Frank Martinez Thought He Was Fully Insured... The Policy Exclusion Proved Otherwise.
Most Workers’ Compensation policyholders never realize how specific policy language can affect their policies — until they learn how it can affect a claim. My Policy Advocate™ helps you understand your coverage before you need it.
Apex's Remote Work Ambiguity*
Apex Office Solutions had a remote workforce. When an employee, Sarah, broke her wrist tripping over her dog while taking a break in her home kitchen, she filed a claim. The insurer denied the claim, arguing that the “personal risk” of stepping away from the workspace falls outside the “arising out of and in the course of employment” requirement.
Potential Denial (The Ambiguity):
The definition of “workplace” and what constitutes an accident “arising out of employment” is highly ambiguous and varies by US state for remote workers.
Risk Identified by My Policy Advocate:
“Workplace” location ambiguity and “arising out of employment” standards; highly variable by US state.
Policy Language:
“Applies to bodily injury by accident… arising out of and in the course of employment by the Insured.”
Discovery by Clara, our Ai Assistant:
Clara highlights the lack of clarity regarding WFH breaks and non-work-related home activities, prompting review of state-specific legal standards.
Questions to Ask Your Agent:
- Will my policy cover injuries during WFH breaks?
- What additional documentation or remote safety protocols does my state require to establish work-relatedness?
* This scenario described is fictious and is solely for illustrative or educational purposes so the insured has the opportunity to discuss these issues with their licensed insurance producer.
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