Option Program
TACO would like to introduce to you an "option" for Workers Compensation. Provided by GHS Property & Casualty; it's a chance to actually save money! GHS is a division of Health Care Services Corp., and an Independent Licensee of Blue Cross/Blue Shield. Only one agent, Bill Crawford, of Crawford Insurance Agency will be authorized to write a policy with the special rate for TACO,.
The State of Texas does not require an employer to provide Worker's Compensation Insurance. However, whether you have 2 employees or 30, or you are the only employee, you should take a serious look at the policy that is being offered exclusively to TACO Members within Texas only. Click here to see what TACO members are saying and what they have saved.
RV Parks that sell propane are confronted with issues of workman's compensation at the time of licensing or renewal. In the past an RRC Agent would demand that you obtain workman's compensation before they issue you an operator's license. That was at one time the rule. However, on November 12, 2007, the Texas Administrative Code, Title 16, Part 1, Chapt. 14, Subchapt. A, Sub Para. (h) RULE 14.2031 "Insurance Requirements" was amended to read as follows:
(h) – Notwithstanding the requirements specified in Table 1 of subsection (a) of this section that each licensee carry a policy of worker's compensation insurance, (as amended) – " the licensee may protect its employees by obtaining accident and health insurance coverage from an insurance company authorized to write such policies in Texas as an alternative to worker's compensation coverage." The alternative coverage shall be in the amounts specified in Table 1 of subsection (a) of this section. Click here for more information.
The Employer selects the combined benefit amount, combined benefit period and combined deductible that tailors the policy to the needs of their business.
The Combined Benefit amount selected by the employer is the maximum amount payable for all benefits to a covered employee in any one occupational accident.
The Combined deductible Amount is applied once per occurrence, per insured, before any benefits are paid.
When an accidental injury occurs, the Occupational Accident Policy pays the cost of covered charges up to the Combined Benefit Amount.
Note: The employer selects the Combined Benefit Amount.
Covered charges must be the direct result of a covered accidental injury.
The first covered charges must occur within 30 days of the accident and all covered charges must be incurred within the selected Combined Benefit Period.
Covered charges must be medically necessary and usual and customary for such services in the geographic area where the services were preformed.
If an employee's coverage terminates, because the employee terminates employment or the policy is terminated, coverage will be extended for covered charges that result from an injury that occurred before the date of termination. Coverage for the extension of benefits will be limited to the lesser of payment of the Combined Benefit Amount or payment for the Combined Benefit Period.
This Occupational Accident policy meets the needs of responsible employers who desire coverage from a stable and respected insurance company. It is designed for employers who choose not to subscribe to Workers' Compensation and is an affordable alternative to going without coverage for occupational accidents.
Accident Medical Expense
Weekly Accident Disability
Rehabilitation Benefits
Accidental Death and Dismemberment to $150,000
Combined Destructible starting at $500
12, 27, or 36-month Benefit Period
Combined Benefit Amounts from $100,000 to $6,000,000
*The employer agrees to make modified duty available for partially disabled employees able to return to some form of work as agreed to by the employee's treating physician
When an employee is injured and is totally disabled, the policy pays the scheduled benefits up to the maximum Combined Benefits Amount.
Note: The employer selects the Combined Benefit Amount.
The disability must start within 1 year of the date of the accident and the employee must be totally disabled and under the regular and continuous care and treatment of a doctor.
After the seven-day elimination period, the policy will reimburse you 75% if the injured employee's weekly wage up to $700. the benefit will be paid each week during the Combined Benefit Period. (The amount paid may be offset by other disability policies that may be in force at the time of the accident.)
For a partial week of disability, the policy will pay one-seventh of the benefit for each day the employee is disabled, after the elimination period.
Benefits will ne be paid beyond:
A. The maximum number of weeks selected.
B. The death of the employee.
C. The date the employee no longer qualifies and totally and continuously disabled.
D. The date the employee returns to work.
Upon approval by GHS property & Casualty (GHS), an injured employee must maintain a totally disabled status and still work up to 20 hours a week*.
The employee receives a weekly payment to supplement lost earnings.
