GLOSSARY

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A

Accident: shall mean an unexpected, unforseen and unanticipated event that occurs at a specificlly identifiable time and place during the course and scope of employment, and in the furtherance of business of the Employer, and that may or may not result in a Participant'snjury. (USSIC-Policy)

Accident: means an event that: 1. was sudden, unforseen, unplanned and unespected; 2. occurred at a specifically identifiable time and place; 3. occurred by chance; 4. was independent of all other causes, and resulted in physical Bodily Injury to a Covered Person; 5. arose out of the Covered Person's Scope of Employment, and 6. occurred while the policy was effective.(CEM-Policy)

Accident: An event which is unforseen, uinintended, unplanned and occurs by chance resulting: (a) in bodily Injury to an Insured; and (b) direcly and independently from all other causes. The Injury must be directly caused by the Accident and not a result of disease or bodily infirmity. (Union Central-Policy)

Accident: means a sudden and unforseen event causing loss or injury, which is not due to any fault or misconduct of the Insured, is independent of all other causes and occurs while the Insured is Actively at Work. (Tex-Flex-Policy)

Accident: means an external event which is violent, unforseen, unintended, inplanned, and occurs by chance.(TAPP-Policy)

Accident or Accidental: An event that (1) was unintended, unanticipated, unforeseen, unplanned and unexpected by you; (2) occurred at a specifically identifiable time and place; (3) occurred by chance or from unknown causes; (4) directly (independent of sickness, disease, mental incapacity, bodily infirmity or any other cause) resulted in physical Injury to a Covered Person: (5) arose out of the Covered Person's Scope of Employment; and (6) occurred during the Policy Period. (Lexington-Policy)

Accidental Bodily Injury: An injury suffered by the Insured while Actively at Work that is the direct result of an Accident when such Injury is involuntary and is direct and independent of all other causes. (The Peak-Policy)

Accumulation Period: The maximum period of time, as shown on the Schedule of Benefits, in which Covered Charges under the Accident Medical and Dental Expense Benefit Must be incurred. (GAPP-1-Policy)

Active Service: means a Covered Person is either 1) actively at work performing all regular duties on a full-time basis either at his or her employer's place of business or someplace the employer requires him or her to be; or 2) actively at work performing restricted or modified duty work at the direction of the Employer in the course of his or her Scope of Employment. (ACE-Policy)

Actively At Work: An employee will be considered Actively At Work only if he performs, for a full normal workday, the regular duties of his employment at the Participating Employer's regular place of business or at another location to which he may be required to travel to perform the duties of his employment with the Participating Employer. (Union Central-Policy)

Actively At Work: means the employee is: (1) working for his employer on a permanent basis; and (2) performing the material and substantial duties of the employee's regular job at either the employer's usual place of bsoness or at a location to which the employer requires the Insured to travel. (TAPP-Policy)

Actively At Work or Active Work: The Insured must be: 1. Working for you on a permanent Basis; and 2. Performing the material and substantial duties of the Insured's regular job: a. At Your usual place of business; or b. at a location to which Your business requires the Insured to travel; or c. while traveling between Your usual place of business and a location to which Your business requires the Insured to travel. (The Peak-Policy)

Administrator: The Company that is servicing the Group Policy on our behalf by performing such functions as certificate issuance, billing, collecting, payment of commissions and claims. (Union Central-Policy)

Aggregate Limit: The maximum dollar amount stated on the Schedule of Benefits that will be paid by us for all Occurrences during the Policy Period. (Aegis-Policy)

Aggregate Limit of Liability Per Accident: For all coverage under the Group Policy for a Participating Employer, the Aggregate Limit of Liability Per Accident is the amount shown in the Schedule of Coverage. This amount applies to all benefits combined, which are payable under the Group Policy to all insured employees of a Participating Employer who sustain Occupational Injuries as the result of any one Accident. If the Aggregate Limit of Liability Per Accident payable for all Insureds of a Participating Employer cannot pay the full amount of each claim, the amount of each claim will be paid in the same portion that it has to the Aggregate Limit of Liability Per Accident. (Union Central-Policy)

Ambulatory Surgical Center: any public or private establishment which: (1) has an organized medical staff; (2) has permanent facilities that are equipped and operated mainly for the purpose of performing surgical procedures; (3) prvides continuous services of Physicians and registered nurses; and (4) does not provide services or accommodations for patients to stay overnight. (Union Central-Policy)

Ambulatory Surgical Center: An institution or facility, either free standing or as part of a Hospital with permanent facilities, equipped and operated for the primary purpose of performing surgical procedures and to which a patient is admitted to and discharged from within a twenty-four (24) hour period. An office maintained by a Physician for the practice of medicine or dentistry, or for the primary purpose of performing terminations of pregnancy, shall not he considered to be considered to be an Ambulatory Surgical Center. (The Peak-Policy)

Application: The form(s) you filled out, or which were filled out on your behalf, to request coverage under the Policy, including but not limited to the Application for Employer's Primary Indemnity Coverage and the Fax-a-Quote. (Lexington-Policy)

Appropriate Care: means the determination of an accurate and medically supported diagnosis and on going medical treatment and care of the Employee's condition or Disability by a Doctor that conforms to a generally-accepted medical standards, including frequency of treatment and care.(ACE-Policy)

Average Weekly Income: The earnings that are calculated by dividing the Participant's Base Annual Earnings by 52 (or the number of weeks that the Participant has worked if less than 52). (USSIC–ERISA)

Average Weekly Wage: means an Employee's annual Base Earnings divided by fifty Two (52) (ACE-Policy)

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B

Base Earnings: means an Employee's annual wage or salary as reported by the Policyholder and shown on the state employment tax rolls for work performed for the Policyholder as in effect just prior to the date of the Covered Loss. For commissioned Employees, Base Earnings shall be the aveage annual earnings over the most recent three (3) year period or the period of employment with the Policyholder if shorter, immeciately preceding the Covered Loss. For hourly Employees, Base Earnings means an Employee's earnings as reported by the Policyholder for work performed for the 12 months immediately prior to the date of the Covered Loss. If the Employee was not employed by the Policyholder for the full 12 months. Base Earnings means the Employee's average monthly earnings from the employer for the months employed times twelve. It does not include amounts received for bonus, commissions, overtime pay or other extra compensation. (ACE-Policy)

Base Salary: means a combinaation of the Insured's regular annual pay at the time of loss and, if aplicable, an average annual amount of additional compensation (commissions, bonuses, overtime and any other compensation ultimately reported as income to the Internal Recenue Service), which the Insured has received. For Salaried employees, as defined on the Schedule of Benefits, regular annual pay is the Insured's actual salary for a 12-month period. For Non-Salaried employees, as defined on the Schedule of Benefits, who have worked for more than one year, regular annual pay is the total amount of earnings, excluding additional compensation, which the Insured has received in the previous 12 months. For Non-Salaried employees who have worked for less than one year, regyular annual pay is the amount actually earned by the Emoloyee, excluding additional compensation, since the date of hire. For all Insured's, average annual amounts of additional compensation will be calculated based on length of employment. If the Insured has been employed by the Policyholder for three or more years prior to the date of loss, all additional compensation paid over the prior three years will be averaged in order to determine an average annual amount of additional compensation. If the Insured has been employed by the Policyholder for less than three years prior to the date of loss, an average annual amount of additional compensation will be calculated by determining the total amount of additional compensation paid to the Insured since the date of hire. That amount will then be divided by the period of weeks beginning with the date of hire and ending with the lase week the insured worked and then myultiplying that number by 52.(TAPP-Policy)

Base Annual Salary: The amount of compensation to a Covered Person, including overtime, tips and commission as reported to the Internal Revenue Service. For Covered Persons receiving payment by commission, Base Annual Salary shall be the annual earnings over the three-year period immediately preceding the date of loss. For Covered Persons receiving payment by commission that have less than a three year employment history with you, average monthly earnings will be calculated and multiplied by 12 to calculate the Base Annual Salary. The maximum Base Annual Salary that we will recognize for coverage under this Policy is $60,000, regardless of whether a Covered Person has a Base Annual Salary in excess of this sum. (Lexington-Policy)

Base Annual Salary: means the amount of compensation to a Covered Person, including overtime, tips and commissions but excluding the extra pay increment for overtime as reported to the Internal Revenue Service. For Covered Persons receiving compensation who have less than a three (3) year employment history with you, average monthly compensation will be calculaed and multiplied by twelve(12) to calculate the Base Annual Salary. (CEM-Policy)

Base Annual Earnings: a. The amount of compensation to a Covered Person, excluding overtime, bonuses and commissions for the most recent fifty-two (52) weeks prior to the Occurrence (or the annualized compensation, excluding overtime, bonuses, and commissions, for the entire period of employment, if employed less than fifty-two (52) weeks). For commissioned Employees, Base Annual Earnings shall be the average annual earnings over the most recent three (3) year period or period of employment with you, whichever is shorter, immediately preceding the Occurrence; and b. One-third of the annual or annualized total compensation paid by Policyholder for transportation services to an "Owner Operator." (Aegis-Policy)

