§ 22-3-5-5 — Policy provisions; failure to pay claims

Indiana § 22-3-5-5

• Jurisdiction: Indiana
• Art. 3: WORKER'S COMPENSATION SYSTEM
• Ch. 5: Worker's Compensation: Insurance Requirements

Text

(a) No insurer shall enter into or issue any policy
of insurance under IC 22-3-2 through IC 22-3-6 until its policy form
shall have been submitted to and approved by the department of
insurance.
(b) All policies of insurance companies and of reciprocal insurance
associations insuring the payment of compensation under IC 22-3-2
through IC 22-3-6 are conclusively presumed to cover all the
employees and the entire compensation liability of the insured. Any
provision in any policy attempting to limit or modify the liability of the
company or association issuing the same shall be wholly void.
(c) Every policy of any such company or association is deemed to
include the following provisions and any change in the policy which
may be required by any statute enacted after May 21, 1929, as fully as
if they were written in the policy:
(1) Except as provided in section 5.5 of this chapter, the insurer
hereby assumes in full all the obligations to pay physician's fees,
nurse's charges, hospital services, hospital supplies, burial
expenses, compensation, or death benefits imposed upon or
accepted by the insured under the provisions of IC 22-3-2 through
IC 22-3-6.
(2) This policy is made subject to IC 22-3-2 through IC 22-3-6
relative to the liability of the insured to pay physician's fees,
nurse's charges, hospital services, hospital supplies, burial
expenses, compensation, or death benefits to and for the
employees, the acceptance of such liability by the insured, the
adjustment, trial, and adjudication of claims for such physician's
fees, nurse's charges, hospital services, hospital supplies, burial
expenses, compensation, or death benefits, and the liability of the
insurer to pay the same are and shall be a part of this policy
contract as fully and completely as if written in this policy.
(3) As between this insurer and the employee, notice to or
knowledge of the occurrence of the injury on the part of the
insured (the employer) shall be notice or knowledge thereof, on
the part of the insurer. The jurisdiction of the insured (the
employer) for the purpose of IC 22-3-2 through IC 22-3-6 shall be
the jurisdiction of this insurer. This insurer shall in all things be
bound by and shall be subject to the awards, judgments, and
decrees rendered against the insured (the employer) under IC 22-3-2 through IC 22-3-6.
(4) This insurer will promptly pay to the person entitled to the
same all benefits conferred by IC 22-3-2 through IC 22-3-6,
including physician's fees, nurse's charges, hospital services,
hospital supplies, burial expenses, and all installments of
compensation or death benefits that may be awarded or agreed
upon under IC 22-3-2 through IC 22-3-6. The obligation of this
insurer shall not be affected by any default of the insured (the
employer) after the injury or by any default in giving of any notice
required by this policy, or otherwise. This policy is a direct
promise by this insurer to the person entitled to physician's fees,
nurse's charges, fees for hospital services, charges for hospital
supplies, charges for burial compensation, or death benefits, and
shall be enforceable in the name of the person.
(5) Any termination of this policy by cancellation shall not be
effective as to employees of the insured covered hereby unless at
least ten (10) days prior to the taking effect of such cancellation,
a written notice giving the date upon which such termination is to
become effective has been received by the worker's compensation
board of Indiana at its office in Indianapolis, Indiana.
(6) This policy shall automatically expire one (1) year from the
effective date of the policy unless:
(A) the policy covers a period of three (3) years, in which event,
it shall automatically expire three (3) years from the effective
date of the policy;
(B) the policy is issued as a continuous policy, in which event
it shall not expire until terminated by the insured or the insurer
in accord with applicable state law and applicable policy
provisions; or
(C) the policy covers a period permitted in bureau rules under
IC 27-7-2-20.
The termination of a policy, as provided in this subdivision, shall
be effective as to the employees of the insured covered by the
policy.
(d) All claims for compensation, nurse's charges, hospital services,
hospital supplies, physician's fees, or burial expenses may be made
directly against either the employer or the insurer or both, and the
award of the worker's compensation board may be made against either
the employer or the insurer or both. If any insurer shall fail or refuse to
pay final award or judgment (except during the pendency of an appeal)
rendered against it, or its insured, or, if it shall fail or refuse to comply
with any provision of IC 22-3-2 through IC 22-3-6, the board shall not
accept any further proofs of insurance from it until it shall have paid
the award or judgment or complied with the violated provision of IC 22-3-2 through IC 22-3-6.
Formerly: Acts 1929, c.172, s.72; Acts 1943, c.247, s.1; Acts
1959, c.371, s.1; Acts 1961, c.242, s.1. As amended by P.L.144-1986,
SEC.53; P.L.28-1988, SEC.46; P.L.3-1989, SEC.133; P.L.249-1989,
SEC.18; P.L.170-1991, SEC.14; P.L.1-1994, SEC.109; P.L.116-1994,
SEC.2; P.L.2-1995, SEC.83; P.L.217-1995, SEC.1; P.L.275-2013,
SEC.9.