Benefits will be payable for an initial three-month period while such status continues.
Benefits may be extended for additional three-month periods, up to a maximum of 12 months in any one period of total and continuous disability.
When an employee suffers any one of the losses listed in the chart, he or she will recieve the applicable benefit.
Note: The employer selects the combined Benefit Amount.
A loss must occur within the Combined Benefit Period selected and coverage must be in force under policy for the employee at the time of the accident.
The amount payable for the Accidental Loss of Life is guaranteed to be no less than 15% of the AD&D Benefit Amount, regardless of the total amount paid for other benefits.
The employer is responsible for all premium payments.
100% of all part-time and full-time employees must participate.
Premiums are due monthly on the premium due date. For premiums not paid when due there is a 31-day grace period. If premiums have not been paid by the end of the grace period, insurance under the policy shall terminate on the due date.
Aggregate Limit of Liability - Ten million dollars, which is the maximum amount GHS will pay for any one common accident regardless of the number of employees involved.
Base Annual Earnings - the amount of compensating paid to an employee, including overtime and commissions. for commissioned employees, Base Annual Earnings shall be the average annual earnings over the three year period immediately preceding the date of loss. for commissioned employees with less than three years history, average monthly earnings will be calculated and multiplied by twelve to calculate Base Annual Earnings.
Elimination Period - the number of days after a coerced accidental bodily injury has been suffered and the employee is totally and continuously disabled, but for which no disability benefits are payable.
Total and Continuous Disability means during the first 24 moths, the employee is not able to perform any of the material and substantial duties of the employee's regular occupation which he or she held when the disability began. After 24 months of disability an any-occupation definition will apply. Benefits will not be paid when the employee is not under the continuous care of a physician.
Act of Terrorism - means an activity that:
1. Is an unlawful or threaten use of force, violence, chemicals, biological weapons, technology, or any other act of aggression against persons or property; or
2. Appears to be intended to:
A) Intimidate or coerce a civilian population, or
B) Influence the policy of a government or segment thereof by intimidation or coercion.
in furtherance of ideological, political, social or religious objectives.
Coverage for losses resulting from Acts of Terrorism is limited to $200,000 per incident.
Any loss cause by or resulting from the following are not covered under the provisions of the Occupational Accident Policy.
Suicide or any attempt at suicide or intentionally self-inflicted injury, while sane or insane.
Committing or attempting to commit an assault of felony.
War or any act of war, whether decaled or undeclared.
Disease, bodily or mental infirmity, or medical or surgical treatment for any of these.
Participation in the armed forces of any country.
Participation in a riot, rebellion or insurrection or any act incident to any of these (as used in this exclusion: "Participation" means to take an active part in common with others; and "Riot" means any use of or the threat to use force or violence by three or more persons without the authority of law).
With regard to aircraft, the policy shall not cover:
a. Boarding, alighting from, or being on any aircraft owned, operated or leased by you, the employee or a member of the employee's household.
b. Riding as a pilot, operator or crew member in any aircraft;
c. Flying in any aircraft which is rocket propelled;
d. Flying in any aircraft being used for aerobatics, racing or an endurance test;
e. Crop dusting, seeding fertilizing, or spraying, fighting a fire, any exploration or powering patrol the pursuit of animinals or birds, aerial photography, banner towing or skywriting or any test or experimental cause;
f. Flying when a special permit, or waiver from the proper authority has not been issued.
Any accidental bodily injury that occurs while an employee has been determined to be legally intoxicated, under the influence of any alcohol, narcotic, barbiturate or hallucinogen unless administered on the advise of a physician and taken in accordance with the prescribed dosages. An injured employee may be subject to drug testing at an approved facility at the time of the accident.
Travel to and from work.
A condition for which treatment or advice was received within the 6-month period just prior to the effective date of insurance. this exclusion will not apply fter the employee has been )A free from treatment for 6 consecutive months; or B) covered for this benefit for 12 consecutive months.
Nuclear incidents or radioactive contamination.
Note: For a complete list of exclusions, limitations and coverage conditions, please refer to your policy.