Base Annual Earnings: means the amont of compensation to an employee, including overtime, tips and commissions. For commissioned employees, Base Annual Earnings shall be the average annual earnings over the three (3) year period immediately preceding the date of loss; for commissioned employees with less than three years history an average monthly earning will be calculated and multiplied by twelve to calculate Base Annual Salary. (Tex-Flex-Policy)

Base Weekly Earnings: Is the Amount of weekly compensation to an Insured, excluding overtime, tips, bonuses and/or commissions. If an Insured is compensated on an hourly basis, Basic Weekly Earnings will be determined by multiplying his hourly wage by 40 hours. If an Insured is compensated on a monthly wage basis, Basic Weekly Earnings will be determined by dividing his monthly wage by 4.33. If an Insured is compensated on an annual salary basis, Basic Weekly Earnings will be determined by dividing his annual wage by 52 weeks. For Insureds who are on commission, Basic Weekly Earnings shall be the average basic weekly earnings with the Participating Employer over the past three years; for Insureds who are on commission who have less than three years service with the Participating Employer, the average basic weekly earnings will be calculated by dividing his annual salary with the Participating Employer by 52 weeks. If employed with the Participating Employer less than one year, the average weekly earnings will be based upon the number of weeks worked. In the absence of credible salary information, the salary determined shall not exceed the National Industry Average, as defined. (Union Central-Policy)

Beneficiary: The person to whom loss of Life Benefits will be paid. (The Peak-Policy)

Beneficiary: means the person designated by the Insured, as on file with Us, to whom loss of life benefits will be paid.(TAPP-Policy)

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Benefit Waiting Period: means the period of time an Employee must be continuously temporarily Disabled before Weekly Disability Benefits may be reimbursed. The Benefit Waiting Period is shown in the Schedule of Benefits. (ACE-Policy)

Bodily Injury: means an identifiable physical Bodily Injury, including resulting death, suffered by a Covered Person, that is the direct result of an Occurrence which occurs during the Policy period. Bodily Injury does not include Occupational Disease or Cumulative Trauma unless it results directly from an Occurrence. (CEM-Policy)

Bodily Injury or Injury: A physical Bodily Injury to a Covered Person which: (1) is sustained solely through external, violent and Accidental means; (2) directly (independent of sickness, disease, mental incapacity, bodily infirmity or any cause) causes a covered loss; (3) occurs while the Covered Person is covered under this Policy; and (4) occurs within his or her Scope of Employment or while performing an alternative occupation at the request and direction of the Named Insured. (Lexington-Policy)

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C

Chiropractic Care: Chiropractic Care only if prescribed by a designated Provider. (Lexington-Policy)

Chiropractic Care: means chiropractic treatment or therapy provided by a person appropriately licensed to provide chiropractic services, who is not also a member of the Employee's Immediate Family or household. (ACE-Policy)

Claims Administrator: The Claims Administrator shown in the Declarations. (Lexington-Policy)

Class: A class of persons the Policyholder has selected to be eligible for coverage under this Policy. Class(es) are shown in the application for this Policy. (Fidelity Security-Policy)

Closely Related Person: The Insured, the Insured's spouse, child, grandchild, brother, sister or parent or his spouse's child, grandchild, brother, sister or parent. For the purposes of this insurance, "Closely Related Person" includes the Participating Employer, the Insured's spouse's employer and any employee of such employer. (Union Central-Policy)

Code: The Internal Revenue Code of 1986, as amended from time to time. Reference to any section of the Code shall include any successor provision thereto. (USSIC- ERISA)

Combined Amount: means the Combined Amount shown on the Declarations. It is the most We will reimburse You for payments made to any one Covered Person whether reimbursements are made unde one or more or all coverages provided by this Policy. The Combined Amount per any one Occurrence is the most We will reimburse for the amounts paid to all Covered Persons whose Bodily Injury is the direct result of any one Occurrence whether reimbursements are made under one or more or all coverages provided by this Policy. (CEM-Policy)

Combined Benefit Amount: is the maximum benefit payable to or on behalf of the Policyholder, Insured or the Insured's Beneficiary for Accidental Death and Dismemberment, Accidental Medical Expense and Weekly Accident Indemnity per Accident, subject to the terms limitations and restrictions of the Policy. The Maximum Combbined Benefit Amount is shown on Schedule I.(Tex-Flex-Policy)

Combined Benefit Amount: The maximum benefit payable to or on behalf of the Policyholder, Insured if the Insured's Beneficiary for Accidental Death and Dismemberment, Accidental Medical Expense and weekly Accident Indemnity per Accident, subject to the terms, limitations and restrictions of the Policy. The Maximum Combined Benefit Amount is shown on Schedule 1. (The Peak-Policy)

Combined Benefit Period: means that amount of time within which benefits must become payable to or on behalf of a Policyholder, Insured or Insured's Beneficiary. The benefit period begins on the date the Accidental Bodily Injury occurred. A seperate Combined Benefit Period will start for each Accidental Bodily Injury. (Tex-Flex-Policy)

Combined Benefit Period: means the period of time as stated on the Declarations within which paymentss must become reimbursable on behalf of a Covered Person. The Combined Benefit Period begins on the date of Occurrence.(CEM-Policy)

Combined Coverage Limit – Accident: The maximum benefit amount payable to the Participant (or on his behalf) for Accidental Death & Dismemberment, Medical Expense, and Wage Replacement for each Accident or Occurrence, subject to the terms, limitations and restrictions of the Plan. The Combined Coverage Limit amount is shown in the Schedule of Benefit Coverage. (USSIC – ERISA)

Combined Coverage Limit – Disease: The maximum benefit amount payable to the Participant (or on his behalf) for Accidental Death & Dismemberment, Medical Expense, and Wage Replacement for Occupational Disease or Cumulative Trauma for each Accident or Occurrence, subject to the terms, limitations and restrictions of the Plan. The Combined Coverage Limit amount is shown in the Schedule of Benefit Coverage. (USSIC – ERISA)

Combined Coverage Period: The period of time within which payments must become reimbursable on behalf of a Covered Person. The coverage period begins on the date the Bodily Injury occurred. A separate Combined Coverage Period will start for each Bodily Injury. (Lexington-Policy)

Combined Deductible Amount: The Covered Charges that must be paid for each Insured for each covered Accidental Bodily Injury before benefits are payable under this Policy. (The Peak-Policy)

Combined Single Limit: The maximum amount reimbursable on behalf of a Covered Person for all losses paid for each Accident or Occurrence subject to the terms, limitations and restrictions of the Policy. The maximum Combined Single Limit is shown in the Declarations. (Lexington-Policy)

Commutation: All claims reimbursable under this policy, shall be commuted 36 months after the end of the policy period. The claim listing you provide must include all pertinent information necessary to arrive at a valuation of all reimbursable claims. The claim listing you supply will be discounted net worth of all reimbursable claims. We will pay you the discounted net worth of each claim that is in excess of the deductible, subject to our limit of liability, within 30 days of receipt from the actuary or appraiser. If the actuary or appraiser cannot be agreed upon by both you and us, each will appoint its own actuary or appraiser who will, in turn, appoint an independent actuary or appraiser who will establish the discounted net worth of each reimbursable claim. We will pay you the discounted net worth if each reimbursable claim that is in excess of the deductible, subject to our limit of liability within 30 days of receipt from the independent actuary or appraiser. If the actuary or appraiser cannot be agreed upon by both you and us, each will appoint its own actuary or appraiser who will, in turn, appoint an independent actuary or appraiser who will establish the discounted net worth of each reimbursable claim. We will pay you the discounted net worth if each reimbursable claim that is in excess of the deductible, subject to our limit of liability within 30 days of receipt from the independent actuary or appraiser. (USSIC-Policy)

Contract Labor Census Form: A form acceptable to Us on which the Policyholder must list any Eligible Person not shown on the TWC Tax Employer's Quarterly Report (Form C-3) filed with the Texas Workforce Commission. (GAPP-1-Policy)

Contractor: A party that enters into agreement, by written contract or otherwise, to provide services to, or on behalf of, the Policyholder. (GAPP-I-Policy)

Convalescent Nursing Facility: An institution or distinct part thereof, operated pursuant to law and one which meets all of the following conditions: A. It is licensed to provide, and is engaged in providing, on an inpatient basis, for persons convalescing from an injury, professional nursing services rendered by a Nurse to assist patients to reach a degree of body functioning to permit self-care in essential daily living activities; B. Its services are provided for compensation from its patients and under the full-time supervision of a Physician or Nurse; C. It provides twenty-four (24) hour per day nursing services by licensed Nurses, under the direction of a full-time nurse; D. It maintains a complete medical record on each patient; E. It has an effective utilization review plan; F. It is not, other than incidentally, a place for rest, the aged, drug addicts, alcoholics, mental retardates, custodial or educational care, or care of mental disorders; and G. It is approved and licensed by Medicare. This term shall apply to expenses incurred in an institution referring to itself as a Skilled Nrsing Facility, Extended Care Facility, Convalescent Nursing Home, or any such other similar nomenclature.(The Peak-Policy)

