13.4 Other States, USL&H, and Federal Acts

Where the Policy Applies: Item 3.A vs. 3.C

The Information Page of the WC policy controls geography:

Other States Coverage matters when a worker travels or temporarily works outside the home state. If Item 3.C lists "all states except those in 3.A and the monopolistic states," the policy automatically covers a new state the moment work begins there — paying benefits under that state's law.

Trap: A state where the employer was already operating at inception but that appears in neither 3.A nor 3.C is uninsured. Item 3.C protects future expansion, not an existing gap.

Reading the Information Page Items

The whole geography question turns on a handful of numbered items:

Exam Key: A state must appear in 3.A or 3.C for the policy to respond there.

Monopolistic States and Stop Gap

In the four monopolistic states — Ohio, North Dakota, Washington, Wyoming — private WC insurance is prohibited; employers buy Coverage A directly from the state fund. The fund sells statutory benefits only, never employers liability.

Because the fund gives no Coverage B, the employer adds stop gap employers liability as an endorsement to its Commercial General Liability (CGL) policy. Other States Coverage (Item 3.C) cannot reach a monopolistic state — the employer must buy from the fund and add stop gap on the CGL.

The Four Federal Acts

Four federal systems override state comp for specific occupations. Two are no-fault; two are negligence suits. The type of worker — not the accident location — controls.

Exam Key: Only the two negligence acts (Jones Act, FELA) allow pain-and-suffering recovery; the two no-fault acts (USL&H, FECA) pay a benefit schedule like state comp.

USL&H in Detail

The USL&H Act covers longshore workers, harbor workers, ship builders/repairers/breakers, and workers on or adjoining navigable U.S. waters (piers, wharves, dry docks, terminals). It excludes seamen and crew (Jones Act) and certain small-vessel, clerical, and recreational workers.

• Benefits: no-fault, structured like state comp, tied to the national average weekly wage with a statutory maximum, administered by the U.S. DOL Office of Workers' Compensation Programs
• How it attaches: the Longshore and Harbor Workers' Compensation Act Coverage Endorsement, WC 00 01 06, added to the WC policy
• Dual jurisdiction: in some coastal states a single waterfront injury supports a claim under both USL&H and state comp; the worker cannot double-recover but may choose the better forum
• OCSLA: the Outer Continental Shelf Lands Act extends USL&H to workers on fixed offshore drilling platforms

Jones Act vs. USL&H are mutually exclusive: a "master or member of the crew of any vessel" falls under the Jones Act, never USL&H. A worker fits one or the other, not both.

Decision Map for the Exam

Work through worker type first, then geography:

1. Railroad worker? → FELA (prove negligence)
2. Seaman / crew of a vessel? → Jones Act (prove negligence)
3. Longshore / harbor / ship repair on navigable waters? → USL&H (no-fault, WC 00 01 06)
4. Federal civilian employee? → FECA
5. Otherwise a state worker traveling out of state? → Other States Coverage if the state is in Item 3.C and not monopolistic; if monopolistic, buy from the state fund plus stop gap on the CGL.

Exam Key: Other States Insurance is purely a convenience for non-monopolistic states — the four state-fund jurisdictions can never be added through Item 3.C.

Why Other States Coverage Matters

Without Item 3.C, an employer that opens a new branch in a previously unlisted state would have no coverage there until it amended the policy — a dangerous gap if a worker is hurt on the first day. Other States Insurance closes that timing gap: the moment operations begin in a 3.C state, full statutory coverage springs up under that state's law, and the carrier picks up the new exposure at audit.

This is why brokers commonly write Item 3.C as "all states except those in Item 3.A and the monopolistic states." That phrasing leaves only the four fund states uninsured by the WC policy, which is correct because private carriers cannot write them anyway. A worker who lives in a 3.A state but is temporarily injured in a 3.C state is paid under the state where the injury occurred, not the home state — a frequent fact-pattern twist. Remember the contrast with the Jones Act and FELA, where coverage follows the worker's occupation regardless of where the policy lists states.

Dual Jurisdiction and OCSLA in Practice

In coastal dual-jurisdiction states, a single waterfront injury can support claims under both USL&H and the state act. The worker cannot collect twice for the same loss, but may pursue the more generous forum, and a credit prevents double recovery. Carriers writing waterfront risks therefore attach WC 00 01 06 so the federal exposure is insured alongside the state coverage.

The Outer Continental Shelf Lands Act (OCSLA) extends USL&H benefits to workers injured on fixed offshore platforms (oil and gas rigs anchored to the seabed). Contrast this with crew aboard a mobile vessel, who are seamen under the Jones Act. The seabed-versus-vessel distinction is exactly the kind of detail the national exam uses to separate the four federal acts — always classify by the worker's actual role and worksite, never by the general industry.