13.4 Other States, USL&H, and Federal Acts

Three State Schedules

The policy's geography lives in three places on the Information Page:

Part Three: Other States Insurance

Other States Insurance (Part Three) protects an employer that expands into a state it did not anticipate at inception, provided that state is named in Item 3.C. If work begins in a 3.C state, the policy responds as though that state had been listed in 3.A. The key trap: a state listed in neither 3.A nor 3.C is not covered, leaving the employer exposed to direct claims and penalties.

Exam Key: Many employers write "all states except those in 3.A and the monopolistic states" in Item 3.C to avoid an accidental coverage gap.

Monopolistic states cannot be added under Part Three. Operations in Ohio, North Dakota, Washington, or Wyoming must be insured through that state's fund, with stop-gap employers liability added to the CGL (see 13.2).

USL&H: Longshore and Harbor Workers

The Longshore and Harbor Workers' Compensation Act (USL&H) is a federal no-fault system for maritime workers who are not seamen: longshore workers, harbor workers, ship-builders, and ship-repairers injured on navigable waters or adjoining piers, docks, and terminals. Benefits are richer than most state acts. On the standard policy, USL&H exposure is added by the Longshore and Harbor Workers' Compensation Act Coverage Endorsement, WC 00 01 06.

The Negligence-Based Federal Acts

Two federal acts replace no-fault with a negligence lawsuit. The worker must prove the employer's fault, but may then recover pain and suffering that no state no-fault act allows.

Drawing the Maritime Line

The line between the Jones Act and USL&H is a favorite question. A seaman is a member of a vessel's crew with a substantial connection to a vessel in navigation; a seaman is excluded from USL&H and instead uses the Jones Act negligence remedy. A longshore or harbor worker loading, unloading, building, or repairing vessels, but not a crew member, uses no-fault USL&H.

Extensions of USL&H

Several acts extend USL&H principles to special groups, commonly tested as a cluster:

• Defense Base Act (DBA): civilian contractors working on overseas U.S. military bases or public-works contracts.
• Outer Continental Shelf Lands Act: offshore workers (e.g., oil rigs) on the outer continental shelf.
• Nonappropriated Fund Instrumentalities Act: workers at military post exchanges and similar facilities.

The Decisive Test

Exam Key: Coverage is driven by the class of worker, not the location of the accident. A railroad employee hurt in a parking lot is still FELA; a seaman injured on a dock is still Jones Act. Match the worker to the act first, then ask whether the act is no-fault (USL&H, FECA) or negligence-based (FELA, Jones Act).

Other States Insurance and Monopolistic Limits

Part Three - Other States Insurance extends coverage to operations that expand into states listed in Item 3.C of the declarations. The trap is that a state left off both Item 3.A (where coverage is primary) and Item 3.C is uninsured - so the worker's class/origin, not merely the accident location, drives whether coverage exists. Listing all states an employer might enter (or using "all states except..." wording where allowed) prevents a gap.

Monopolistic states (Ohio, North Dakota, Washington, Wyoming) can never be added under Other States Insurance; comp there must be bought from the state fund, and because those funds omit employers liability, the employer adds stop-gap coverage to its CGL. A traveling employee injured in a monopolistic state therefore is not protected by adding that state to Item 3.C.

Federal Workers' Compensation Acts

Several federal acts sit alongside state comp, and the exam contrasts the no-fault ones with the negligence-based ones:

The key distinction: FELA (railroads) and the Jones Act (seamen) require the worker to prove employer negligence, but in exchange the worker can recover pain and suffering unavailable under a no-fault state act. USL&H and FECA are no-fault like state comp.