Convalescent Period: means a period of time commencing with the date of confinement by an Insured to a Convalescent Nursing Facility. Such confinement must meet all of the following conditions: A. Such confinement must commence within fourteen (14) days of being discharged from a Hospital; B. Said Hospital confinement must have been for a period of not less than three (3) consecutive dates; and C. Both the hospital and convalescent confinements must have been for the care and treatment of the same injury. A convalescent Period will terminate when the Insured has been free of confinement in any and all institutions providing Hospital or nursing care for a period of ninety (90) consecutive days. A new Convalescent Period shall not commence until a previous Convalescent Period has terminated.(Tex-Flex-Policy)

Coverage Period: The period of time within which benefits are payable to Participants. The coverage period begins on the date the Injury occurred or disease diagnosis is made. A separate Coverage Period will start for each Injury or disease diagnosis. (USSIC – ERISA)

Cosmetic Procedure: A procedure performed solely for the improvement of an Insured's appearance rather than for the improvement or restoration of bodily functions. (The Peak-Policy)

Course and Scope of Employment: An activity of any kind or character that has to do with and originates in the work, business, trade, or profession of the Insured and that is performed by an Employee while engaged in or about the furtherance of the affairs or business of the Insured. The term includes an activity conducted on the premises of the Insured or at other locations. The term does not include: A. transportation to and from the place of employment unless: (1) the transportation is furnished as a part of the contract of employment or is paid for by the Insured: (2) the means of the transportation are under the control of the Insured; or (3) the Employee is directed in the Employee's employment to proceed from one place to another place; or B. travel by the Employee in the furtherance of the affairs or business of the Insured if the travel is also in furtherance of personal or private affairs of the Employee unless; (1) the travel to the place of the Accident would have been made even had there been no personal or private affairs of the employee to be furthered by the travel; and (2) the travel would not have been made had there been no affairs or business of the Insured to be furthered by the travel. (GAPP-II-Policy)

Covered Accident: means an Accident that occurs during the Policy Term while coverage is in force for a Covered Person and that results in a loss or Injury covered by the Policy for which benefits are payable.(ACE-Policy)

Covered Charges: Charges actually incurred by the Insured for inpatient or outpatient medical care and treatments. (The Peak-Policy)

Covered Class(es): The class of Covered Persons you have defined to be eligible for coverage under this Policy. The Covered Class(es) are shown by Classification Codes in the Declarations. (Lexington-Policy)

Covered Class(es): The Class(es) of Employees you have defined to be eligible for coverage under this Policy. The Covered Class(es) are shown on Schedule 1. (The Peak-Policy)

Covered Expense: means expenses actually incurred by or on behalf of a Covered Person for treatment, services and supplies covered by the Policy. An Eligible Medical Expense is deemed to be incurred on the date such treatment, service or supply, that gave rise to the expense or the charge, was rendered or obtained. (ACE-Policy)

Covered Loss or Covered Losses: means an accidental death, dismemberment or other Injury covered under the Policy. (ACE-Policy)


Covered Occurrence:
means an Accident or series of Accidents arising out of one event or incident occurring during the Policy Term in the Employee's Scope of Employment with the Policyholder that result in his or her Occupational Injury. The date of a Covered Occurrrence for an Occupational Injury is the date of an Accident or the date of the first in a series of Accidents.(ACE-Policy)

Covered Person: A person who is employed in your regular business and receives his or her pay on a regular basis by means of a salary or wage directly from you. Covered Person does not include an independent contractor or third-party agent. (Lexington-Policy)

Covered Person: means a person who at the time of each Occurrence, is employed in Your regular business of, is under the direction and control of, and receives his pay on a regular basis by means of a salary, commission or wage directly from the Named Insured. Covered Person does not include an independent contractor or third-party agent. Covered Person includes only those persons who, at the direction of the Named Insured, work in Texas in the regular business of the Named Insured, including those Covered Persons working temporarily outside the state of Texas, but under the direction and control of, and in the regular business of, the Named Insured. (CEM-Policy)

Covered Person: means an Employee who is covered under the Policyholder's Plan and at the time of the Covered Occurrence, is employed by the Policyholder in the Policyholder's regular business and receives his or her pay on a regular basis by means of salary or wage directly from the Policyholder. Covered Person does not include an independent contractor or third-party agent.(ACE-Policy)

Crew Member: Any person who has any duties aboard an aircraft. (GAPP-1-Policy)

Cumulative Trauma: an injury that fulfills all of the following conditions: (a) it is not traceable to a definite compensable accident occurring during the employee's present or past employment; (b) it has occurred from, and has been aggravated by, a repetitive employment-related activity; and (c) it has resulted in a disability or death. (Union Central-Policy)

Cumulative Trauma: Injury to a Covered Person, occurring within his or her Scope of Employment, and which is caused by the combined effect of repetitive physical activities extending over a period of time. (Lexington-Policy)

Cumulative Trauma: shall mean the damage to the physical structure of a Participant which results from repititous, physically traumatic activity in the course and scope of the Participant's performance of the duties of his/her usual occupation, and independent of all other causes. In order to be covered, a Cumulative Trauma must manifest itself and be diagnosed while this Plan is in effect as to the Participant. (USSIC-Policy)

Cumulative Trauma: means damage to the physical structrre of the Covered Person occurring as a result of repetitious, physically traumatic activities that occur in the Scope of Employment while this Pilicy is in force, and independent of all other causes. (CEM-Policy)

Cumulative Trauma: an injury that fulills all of the following conditions:(a) it is not traceable to a definite compensable accident occuring during the employee's present or past employment;(b) it has occurred from, and has been aggravated by, a repetitive employment-related activity; and (c) it has resulted in a disability.(Union Central-Policy)

Cumulative Trauma: means damage to the physical structure of the Insureds body resulting from repetitious physically traumatic activities that occur solely while the Insured is performing the duties of his or her regular job. Cumulative Trauma includes repetitive motion disorders, overuse disorders and Carpal Tunnel Syndrome. It does not include Injury resulting from an Accident or Occupational Disease. (Tex-Flex-Policy)

Cumulative Trauma: means Injury to a Covered Person, occurring within his or her scope of Employment, and which is caused by the combined effect of repetitious, physically traumatic activities extending over a period of time. Cumulative Trauma excludes Occupational Injury. (ACE-Policy)

Custodial Care: Care which is administered for assistance (rather than for training or education) of the patient in performing the activities of daily living. Such activities include, but are not limited to, walking, getting in and out of bed, personal hygiene, feeding, preparing special diets and administering medication. Custodial Care also includes non-acute care for comatose, semi-comatose, paralyzed, of mentally incompetent patient. (The Peak-Policy)

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D

Deductible: means the dollar amount shown in the Policy Declarations that tthe Policyholder must pay before we will reimburse/pay any benefits under the Policy. We will not reimburse/pay for sums that do not exceed the Deductible amount. (ACE-Policy)

Deductible: The dollar amount, as shown in the Declarations, that you must pay before we will reimburse you. We will not reimburse you for sums that do not exceed the Deductible amount. (Lexington-Policy)

Deductible: means, for the Accident Medical & Dental Expense Benefit, the total amount of Covered Charges incurred for a covered loss by an Insured, as shown on the Schedule of Benefits, that will not be reimbursed under this Policy. For the Accidental Death and Dismemberment Benefit and the Accident Weekly Indemnity Benefit, and when coverage is provided to an Insured on a Combined Single Benefit basis, as shown on the Schedule of Benefits, the Deductible means the amount that will be withheld only one time for any one Injury from whichever benefits are payable due to that Injury.(TAPP-Policy)

Deductible Amount Per Insured Per Accident: This amount is shown in the Schedule of Coverage. It applies to each Insured before benefits are payable for any Occupational Injury, Covered Expenses must add up to the Deductible Amount Per Insured Per Accident before We pay any benefits under the Group Policy. (Union Central-Policy)

Disabled or Disability: (1) Permanent Partial Disability; (2) Permanent Total Disability; (3) Temporary Partial Disability; and (4) Temporary Total Disability. (Lexington-Policy)

Disability: means a medically demonstrable anatomical or physiological abnormality that causes a covered Person to be absent from his place of employment and prevents him from performing essential acts and duties of his regular occupation. 1. Temporary Total Disability occurs if it a. causes the Covered Person to be under the continuous care of a Physician: and b. causes the Covered Person to be unable to perform the essential duties of his own occupation. 2. Permanent Total Disability occurs if it: a. causes the Covered Person to be under the continuous care of a Physician; and b. causes the Covered Person to be unable to perform the duties of any occupation for which he is or may become reasonably fitted by education, training or experience. (CEM-Policy)

Disability Benefit Period: The maximum period for which Temporary Disability benefits may be paid by us. The Disability Benefit Period is stated on the Schedule of Benefits. (Aegis-Policy)

Disability Coverage Period: is the maximum period that Disability Benefits may be paid by Us for any one Occupational Injury. It is shown on the Schedule of Benefits.(ACE-Policy)

Disease: A condition that is a pronounced deviation from the normal health state or normal pregnancy of the Covered Person. (Aegis-Policy)

