W. Va. Code R. § 85-3-5

Current through Register Vol. XLI, No. 45, November 8, 2024
Section 85-3-5 - Coverage of insuring agreement
5.1. Coverage. -In consideration of the payment of premiums and subject to the limits of liability, exclusions, conditions and other requirements of the policy and is rule, the Commission agrees with the insured:
a. To pay on behalf of the insured, an amount up to the Fund's limit of liability, that is payable by the insured on account of an injury or death to one of its employees, where all five (5) of the following facts are proven:
1. That a specific unsafe working condition existed in the insured's workplace which presented a high degree of risk and a strong probability of serious injury or death;
2 That the insured had a subjective realization and an appreciation of the existence of such specific unsafe working condition and of the high degree of risk and the strong probability of serious injury or death presented by such specific unsafe working condition;
3. That such specific unsafe working condition was a violation of a state or federal safety statute, rule or regulation, whether cited or not, or of a commonly accepted and well-known safety standard within the industry or business of the insured, which statute, rule, regulation or standard was specifically applicable to the particular work and working condition involved, as contrasted with a statute, rule, regulation or standard generally requiring safe workplaces, equipment or working conditions;
4 That notwithstanding the existence of the facts set forth in 5.1.a.1, -2 and -3 of this rule, the insured nevertheless thereafter exposed an employee to such specific unsafe working condition intentionally, and
5. That such employee so exposed suffered serious injury or death as a direct and proximate result of such specific unsafe working condition.
b. That coverage shall apply only to accidents that occur where both (1) the employe is injured while the policy is in effect, and (2) the policy was in effect when the employee was exposed to the above specific unsafe working condition.
c To defend any suit or claim made against the named insured, to the extent the suit or claim alleges liability covered by this policy: Provided, however, That the Commission may make any settlement of the suit or claim as it deems expedient and that the Commission is not obligated to defend any claim or suit after its limit of liability has been exhausted and provided that the Commission shall have sole authority to select defense counsel.

W. Va. Code R. § 85-3-5