Workers Comp Insurance Contract

Workers Comp Insurance Contract

This Workers Comp Insurance Contract (the Agreement) is made and entered into as of by and between:

Employer Name:

Employer Address:

Insurer Name:

Insurer Address:

WHEREAS

WHEREAS, Employer conducts a business that employs workers who may be exposed to occupational injuries or illnesses; and

WHEREAS, Insurer is duly licensed to underwrite workers compensation and employers liability insurance and desires to provide coverage to Employer on the terms set forth herein; and

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows.

Scope of Work and Coverage

Coverage Provided: The Insurer shall provide workers compensation insurance and employers liability coverage for Employer's operations described above, including statutory benefits required by applicable law and employers liability limits not less than per occurrence.

Payment Terms

Premium Amount: Employer agrees to pay the initial premium in the amount of payable as set forth below.

Late Fee: Any payment not received within days of its due date shall incur a late fee equal to the lesser of per month or .

Term and Termination

Term Commencement Date:

Term Expiration Date:

Termination for Cause: Either party may terminate this Agreement for material breach by the other party if such breach is not cured within days after written notice.

Termination for Convenience: Either party may terminate this Agreement without cause upon providing days' prior written notice to the other party.

Confidentiality

Definition: "Confidential Information" means non-public information disclosed by either party that is identified as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure.

Obligations: The receiving party shall (a) hold Confidential Information in strict confidence, (b) not disclose Confidential Information to any third party except employees, agents, or professional advisors who have a need to know and who are bound by confidentiality obligations, and (c) use Confidential Information solely for performance under this Agreement. The receiving party shall exercise at least the same degree of care in protecting Confidential Information as it uses with respect to its own confidential information, but in no event less than reasonable care.

Exceptions: Confidential Information does not include information that (i) is or becomes generally available to the public other than through breach of this Agreement, (ii) was rightfully in the receiving party's possession prior to disclosure by the disclosing party, or (iii) is independently developed by the receiving party without use of the disclosing party's Confidential Information.

Duration: The confidentiality obligations in this section shall survive termination or expiration of this Agreement for a period of unless a longer period is required by applicable law.

Claims Handling and Cooperation

Claims Notification: Employer shall notify Insurer promptly of any workplace injury or claim that may be covered under this Agreement and shall provide all information reasonably requested by Insurer to process claims.

Cooperation: Employer shall cooperate with Insurer in the investigation, defense, and settlement of claims, including providing access to records and witnesses. Failure to cooperate may be a basis for denial of coverage to the extent such failure prejudices Insurer.

Representations and Warranties

Each party represents and warrants that it has full power and authority to enter into this Agreement and to perform its obligations. Employer warrants that all statements and payroll information provided to Insurer are true and complete and shall promptly notify Insurer of any material change in payroll, operations, or classification.

Indemnification

Employer shall indemnify and hold harmless Insurer from and against any third-party claims arising from Employer's willful misconduct, fraud, or failure to comply with statutory obligations, except to the extent such claims are covered by the policy issued by Insurer under this Agreement.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict of laws principles.

Entire Agreement

This Agreement, including any schedules, endorsements, and policy documents expressly incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, and communications, whether written or oral.

Amendment; Waiver

No amendment or waiver of any provision of this Agreement shall be effective unless in writing and signed by duly authorized representatives of both parties. No failure or delay by either party in exercising any right shall operate as a waiver of that right.

Notices

Miscellaneous Provisions

Severability: If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect and the parties shall negotiate in good faith a substitute provision that best effectuates the parties' original intent.

Assignment: Neither party may assign this Agreement or any rights hereunder without the prior written consent of the other party, except that Insurer may assign to an affiliated entity or successor insurer without Employer's consent.

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