Disease: means a condition marked by a pronounced deviation from the normal healthy state of an Employee that is first diagnosed or treated by a Doctor while the Policy is in force with regard to the person whose sickness is the basis of a claim.(ACE-Policy)

Dispatch: The time during which the "Owner Operator" or employee of an "Owner Operator" is engaged in the performance of any activity that has to do with such person's work providing transportation services under contract of hire with the Policyholder, including while operating the vehicle transporting for the Policyholder, while en route to picking up a load for Policyholder, or loading or unloading a load for Policyholder. (Aegis-Policy)

Doctor: means a licensed health care provider acting within the scope of his or her license and rendering care or treatment to a Covered Person that is appropriate for the conditions and locality. It will not include a Covered Person or a member of the Covered Person's Immediate Family or household.(ACE-Policy)

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E

Eligible Expenses: Those expenses which are incurred on the date the service was rendered or the supply privided (Union Central-Policy)

Eligible Employee: An active full-time person working at least 30 hours per week (or an active part-time person, if the Participating Employer elects to cover part-time employees) who has completed the Employment Waiting Period and for whom the Participating Employer deducts FICA taxes with each pay. (Union Central-Policy)

Eligible Person: A person, Actively at Work for the Policyholder, who is a member of an Eligible Class, defined on the Schedule of Benefits. A Contractor, or an employee of a Contractor, may be an Eligible Person. A sub-contractor of the Contractor (or an employee thereof) can never be an Eligible Person. All Eligible Persons must be identified by the Policyholder or Contractor on either: (1) the most recent TWC Tax Employer's Quarterly Report (Form C-3) filed with the Texas Workforce Commission or (2) the most recent Contract Labor Census form. (GAPP-I-Policy)

Eligible Medical Expense: Those charges Incurred by a Covered Person to treat an Occupational Injury, Occupational Disease, or Cumulative Trauma which occurs during the Policy Period. Eligible Medical Expenses are the actual charges (but not more than the Usual, Customary, and Reasonable charge) incurred for medical aid, medical rehabilitations, and medical services, if the treatment is Medically Necessary, including the following: a. medical, surgical, Chiropractic Care, podiatric, dental, nursing, and physical therapy services provided by or at the direction of a Provider; b. physical rehabilitation services performed by a licensed occupational therapist provided by or at the direction of a Provider; c. services of a Hospital of skilled nursing facility; d. prescription drugs, medicines, and other remedies; e. medical and surgical supplies, appliances, braces, artificial members, and prostheses, including training in their use. (Aegis-Policy)

Elimination Period: A period of consecutive days of disability for which no benefits are payable under Weekly Accident Indemnity Insurance. It starts on the first day the Insured is disabled. It is shown in the Schedule of Coverage. (Union Central-Policy)

Elimination Period: The number of days after the Accidental Bodily Injury has been suffered and the Insured is Totally Disabled, but for which no benefits are payable. (The Peak-Policy)

Elimination Period: means the number of days shown of the Declaration Page after the date of Occurrence and the Covered Person is totally and continuously disabled, but for which no payments are reimbursable under this Policy. (CEM-Policy)

Emergency Care: Bona fide emergency services provided after the sudden onset of a medical condition resulting from an Injury manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably expect to result in: (1) placing the patient's health in serious jeopardy; (2) serious impairment to bodily function; or (3) serious dysfunction of a bodily organ or part. (GAPP-1-Policy)

Employee: shall mean each person who is employed in the State of Texas by the Employer as defined herein, but shall not include any person who performs services for the Employer as an independent contractor or otherwise in a non-employee status. (USSIC-Policy)

Employee: Is a person directly employed by you, whose salary is paid directly by you, and whose salary is subject to all applicable state and federal income taxes. An Employee does not include sub-contractors or independent contractors, whether they are employed by you on an occasional part-time or full-time basis. (The Peak-Policy)

Employee: A person who is in one of the Covered Classes and, at the time of the Occurrence, is employed in the regular business of, is under the direction and control of, and receives his pay on a regular basis by means of a salary or wage directly from the Policyholder. Employee does not include an owner operator, independent contractor, subcontractor, day laborer, or third-party agent. Employee includes only those persons who, at your direction, work in Texas on your regular business, including those Employees working temporarily outside the State of Texas but under your direction and control, and in your regular business. (Aegis-Policy)

Employer: shall mean the entity that provides its federal tax identification number for payroll purposes of the particular Employee.(USSIC-Policy)

Employment Waiting Period: The period of time, as shown on the Schedule of Benefits, the Eligible Person must be Actively at Work before such person is eligible to be an Insured. (GAPP-1-Policy)

ERISA: The Employee Retirement Income Security Act of 1974, as amended from time to time. References to any section of ERISA shall include any successor provision thereto. (USSIC – ERISA)

ERISA Plan or Plan: The named Insured's Covered Person welfare benefit plan to the extent it provides benefits to Covered Persons for bodily Injury occurring within the Covered Person's Scope of Employment. The Company must be notified in writing within 31 days of any and all amendments to the Plan. The acceptance of all changes by the Company must be in writing. If the Company is not so notified, or if the Plan changes or Plan amendments are not approved by the Company, this Policy will provide coverage based on the Plan prior to such change. (Lexington-Policy)

Experimental Treatment: Treatment provided when: (1) the treatment is not recognized or used by a majority of Physicians in the same area; (2) a facility is not recognized as being able to properly perform the treatment; or (3) the treatment is not considered to be effective for the Occupational Injury. We will make Our determination of whether or not treatment received is experimental based on information and positions developed by the American Medical Association, the Federal Drug Administration, the Council of Medical Specialty Societies, the National Institute of Health, the State Medical Association, or other similar organizations. (Union Central-Policy)

Extended Care Facility: An institution, or a distinct part of an institution, which: A. Is licensed as a Hospital, Extended Care Facility or rehabilitation facility by the state in which it operates. B. Is regularly engaged in providing twenty-four (24) hour skilled nursing care under the regular supervision of a Physician and the direct supervision of a Registered nurse. C. Maintains a daily record on each patient. D. Has an effective utilization review plan. E. Provides each patient with a planned program of observation prescribed by a Physician; and F. Provides each patient with active treatment of an Infury or related rehabilitation in accordance whth existing standards of medical practice for that condition. (The Peak-Policy)

Extended Care Unit: An institution or a distinct part hereof which operates under law and which, for compensation from its patients: (1) is primarily engaged in providing skilled nursing care 24 hours a day for persons recovering from Injury; (2) is under the full-time supervision of a Physician or registered nurse; (3) admits parients as recommended by a Physician; (4) maintains medical records for all patients; (5) has under an agreement the services of a Physician always available; (6) has a written transfer agreement in effect with one or more Hospitals; and (7) is not, except incidentally, a place for custodial care, rest, the aged, individuals considered mentally or emotionally impaired, or treatment of substance abuse. (Union Central-Policy)

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F

Functional Capacity Examination: A test performed by a physical therapy professional to evaluate and estimate physical limitations. (Lexington-Policy)

Fungal Pathogens: Any fungus or mycota or any byproduct or type of infestation produced by such fungus or mycota, including but not limited to, mold, mildew, mycotoxins, spores or any biogenic aerosois. (Aegis-Policy)

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G

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H

Hazardous Properties: Include radioactive, toxic or explosive properties. (USSIC-Policy)

Home Health Care Agency: A public or private agency or organization that specializes in providing medical care and treatment in the home. Such a provider must meet all of the following conditions: A: It is primarily engaged in and duly licensed, if such licensing is required, by the appropriate licensing authority to provide skilled nursing services and other therapeutic services; B: It has policies established by a professional group associated with the agency or organization. This professional group must include at least one (1) Physician and at least one (1) registered graduate Nurse to govern the services provided and it must provide for full-time supervision of such services by a Physician or registered graduate Nurse; C: It maintains a complete medical record on each individual; and D: It has a full-time Administrator. (The Peak-Policy)

Home Health Care Plan: A program for continued care and treatment of the insured established and approved in writing by the insured's attending Physician within seven (7) days following termination of a Hospital confinement as a resident patient, and is for the same or related condition for which (s) he was hospitalized. The attending Physician must certify that the proper treatment of the Injury would require continued confinement as a resident Inpatient in a Hospital in the absence of the services and supplies provided as part of the Home Health Care Plan. (The Peak-Policy)

Hospital: An institution which, under law, and for compensation from its parients: (1) provides major surgery; (2) diagnostic and inpatient facilities for care and treatment of sick or injured persons; (3) has constant supervision of care and treatment by Physicians and 24-hour service by registered nurses; (4) is not, except incidentally, a nursing home, or a place for rest or for the aged; but (5) includes a facility which has a transfer arrangement with a Hospital or which is a licensed Ambulatory Surgical Center. (Union Central-Policy)

Hospital: A facility that: (1) is operated according to law for the care and treatment of injured people; (2) has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis; (3) has 24 hour nursing service by registered nurses (RNs); and (4) is supervised by one or more Physicians.(Lexington-Policy)

