18 Del. Admin. Code § 801-5.0
Attachments:
Deductible Endorsement - Delaware
In consideration of the reduced premium charged for this policy, the insurance afforded by the policy for death benefits and for medical benefits payable under the Delaware Workers' Compensation Law applies only to death and medical reimbursement benefits in excess of the deductible amount shown below. The deductible shall apply separately to each accident, regardless of the number of people who sustain injury by such accident.
The company shall pay the deductible amount to the persons entitled thereto. Upon notice of payments by the company, the insured will promptly reimburse the company for any amounts so paid. Failure of the insured to reimburse the company, within 30 days of statement mailing date, may result in the coverage being cancelled pro rata upon ten (10) days written notice and any resulting return premium may be applied to the deductible amount due.
The deductible amount is ________________________ for each occurrence.
The premium is reduced _____________________% in consideration of this deductible.
Note 1: Use this Endorsement with the standard policy to provide a death and medical benefits deductible selected in accordance with 19 Del.C. § 2372.
Note 2: The company may use its own attachment clause and method of execution.
Delaware Insurance Form B
Notice of Election to Accept or Reject an Insurance Deductible for Delaware Workers' Compensation Death and Medical Benefits
Delaware law permits an employer to buy workers' compensation insurance with a deductible. The deductible is for death and medical benefits and applies to each accident. The deductibles available and the corresponding premium reductions are as follows:
| Deductible Per Accident | Percent Premium Reduction |
| $500 | 4.0 |
| 1,000 | 5.5 |
| 1,500 | 6.5 |
| 2,000 | 7.0 |
| 2,500 | 7.5 |
| 3,000 | 8.0 |
| 3,500 | 8.5 |
| 4,000 | 9.0 |
| 4,500 | 9.5 |
| 5,000 | 10.0 |
You are not required to choose a deductible program. However, if you do so choose, it is to be understood that your insurance company will administer and pay all claims and that you will reimburse the insurance company for payments it makes within the amount of the deductible selected. Failure to reimburse the insurance company for such deductible amounts within 30 days can result in cancellation of coverage.
Please show whether or not you want the deductible by initialing the appropriate choice below.
_____________ Yes, I want a deductible of _____________ applied to death and medical benefits under the Delaware workers' Compensation law. I understand that the company shall pay the deductible amount and be reimbursed by the employer shown below.
_____________ No, I do not want the deductible described in this Notice.
I understand that in accordance with 19 Del.C. § 2372, I have the option of modifying the above deductible program choice at the time of renewal of my workers' compensation insurance policy with the insurance company named below.
_____________ __________________________________________________
Date Employer
__________________________________________________
Name
__________________________________________________
Title
__________________________________________________
Insurance Company
DELAWARE INSURANCE FORM B
18 Del. Admin. Code § 801-5.0