13.4 Other States, USL&H, and Federal Acts

Coverage Beyond the Home State

Part One covers only the states listed in Item 3.A of the Information Page. But real businesses cross state lines, and certain workers fall under federal law rather than any state WC statute. This section covers the three big extensions the exam tests: Other States Insurance, the USL&H Act, and the other major federal acts and the endorsements that add them.

Other States Insurance (Item 3.C)

Other States Insurance is Part Three of the policy, triggered by listing states in Item 3.C of the Information Page. It extends Part One benefits to operations the insured begins during the policy term in a state listed in 3.C, providing seamless coverage before the insured can request a new 3.A endorsement.

• A state listed in 3.A is primary coverage that applies from day one of the policy.
• A state listed in 3.C is picked up automatically the moment the insured starts work there mid-term, so a contractor expanding into a neighboring state is protected immediately.
• A monopolistic-fund state can never be listed in 3.A or 3.C, because the private policy is not sold there; coverage must come from that state's fund.
• To maximize protection an insured often lists "all states except [the monopolistic states and any state of domicile not already in 3.A]" in 3.C. The critical trap: if the insured operates in a state that appears in neither 3.A nor 3.C, there may be no coverage for benefits owed to a worker injured there, leaving the employer exposed to the full statutory liability.

Monopolistic Fund States

A handful of states require employers to buy workers compensation only from a state-operated fund; private WC policies are not available. The current exam outline commonly tests these as North Dakota, Ohio, Washington, and Wyoming (Puerto Rico and the U.S. Virgin Islands are also monopolistic).

In these jurisdictions the standard policy's Part One is unavailable, but the state fund typically does not provide employers liability (tort) protection. To fill that gap, employers buy Stop Gap (employers liability) coverage by endorsement on their commercial general liability (CGL) policy. Memorize the pairing: monopolistic state → state fund for benefits + Stop Gap on the CGL for employers liability.

USL&H — U.S. Longshore and Harbor Workers Compensation Act

The USL&H Act is a federal no-fault law covering maritime workers injured on the navigable waters of the United States and the adjoining piers, docks, wharves, and loading/unloading areas. Covered persons include longshoremen, harbor workers, ship repairers, shipbuilders, and ship-breakers who are not members of a vessel's crew. Because it is a federal benefit scale, USL&H benefits are typically higher than ordinary state WC benefits, and coverage is not automatically included in the standard policy.

• Add coverage with the Longshore and Harbor Workers Compensation Act Coverage Endorsement (WC 00 01 06).
• The endorsement amends Part One so the policy will pay USL&H benefits for the described maritime work; because it is no-fault, it belongs on the Part One side.

The Jones Act

The Jones Act (Merchant Marine Act of 1920) covers a member of the crew of a vessel, a "seaman." Unlike USL&H, the Jones Act is not a no-fault system: it gives the seaman a negligence cause of action against the employer, similar to FELA. Because the exposure is fault-based liability, Jones Act coverage is added under Part Two (Employers Liability) through the Maritime Coverage Endorsement, not under Part One. The endorsement also addresses related general-maritime remedies such as maintenance and cure and unseaworthiness.

FELA — Federal Employers Liability Act

The FELA covers interstate railroad workers. Like the Jones Act, FELA is fault-based: the injured railroad worker must prove the employer's negligence, though the burden is relaxed (a "featherweight" causation standard). FELA exposure is added by a Federal Employers Liability Act endorsement that operates on the Part Two (employers liability) side, since it is a tort recovery rather than a statutory benefit.

Other Federal Acts (Recognition Level)

Quick Exam Discrimination

Use the keyword in the question stem to choose the act:

• "Seaman" or "crew of a vessel" → Jones Act (Part Two, Maritime Coverage Endorsement, fault-based).
• Dockworker, longshoreman, ship repairer on navigable waters → USL&H (Part One endorsement WC 00 01 06, no-fault).
• Railroad worker → FELA (Part Two, negligence-based).
• Coal miner with lung disease → Federal Black Lung.

The single distinction that resolves most questions is crew member vs. shore-side maritime worker: crew goes to the Jones Act, everyone else on the docks goes to USL&H.