Hospital: means an institution which meets all of the following conditions: A. It is engaged primarily in providing medical care and treatment to the injured person on an Inpatient basis at the patient's expense; B. It is constituted, licensed and operated in accordance with the laws of jurisdiction in which it is located which pertain to Hospital; C. It maintains on its premises all the facilities necessary to procide for the diagnosis and medical and surgical treatment of an Injury; D. Such treament is procided for compensation by or under the supervision of Physicians with continuous twenty-four (24) hour nursing services; E. It is a provider of services under Medicare; and F. It charges patients for its services. A Hospital is not, other than incidentally, a place for rest, a place for the aged, a place for drug addicts, a place for alcoholics, or a nursing home.(ACE-Policy)

Hospital: means a licensed general medical and surgical institution that: (1) has Inpatient Services for sick and injured persons (2) charges for its services; (3) is supervised by a staff of Physicians; (4) has 24-hour per day nursing service by registered nurses (R.N.'s); (5) has organized facilities for diagnosis and major surgery, either on site or available elsewhere under formal agreement; and (6) is not, other than in a minor way: (a) a place for rest, or the aged; (b) a place for treating alcoholics, drug addicts, or the mentally ill; or (c) a nursing or convalescent home.(TAPP-Policy)

Hospital: means an institution that: 1) operates as a Hospital pursuant to law for the care, treatment, and providing of in-patient services for sick or injured persons; 2) provides 24-hour nursing service by Registered Nurses on duty or call; 3) has a staff of one or more licensed Docters available at all times; 4) provide organized facilities for diagnosis, treatment and surgery, either: (i) on its premises; or (ii) in facilities available to it, on a pre-arranged basis; 5) is not primarily a nursing care facility, rest home, convalescent home, or similar establishment, or any separate ward, wing or section of a Hospital used as such; 6) is not a place for the care and treatment of mentally ill, emotionally ill or retarded persons; and 7) is not a place for drug addicts, alcoholics, or the aged. (ACE-Policy)

A Hospital does not include: (1) a nursing, convalescent or geriatric unit of a Hospital when a patient is confined mainly to receive nursing care; (2) a facility that is, other than incidentally, a rest home, nursing home, convalescent home or home for the aged; nor does it include any ward, room, wing, or other section of the Hospital that is used for such purposes; or (3) any military or veterans Hospital or soldiers home or any Hospital contracted for or operated by any national government or government agency for the treatment of members or ex-members of the armed forces. (Lexington-Policy)

Hospital Intensive Care: Confinement in that section or portion of a Hospital established for critically injured persons, Which has full-time nurses or other skilled Hospital employees in constant attendance; equipment for treating the critically injured person, and direct supervision of a full-time Physician or intensive care committee of the medical staff. (GAPP-1-Policy)

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I

Immediate Family: means a Covered Person's parent, grandparent, spouse, child, brother, sister or in-laws. (ACE-Policy)

Immediate Family Member: A person who is related to the Covered Person in any of the following ways: spouse, brother-in-law, sister-in-law, son-in-law, daughter-in-law, mother-in-law, father-inlaw, parent (includes stepparent) brother or sister (includes stepbrother or stepsister), or child (includes legally adopted or stepchild). (Lexington-Policy)

Incurred: The date on which a medical procedure, service or supply is provided to a Covered Person for treatment of an Occupational Injury, or, an Occupational Disease, or Cumulative Trauma. (Aegis-Policy)

Incurred Expenses: Those services and supplies tendered to an Insured. Such expenses shall be considered to have occurred at the time or date the services or supplies are actually provided. (The Peak-Policy)

Incurred Expenses: means those services and supplies rendered to an Insured. Such expenses shall be considered to have occurred at the time or date the services or supplies are actually provided. (Tex-Flex Policy)

Injury: shall mean the identifiable physical condition, including death, that results directly from an Accident or Occurrence and that occurred in the course and scope of the Participant's employment. Injury dors not include (1) Occupational Disease or Cumulative Trauma unless it results directly from an on-the-job Accident or Occurrence; (2) an identifiable physical condition that is related to or caused by, in whole or in part, a prior or pre-existing identifiable physical condition; or(3) mental or emotional injury, anguish or stress. (USSIC-Policy)

Injury: means identifiable damage or harm to the physical structure of the body that is incurred solely as the result of a Covered Occurrence. The term does not include: 1) any mental trauma, emotional distress or similar injury; or 2) a heart attack, stroke or anerysm. The Injury must be caused solely by an Accident. All injuries sustained by one Covered Person in any one Accident, including all related conditions and recurrent symptons of these injuries, are considered a single Injury.(ACE-Policy)

Injury, Injuries: Bodily injury to an Insured which: (1) is sustained solely due to an Accident; and (2) occurs while the Insured is covered under this Policy; and, if the Policy is provided as Occupational Coverage Only (as Shown on the Schedule of Benefits), (3) arises solely out of or in the course of the Insured's regular occupation or performing an alternative occupation at the request and direction of the Policyholder. (GAPP-I-Policy)

Inpatient: A person who is a resident person using and being charged for the room, board and other medical facilities of the Hospital. (Union Central-Policy)

Inpatient: Refers to the classification of Insured, which is admitted to a Hospital, Hospice or Convalescent Nursing Facility for treatment, and charges are made for room and board to the Insured as a result of such treatment. (The Peak-Policy)

In-patient: means a person who is provided and charged for at least one day's room and board by a Hospital. (TAPP-Policy)

Inpatient Services: Services which include: (1) Hospital room and board, but not more than the average semi-private room rate charged by the Hospital for each day of Hospital confinement, except that for Hospital Intensive Care, not more than twice the average semi-private room rate charged by the Hospital for each day of such confinement and for not more than a maximum of 15 days for all Injuries due to any one Accident; and (2) medically Necessary Hospital services and supplies used for the care and treatment of Inpatients. This does not include personal comfort services such as radio, television, telephone, barber and beauty services. (GAPP-1-Policy)

Insured: An Eligible Employee of Participating Employer who is insured under the Group Policy. (Union Central-Policy)

Insured: means an Eligible Person who is covered under the Policy.(TAPP-Policy)

Insured: A person eligible for coverage under the Policy and for whom We have accepted premium. (The Peak-Policy)

Intensive Care Unit: A section, ward or wing within the Hospital which is separated from other facilities and: A: Is operated exclusively for the purpose of providing professional medical treatment for critically ill or critically injured patients; B: Has special supplies and equipment necessary for such medical treatment available on a standby basis for immediate use; and C: Provides constant observation and treatment by Nurse or other highly trained Hospital personnel. (The Peak-Policy)

Intermediate Care Unit: A unit of the Hospital which is a separate and distinct area providing special care, continuous observation, concentration of special lifesaving equipment immediately available for patients who are no longer in critical condition but who are still in serious or guarded condition and need more care than is available in the regular care area and less than is provided in the Intensive Care Unit. (Union Central-Policy)

Intoxicated: The state in which an Insured will be presumed if the level of alcohol in his blood meets or exceeds the amount at which a person is presumed to be under the influence of alcohol or intoxicating substance under the law of the locale in which the injury occurs. (GAPP-1-Policy)

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K

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L

Loss of Use: With regard to foot or hand means the total loss of the ability to perform each and every act and service the foot or hand was able to perform prior to the Occurrence. Loss of Use must commence within 365 days of the date of the Occurrence and continue without interruption for a period of not less than 365 consecutive days. Loss of Use must be total and irrevocable and beyond remedy by surgical or other means. (Aegis-Policy)

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M

Manifest: When an Occupational Disease is reasonably capable of diagnosis by a Physician or, in the option of the Physician, the Covered Person could reasonably be expected to be aware of its existence. (Lexington-Policy)

Masculine Gender: Classification used throughout the Group Policy to include masculine and feminine genders. (Union Central-Policy)

Maximum Medical Improvement: The point at which a Treating Physician determines that a Participant who suffered an Injury will not improve substantially as a result of additional medical treatment or physical therapy, or surgical intervention. (USSIC – ERISA)

Maximum Weekly Benefit: The Maximum Wage Benefit for temporary Disability Benefits stated in the Schedule of Benefits per week. (Aegis-Policy)

Medical Emergency: means a condition caused by an injury that manifests itself by symptoms of sufficient severity that a prudent lay person possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of the person in serious jeopardy. (ACE-Policy)

Medical Expense: An expense incurred by a Covered Person as a result of Bodily Injury due to an Accident or Occurrence and paid by you for medical or dental services, procedures or supplies, provided the expense is Medically Necessary, Usual and Customary and prescribed by a Physician acting within the scope of his or her license. (Lexington-Policy)

Medical Expense Benefit Period: The period during which the Eligible Medical Expense must be Incurred by the Covered Person, and begins on the date of occurrence. The Medical Expense Benefit Period is stated on the Schedule of Benefits. (Aegis-Policy)

Medically Necessary: Service and treatment which is: (1) consistent with symtoms, diagnosis or treatment of the Insured's Injury; (2) appropriate according to standards of good medical practice; (3) performed in the least costly setting where the services and treatments can be safely and appropriately provided; (4) not primarily investigative, educational or experimental; and (5) not primarily for the convenience of the Insured, that person's family, Physician or the facility providing the service. (Union Central-Policy)

