So Just who is the Insurer?
Posted by defensebaseactcomp on February 14, 2011
Posted by Brit Guy
Below is part of the document issued by the insurers to employers the document is called:
International Voluntary Workers’ Compensation and Employers ‘Liability Coverage Form
Page 10 Part Five Conditions
1. DEFENSE BASE ACT
2. It is understood and agreed that no premium will be charged, and no portion of the rating is for any benefits which may become payable under the provision of the War Hazards Compensation Act and any subsequent amendments or modification thereto. It is understood the United States Government self-insures these exposures and will reimburse the company for any and all losses falling under the act, so long as no charge is made for the coverage by the company.
Link to WHCA http://www.dol.gov/owcp/dlhwc/whca.htm
Let me use my case as an example.
(3) The discharge or explosion of munitions intended for use in connection with a war or armed conflict with a hostile force or person as defined herein
Three investigations have been carried out by the US Government
1. The DoD after the incident
2. The DoL to establish right to benefits
3. The Dept of the Army to establish entitlement to the Defense of Freedom Medal. (Which I have been awarded) You only get this if injured as a direct result of enemy or insurgent action
Three Government agencies have established that the vehicle I was in was hit by a discharge of munitions as an act of war (declared or not) This clearly puts me under the WHCA
If the document above is to be believed then my insurer should be the US Government and the employer/carrier is now an administrator of my case.
The administrator (Employer/carrier) appoint another company to administer the claim i.e. to arrange medical care, make appointments, arrange DME’s. This obviously comes at a price so increases the cost of the claim.
So it would appear that I now have two administrators and one insurer.
The insurer (US Government) at an informal conference arranged by the DoL (A department of the US Government) agree to pay benefits and provide medical care. Administrator one the employer/carrier refuse to comply.
They appoint their legal team again at a cost to fight it and my attorney is forced to file for a formal hearing (again increasing the cost) in front of an ALJ to make the administrator (Employer/carrier) comply with the insurers (US Government) wish’s.
In this time of austerity and the increasing spotlight on government waste around the world it is somewhat staggering that the claimant is forced to take the administrator (Employer/carrier) to court to get what the insurer (US Government) has agreed to pay and that the administrator (Employer/carrier) even if they lose can then go back to the insurer (US Government) ask for their money back and charge 15% for doing so. The cost of this claim could be so much reduced if they just followed the insurers (US Government’s) wish’s.
I am not a legal expert and I am sure that people will argue that what is above is not the case. If you read the documents and the facts of the investigations it is hard to see it in any other way.
One last point if an ALJ agrees with the administrator (employer/carrier) is this the end for me? Well I can only assume not.
Why well because as I have said the insurer (US Government) have agreed to pay.
So as I see it the administrator (Employer/carrier) is going to a formal hearing to argue that they should not be paid.
At last they are doing the right thing.