Medically Necessary: Medical Services, Procedures or supplies that are: 1. Required, recognized and commonly accepted nationally by Physicians as the usual, customary and effective means of diagnosing or treating the condition; 2. The most economical supplies or levels of service that are appropriate and available for the safe and effective treatment of the Covered Person; and 3. Not primarily for the convenience of the Covered Person, the Covered Person's family of the Covered Person's Physician of other Provider of medical services, supplies or procedures. NOTE: Even if the service, supply or procedure is Medically Necessary, we will not reimburse you for any service, procedure or supply otherwise excluded by any condition, exclusion or definition in this Policy. (Lexington-Policy)

Medically Necessary: means that a service, medicine or supply is necessary and appropriate for the diagnosis or treatment of an Accidental Bodily Injury based on generally accepted current medical practice. A service, medicine or supply will not be considered Medically necessary if it: 1. is provided only as a convenience to an Insured or provider, or 2. is not appropriate treatment for an Insured's diagnosis or symptoms; or 3. exceeds, in scope, duration or intensity, that level of care which is needed to provide safe, adequate and appropriate diagnosis or treatment. The fact that any particular Physician may prescribe, order, recommend, or approve a service or supply does not make the service or supply Medically Necessary.(Tex-Flex-Policy)

Medical Provider: A health care provider (including but not limited to: physicians, hospitals, physical therapists and pharmacies) designated by the Company to administer medical treatment, physical therapy and drugs for which reimbursement is authorized under this Plan. (USSIC – ERISA)

Medicare: The Health Insurance for the Aged Act, Title XCIII of the United States Social Security Amendments of 1965, as then constituted or later amended. (The Peak-Policy)

Minor Emergency Medical Clinic: A freestanding facility which is engaged primarily in providing minor emergency and episodic medical care to an Insured. A board-certified Physician, a registered Nurse, and a registered X-ray technician must be in attendance at all times that the clinic is open. The clinic facilities must include X-ray and laboratory equipment and a life support system. For the purposes of this Policy, a clinic otherwise meeting these requirements but is, in any way, part if a regular Hospital shall be excluded from the terms of this definition. (The Peak-Policy)

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N

Named Insured: The employer whose name and address are stated in the Declarations, provided that for coverage purposes, the following shall apply: 1. If the Named Insured is an individual, then he or she is a Named Insured, but only with respect to the conduct of a business of which the Named Insured is the sole owner. 2. If the Named Insured is a partnership or a joint venture then members and partners are also Named Insured, but only with respect to the conduct of the partnership's or joint venture's business. 3. If he Named Insured is a corporation, only the corporation is the Named Insured. Officers, directors and shareholders are deemed to be Named Insureds for their actions on behalf of the corporate Named Insured, but only with respect to the conduct of the business or businesses of the corporate Named Insured. (Lexington-Policy)

National Industry Average: With respect to Basic Earnings, National Industry Average means the United States Department of Labor, Bureau of Labor Statistics' Employment and Wages Annual Averages, Bulletin 2373, Latest Edition, Table 5, Private Industry by State and 4 Digit SIC Industry, Reporting Units. (Union Central-Policy)

New Coverage: Either: (1) a newly acquired benefit under this Policy; or (2) an increase in the amount of an in-force benefit. (GAPP-1-Policy)

Non-Preferred Provider: A Licensed provider of medical services who is not under agreement with the Administrator to provide those services. (GAPP-1-Policy)

Nuclear Facility: (a) Any nuclear reactor. (b) Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing spent fuel, or (3) handling processing or packaging waste; (c) Any equipment or device used for the processing, fabricating or alloying of special nuclear material if at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is located consists of or contains mere than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235. (d) Any structure, basin, excavation, premises or place prepared or used for the storage of disposal of waste; and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations; "Nuclear Reactor" means any apparatus designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material. (USSIC-Policy)

Nuclear Material: Source material, special nuclear material or by-product material (USSIC-Policy)

Nurse: A registered Nurse (R.N.); Licensed Practical Nurse (LPN); Licensed Vocational Nurse (LVN); or, a person licensed in the state in which the nursing or health care service was performed, practicing within the scope of such license. (Aegis-Policy)

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O

Occupational Accident Coverage: Coverage provided for Accidental Death & Dismemberment (Section II.A), Medical Expense (Section II. B), Weekly Indemnity (Section II. C). (Lexington-Policy)

Occupational Assessment: A test of vocational capabilities. The process includes a review of medical records, Injury and treatment, history and background (education, military, previous occupation(s)), evaluation of basic skills such as reading, spelling and/or math capabilities, and vocational alternatives. (Lexington-Policy)

Occupational Classification: An Employee's classification which most closely describes the duties he performs for the Participating Employer. (Union Central-Policy)

Occupational Disease: means a Disease arising solely out of a Covered Person's assigned duties in his Scope of Employment that causes damage or harm to the physical structure of the body. Occupational Disease includes other Disease or infections that naturally result from the work-related Occupational Disease. Occupational Disease does not include ordinary Diseases of life to which the general public is exposed outside of a Covered Person's assigned dutirs in his Scope of Employment. (CEM-Policy)

Occupational Disease: means a disease that is caused solely from performance of the Insured's regular duties of his or her job and causes damage or harm to the physical structrure of the body. It includes other diseases or infections that naturally result from the work-related disease. It does not include ordinary diseases to which the general ublic is exposed outside the Insured's rehylar duties of his or her job. It dois not include Injury reslting from an Accident or Cumulative Trauma. (Tex-Flex-Policy)

Occupational Disease or Disease: A disease arising solely and independently out of a Covered Person's assigned duties in his or her Scope of Employment which causes damage or harm to the physical structure of the body. Occupational Disease includes other diseases or infections that naturally result from the work-related disease. Occupational Disease does not include: (1) ordinary disease of life to which the general public is exposed; or (2) a disease resulting from an Accident. (Lexington-Policy)

Occupational Injury or Injuries: A bodily Injury directly caused by an Accident which arises out of or in the course of the Insured's Occupational Class. Occupational Injuries are the only Injuries covered by the Group Policy. (Union Central-Policy)

Occupational Injury or Injury: An identifiable physical injury to, or death of, a Covered Person caused by an Accident during the Scope of Employment. Occupational Injury does not include Disease, Occupational Disease, or Cumulative Trauma. (Aegis-Policy)

Occupational Therapy: Treatment of physically disabled person by means of constructive activities designed and adopted to promote the restoration of the person's ability to satisfactorily accomplish the ordinary tasks of daily living and those required by the person's particular occupational role. (Union Central-Policy)

Occurrence: An Accident or series of Accidents arising out of one event or incident. (Lexington-Policy)

Occurrence: An Accident or series of Accidents arising out of one event or incident. The date of Occurrence for an Occupational Disease or Cumulative Trauma is the date the physical condition manifests itself and is diagnosed by a physician as an Occupational Disease or Cumulative Trauma. (USSIC – ERISA)

Orthotic Appliance: An external device intended to correct any defect in form or function of the human body. (The Peak-Policy)

Other Income Benefits: means any amounts that a covered Person or a Covered Person's dependents receive (or are assumed to receive) under: 1) any Workers' Compensation, occupational disease, unemployment compensation law or similar state or federal law, including all permanenent as well as temporary disability benefits. This includes any damages, compromises or settlement paid in place of such benefits, whether or not liability is admitted, If paid as a lump sum, We will prorate these benefits over the period for which the sum is given. If no time is stated, the lump sum will be prorated over a five year period. If no specific allocation of a lump sum is made, then the total sum will be an Other Income Benefit. 2) any Social Security or retirement benefits the Covered Person receive or any third party receives (or is assumed to receive) on the Covered Person's behalf or for the Covered Person's dependents; or, if applicable, that the Covered Person's dependents receive (or are assumed to receive) because of the Covered Person's entitlement to such benefits. 3) any proceeds payable under any group insurance or similar plan. If there is other insurance that applies to the same claim for disability, and contains the same or similar provision for reduction because of other insurance, We will pay Our pro rata share of the total claim. "Protrata share" means the proportion of the total benefit that the amount payable under one policy, without other insurance, bears to the total benefits under all such policies. (ACE-Policy)

Outpatient: A person who receives a service and treatment, but is not an Inpatient. (Union Central-Policy)

Outpatient: Refers to the insured who receives medical care, treatment, services or supplies at a clinic, a Physician's office, or at a Hospital, if not registered bed patient at that Hospital. (The Peak-Policy)

Outpatient Services: Services that are received at a Hospital, clinic or doctor's office by a person without such person being an Inpatient. (GAPP-1-Policy)

Owner Operator: A non-employee of the Policyholder who, under the contract of hire, performs transportation services for the Policyholder as a motor carrier. An "Owner Operator" is not an "Owner Operator" for purposes of this Policy when not providing transportation services to Policyholder. Nothing in this Policy shall be construed to make the "Owner Operator," or the Owner Operator's employees, employees of Policyholder. (Aegis-Policy)

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P

Partial Disability/Partially Disabled: The Insured's inability to perform one or more, but not all, of the essential duties of his or her occupation. (The Peak-Policy)

Partial Disability or Partially Disabled: Means as a result of the Injury which caused the Total Disability, the Insured is: (a) able to perform one or more, but not all, of the material and substantial duties of his own occupation on a full-time or a part-time basis; or (b) able to perform all of the material and substantial duties of his own occupation on a part-time basis. (Union Central-Policy)

Participant: An eligible Employee who satisfies all requirements for participation in the Plan, and whose participation has not been terminated as provided herein. (USSIC -ERISA)

Participating Employer: An employer who has subscribed to the Trust and made written application for insurance under the Group Policy for its employees and who has been approved for coverage under the Group Policy. (Union Central-Policy)

Payroll: for premium calculation purposes means money or substitutes for money paid by the Policyholder to Employees for compensation. For premium calculation purposes, the Payroll for any one Employee in any year is limited to the Payroll Maximum shown on the Schedule of Benefits (ACE-Policy)

Payroll: The total compensation (as will be declared for Federal Tax Filings) paid by the Insured to the Insured to the Insured's Employees, including all clerical workers and executive officers covered by this Policy during the Policy Period. For computation of premium purposes, the term Payroll shall not include overtime. The maximum compensation for any one Employee for premium computation purposes is limited to One Hundred and fifty Thousand Dollars ($150,000.00) (GAPP-II-Policy)

Payroll - Base Annual Salary: The amount of compensation to a Covered Person, including overtime, tips and commission as reported to the Internal Revenue Service. For Covered Persons receiving payment by commission, Base Annual Salary shall be the annual earnings over the three-year period immediately preceding the date of loss. For Covered Persons receiving payment by commission that have less than a three year employment history with you, average monthly earnings will be calculated and multiplied by 12 to calculate the Base Annual Salary. The maximum Base Annual Salary that we will recognize for coverage under this Policy is $60,000, regardless of whether a Covered Person has a Base Annual Salary in excess of this sum. (Lexington-Policy)

Payroll - Base Annual Earnings: a. The amount of compensation to a Covered Person, excluding overtime, bonuses and commissions for the most recent fifty-two (52) weeks prior to the Occurrence (or the annualized compensation, excluding overtime, bonuses, and commissions, for the entire period of employment, if employed less than fifty-two (52) weeks). For commissioned Employees, Base Annual Earnings shall be the average annual earnings over the most recent three (3) year period or period of employment with you, whichever is shorter, immediately preceding the Occurrence; and b. One-third of the annual or annualized total compensation paid by Policyholder for transportation services to an "Owner Operator." (Aegis-Policy)

Payroll - Base Weekly Earnings: Is the Amount of weekly compensation to an Insured, excluding overtime, tips, bonuses and/or commissions. If an Insured is compensated on an hourly basis, Basic Weekly Earnings will be determined by multiplying his hourly wage by 40 hours. If an Insured is compensated on a monthly wage basis, Basic Weekly Earnings will be determined by dividing his monthly wage by 4.33. If an Insured is compensated on an annual salary basis, Basic Weekly Earnings will be determined by dividing his annual wage by 52 weeks. For Insured's who are on commission, Basic Weekly Earnings shall be the average basic weekly earnings with the Participating Employer over the past three years; for Insured's who are on commission who have less than three years service with the Participating Employer, the average basic weekly earnings will be calculated by dividing his annual salary with the Participating Employer by 52 weeks. If employed with the Participating Employer less than one year, the average weekly earnings will be based upon the number of weeks worked. In the absence of credible salary information, the salary determined shall not exceed the National Industry Average, as defined. (Union Central-Policy)

Periods(s) of Total Disability: The Period of time the Insured is continuously Totally Disabled. New periods must be separated by return to Active Work for at least: (1) two weeks in a row, if due to the same or related causes; or (2) one day, if due to different causes. (GAPP-1-Policy)

Permanent Basis: When used in reference to Actively at Work or Active Work shall mean anyone who is on-the Policyholder's payroll and is being reported by the Policyholder as an employee for the purposes of state and federal income taxes. (The Peak-Policy)

Permanent Partial Disability: The permanent loss of physical function or anatomical loss of use of a body part which is attributable to a work related Injury suffered by a Covered Person and substantiated by a diagnosis from a Physician, which prevents the Covered Person from performing the duties of any occupation for which he or she is qualified by reason of education, training or experience. (Lexington-Policy)

Permanent Total Disability: The complete, permanent and absolute inability, substantiated by a diagnosis from a Physician, of a Covered Person from performing the duties of any occupation for which he or she is qualified by reason of education, training or experience. Such condition must be due to work-related Injury. (Lexington-Policy)

Physician: shall mean a person who is a licensed doctor of medicine or any other licensed provider of medical services that state law requires to be recognized as a Physician. A Physician must be acting within the scope of his license and cannot be the Participant, the Participant's spouse, son, daughter, father, mother, brother or sister. (USSIC-Policy)

Physician: A licensed practitioner of the healing arts acting within the scope of his or her license who is not: (1) the Covered Person: or (2) an Immediate Family Member; or (3) a practitioner retained by the Named Insured. (Lexington-Policy)

Physician: A person licensed by the state to practice the healing arts and acting within the scope of such license.(Union Central-Policy)

Physician: means a person who is a licensed doctor of medicine or osteopathy; or is any other licensed health care provider that state law reqires to be recognized as a physician. He or she must be acting within the scope of his her license; and cannot be Insured, insured,s spouse, son, daughter, father, mother, or sister.(Tex-Flex-Policy)

Physician: means a licensed practitioner of the healing arts who is acting within the lawful scope of his or her license either as a doctor of medicine or a doctor of osteopathy, or as such other practitioner as We must by law recognize as a Physician legally qualified to render such treatment, and who is not a member of the immediate family of the Insured whose loss is the basis of claim under this Policy.(TAPP-Policy)

Plan: means the Named Insured's employee welfare benefit plan to the extent it provides benefits to a Covered Person for Bodily Injury, Occupational Disease or Cumulative Trauma occurring in the Scope of Employment. (CEM-Policy)

Plan: (or "ERISA Plan") means the Policyholder's employee welfare plan to the extent it provides benefits to Covered Persons for injury occurring within the Covered Person's Scope of Employment. The Plan must be in a form approved by Us. we must be notified in writing within 31 days of any and all amendments to the Plan. The acceptances of all changes by Us must be in writing. If We are not so notified, or if the Plan changes of Plan amendments are not approved by Us, this Policy will only provide coverage based on the Plan prior to such change. (ACE-Policy)

Plan Administrator: The Company or its written designee that supervises the administration of the Plan as provided for in Section 6.1 hereof. (USSIC – ERISA)

Plan Benefits: Those benefits payable under the terms of the Plan and actually paid by Named Insured. This Policy indemnifies or reimburses for Plan Benefits only to the extent provided in this Policy. (Lexington-Policy)

Plan Benefits: means those benefits paid under the terms of the Plan. This Policy indemnifies Plan Benefits only to the extent provided in this Policy. (CEM-Policy)

Plan Year: shall mean the twelve (12) month period ending on the last day <<DATE>>. (USSIC-Policy)

Policy: This Policy, Which has been issued by the Company, and delivered to the Named Insured. The term Policy includes the quote sheets, Application and any attached riders, endorsements or amendments and any other attached papers. (Lexington-Policy)

Policy Period: The Policy Period shown in the Declarations. (GAPP-II-Policy)

Policy Term: means the period beginning with the Policy Effective Date or subsequent Renewal Date and ends on the earlier of the cancellation date of the Policy or twelve (12) months after the Policy Effedtive Date or Renewal Date. Each renewal period begins a new Policy Term. (ACE-Policy)

Policyholder: means the insured employer whose name and address are stated in the Policy Declerations, provided that, for coverage purposes, the following shall apply: 1) If the Policyholder is an individual, then he or she is a Policyholder, but only with respect to the conduct of a business that the Policyholder is the sole owner; 2) If the Policyholder is a partnership or joint venture then members and partners are also insured, but only with respect to the conduct of the partnership's or joint venture's business; and 3) If the Policyholder is a corporation, only the corporation is the Policyholder. Officers, directors and shareholders are deemed to be the Policyholder for their actions on behalf of the corporation, but only with respect to the conduct of businesses of the corporation. (ACE-Policy)

Policyholder: The legal entity to which the Policy is issued and named on the first page of the Policy. It is also referred to as "You", "You"r or "Yours". (The Peak-Policy)

Pollution related Disease: Any systematic disease due to hypersensitivity disorder or atopic disease, other than those directly caused from acute allergic reactions. (The Peak-Policy)

Pre-Admission Certification: A program whereby prior to incurring Covered Charges due to Hospital admission (other than an admission for Emergency Care), the Insured or his Physician must obtain authorization to incur such charges from the Administrator. (GAPP-1-Policy)

Pre-Certification: means a program whereby prior to incurring Covered Charges due to hospital admission or Physician treatment, the Insured or his or her Physician obtains prior authorization from the Company. Please refer tot he Pre-Certification provision in Section II, Accident Medical Expense.(Tex-Flex-Policy)

Pre-Certification or Pre-Approval: A program whereby prior to incurring Covered Charges due to Hospital admission (other than an admission of emergency care), physical therapy, MRI, CAT Scan, Sonogram, and other such testing, the Named Insured or the designated Provider will obtain authorization from the authorized Claims Administrator. (Lexington-Policy)

Pre-Existing Condition: Any Injury, Disease or condition for which, during the three months before coverage began, a Covered Person for such Injury. Disease or condition was examined or treated by a licensed health care practitioner acting within the scope of his or her license, took medications or received any other medical care, treatment or advice or where a Covered Person manifested such symptoms such that the Injury. Disease or condition was reasonably capable of diagnosis by a health care practitioner or in the opinion of the health care practitioner the Covered Person could reasonably have been expected to be aware of its existence. (Lexington-Policy)

Pre-Existing Condition: shall mean any illness, injury, disease, or other physical or mental condition, whether or not work-related, which originated or existed prior to the date of Accident or Occurrence. (USSIC-Policy)

Pre-Existing Condition: means an Occupational Injury caused by, or diagnosed to be, the aggravation or re-injury of a condition or injury for which the Covered Person received medical treatment, care or advice prior to the date the Covered Person's coverage became effective under the Policy. (ACE- Policy)

Pre-Existing Condition or Injuries: means a condition or Injury(ies) for which diagnosis, treatment or care, including prescription, or medical advice was recommended or received within the six (6) month period immediately prior to the Insured's effective date.(Tex-Flex-Policy)

Preferred Provider: A licensed provider of medical services who is under agreement with the Administrator to provide those services. (GAPP 1-Policy)

Premium Due Date: The day of the month coinciding with the Policy Effective Date indicated on the Policy face page. (The Peak-Policy)

Provider: Any health care provider designated or approved by the Company to administer medical treatment, for which payment or reimbursement is authorized under the Plan. (Lexington-Policy)

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Q

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R

Recurrent Loss(es): Loss(es) for which an Insured receives medical treatment, including prescriptions, or experiences a period of disability that commences after treatment or disability for which any benefits were payable under this Policy and are considered to be the continuation of the prior period of treatment or disability unless: A. The periods of treatment or disability are separated by an interval during which the Insured received no treatment and during which interval the Employee performed the duties of a gainful occupation with the Policyholder for at least six (6) months, or B. The periods of treatment or disability or due to entirely unrelated causes. (The Peak-Policy)

Rehabilitation: Only those procedures that are performed for the purpose of restoring bodily or body function lost as a result of Bodily Injury. (Lexington-Policy)

Review Committee: The persons appointed to review and determine all requests for review of a denial of benefits in accordance with Section 6.7 hereof. The Review Committee shall consist of three individuals appointed by the Company. (USSIC – ERISA)

Room and Board: Refers to all charges by whatever name called which are made by a Hospital, Hospice, or Convalescent Nursing Facility as a condition of occupancy. Such charges do not include the professional services of Physicians nor intensive nursing care by whatever name called. (The Peak-Policy)

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S

Scope of Employment: An activity of any kind or character that involves the furtherance of your business, trade or profession at our regular workplace in furtherance of your business, trade or profession. Scope of Employment does not include a Covered Person's transportation to and from your regular workplace unless: 1. The transportation is furnished as a part of the contract of employment, or is paid for by you, or the means of such transportation are under your control; or 2. The Covered Person is directed in his or her Scope of Employment to proceed from one place to another place. (Lexington-Policy)

Self Insured Retention (SIR) means the dollar amount, shown on the Declerations, which the Named Insured must Pay, including defense costs, with respect to an Occurrence, before the Company will begin to indemnify the Named Insured for benefits under this Policy. Sums paid for benefits up to the SIR will not be reimbursed by the Company. Sums paid for benefits up to the SIR must be paid by the Named Insured. Amounts paid by the Named Insured will be applied to satisfy the SIR, only if, were it not for this SIR, such amounts would have been eligible for indemnity under the Policy. (CEM-Policy)

Social Security Disability Award: Any Social Security disability benefits claimed by the Insured which have been approved for payment by the Social Security Administration. (GAPP-1-Policy)

Source Material: Special nuclear material, and by-product material having the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. (USSIC-Policy)

Spent fuel: Any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a nuclear reactor. (USSIC-Policy)

Spouse: The Covered Person's legal Spouse. (Lexington-Policy)

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T

Temporary Disability or Temporarily Disabled or Disabled or Disability: means an objectively demonstrable physical, anatomical, or physiological abnormality or condition diagnosed by a Doctor resulting solely from an Occupational Injury occuring within thirty (30) days of the date of a Covered Occurrence that causes an Employee to be unable to perform the material duries of his or her occupation and unable to obtain and retain employment at wages equivalent to his or her Base Earnings prior to the Covered Occurence. (ACE-Policy)

Temporary Partial Disability: A nonpermanent physical impairment, resulting from a work related Injury and substantiated by a diagnosis from a Physician, which prevents a Covered Person from fully performing the duties for which he or she is employed by the Named Insured. (Lexington-Policy)

Temporary Total Disability: A nonpermanent physical impairment, resulting from a work related Injury and substantiated by a diagnosis from a Physician, which prevents a Covered Person from performing the duties of any occupation for which he or she is qualified by reason of education, training or experience. (Lexington-Policy)

Totally Disabled: means that the Insured, due to Injury, is unable to perform the material and substantial duties of his job. In addition, the Insured must be under the care of a Physician. (TAPP-Policy)

Total Disability or Totally Disabled: During the first twenty-four months of any continuous period of disability, an insured is not able to perform any of the material and substantial duties of the insured's occupation, business or employment which he or she held when the disability began and, for the remainder of any such period of continuous disability, total disability shall mean the Insured is not able to perform any of the duties of any occupation for which he or she is reasonably fitted by education, training or experience. Benefits will not be payable for any period of disability during which the Insured is not under the continuous care of a Physician. (The Peak-Policy)

Totally Disabled and Total Disability: A disability resulting solely from an Occupational Injury which prevents an Insured from performing the essential duties of his or her own occupation during the Elinination Period and for the next 12 months. After that, the Insured must be prevented from engaging in any activity for compensation or profit. (Union Central-Policy)

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U

Usual and Customary Charge: The usual charge made by a Physician or other provider of services, supplies, medication r equipment that does not exceed the general level of charges made by other Providers rendering or furnishing such care or treatment within the same area. The term "area" means a county or such other area as is necessary to obtain a representative cross-section of such charges. Due consideration will be given to the mature and severity of the condition being treated and any medical complications or unusual circumstances that require additional time, skill and expertise. (Lexington-Policy)

Usual Customary and Reasonable:

1. "Usual" means the provider's most frequent charge for the service or treatment

2. "Customary" means the charge made, for the same service in the same area, by other Physicians with similar training and wxperience, or by providers other than Physicians; and

3. "Reasonable" means charges within the scope of the law, not exceeding in intensity, quality, or size, the appropriate limits for the service or treatment provided. (Union Central-Policy)

Usual, Customary and Reasonable Charge: means the expense is: A. usual when it is the fee regularly charged, and the pateint's responsibility to pay, in the absence of insurance or other third party reimbursement, by a health care provider or Doctor for a given medical procedure, service or supply; and B. customary in relation to what other Doctors and health care providers in the same geographic area charge for the same procedure service or supply. C. reasonable as a generally accepted medical practice to order the procedure, service or supply for the Employee's Injury or condition. (ACE- Policy)

Usual, Reasonable and Customary Charge: means a charge which is not more than is charged when there is no insurance; and is not more than the prevailing charge in the locality for a like service or supply. A like service is one of the same nature and duration, requiring the same skill and performed by one of similar training and experience. A like supply is one which is the same or substantially equivalent. Locality is the city or town where the service or supply is obtained, if it is large enough so that a representative cross-section of like services or supplies can be obtained. In large cities, it may be a section(s) of the city, if the above criteria can be met. In smaller urban or urual areas, it may have to be expanded to include surrounding areas to meet the criteria.(TAPP-Policy)

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V

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W

Waiting Period: For a Covered Person who becomes Temporarily Disabled while covered under this Policy, the period of time the Covered Person must be continuously Disabled before Disability Benefits are paid under this Policy. The Waiting Period begins on the first day of Temporary Disability, and is stated on the Schedule of Benefits. (Aegis-Policy)

Waste: Any waste material (a) containing by-product material other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its source material content. And (b) resulting from the operation by any person or organization of any nuclear facility included under the first two paragraphs of the definition of nuclear facility. (USSIC-Policy)

We, Us or Our: Fidelity Security Life Insurance Company, Kansas City, Missouri. (Fidelity Security-Policy)

We, Us or Our: mean the insurance company named on the front page of this Policy.(TAPP-Policy)

Weekly Earnings: Base Annual Earnings divided by 52. (The Peak-Policy)

Weekly Wage: means the Covered Person's Base Annual Salary divided by 52.(CEM-Policy)

Written Request: Any form provided by Us in its entirety, which is completed by the Policyholder or an Insured requesting insurance described in this Policy. (GAPP-1-Policy)

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X

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Y

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Z

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WORKERS'
COMPENSATION
- OR -
WORKERS'
?
COMPENSATION
ALTERNATIVE
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