A.M. Best Company
A.M. Best rates insurance companies based on their financial condition and operating performance. Ratings are an industry standard to measure financial performance and strength. WCF was upgraded from an A- to an A (excellent) in 2008.
The year in which an injury occurred.
Accident Year Experience
The matching of accident year losses with accident year premium. Accident Year Experience changes as losses develop and premium finalizes.
Accident Year Losses
The losses that occurred during an accident year. Accident Year Losses, for a given year, change as claims develop. The ultimate Accident Year Losses is known once all claims that occurred during the given accident year are settled. In some cases, it could be 30-40 years before the ultimate losses are known.
Accident Year Premium
The combined premium that is attributed to the accident year. Accident Year Premium, for a given year, changes as premium adjusts in subsequent years. The ultimate Accident Year Premium is known once all premium adjustments are finalized. Accident Year Premium includes the prorata portion of premium activity for the Accident Year.
An individual that uses mathematical, accounting and statistical analysis of past loss data to project the value of future liabilities.
The process of resolving a controversy between parties by litigating the legal and/or factual issues. The court hearing the matter usually pronounces a judgment based on the presented evidence.
An individual that settles a claim filed by an insured. The adjuster evaluates the merits of a claim and determines the proceeds that might be payable for the claim.
The process of settling a claim. The settlement process includes evaluating the cause and amount of a loss, determining coverage and payment of any proceeds required under an insurance policy.
The assets that are permitted by a state to be used in determining the solvency, or financial condition of an insurance company.
Adjusting and Other Expenses (A&O)
The loss adjustment expenses that are not related to the defense, litigation, or cost containment of a claim. Includes the cost of adjusters. Also includes the cost of inspectors, appraisers, fraud inspectors, while working in the capacity of an adjuster. Prior to 1/1/98, Adjusting and Other Expenses were referred to as Unallocated Loss Adjustment Expenses (ULAE).
An individual authorized to represent an insurance company to sell insurance. A direct agent sells exclusively for one insurance company. An independent agent represents two or more insurance companies.
The maximum amount an insurer will pay for all claims covered by a policy during a policy period.
Allocated Loss Adjustment Expenses (ALAE)
See Defense and Cost Containment Expenses
Anniversary Rating Date (ARD)
The date that is used to determining the effective rates on a policy. The date is usually the effective date of the policy, unless the rating board establishes a different date.
The annual report that an insurance company is required to file with the state insurance department, in each state in which they do business. The report is compiled using statutory accounting principles (SAP) by using forms designed by the NAIC. The report provides information needed to assure that an insurance company has adequate reserves, and that the assets are available to meet all benefit payments for which they are liable.
A policyholder that is unable to obtain voluntary insurance coverage. Depending upon the state, to obtain coverage the policyholder is assigned to the carrier of last resort, or to a pool of participating insurers.
A premium discount provided to members of a trade association that has selected as its workers’ compensation insurance carrier of choice. Members must meet the program’s requirements to obtain the discount.
The acceptance by a reinsurer (assuming company), of part or all of the written insurance transferred to it by the primary insurer or another reinsurer. Assumed premium is the premium received from risk transfer to a reinsurer. Assumed losses are the corresponding losses related to the Assumed premium.
The reinsurance company that accepts risk from a primary insurer or another reinsurer.
A percentage of the standard premium used in calculating the premium of a retrospectively rated policy. Basic Premium is the portion of the retrospective premium that is loaded to reflect a policy’s expected overhead cost and profit.
Monetary payments and other services provided by insurers under the terms of an insurance policy.
An additional amount added to reserves to account for claim development that has not been included in the case reserves. Bulk Reserves can not be attributed to any individual claims, but are an adjustment related to all outstanding claims.
Calendar Year Experience
The matching of calendar year losses with calendar year premium. Calendar Year Experience does not change as losses develop and premium finalizes.
Calendar Year Losses
The combined losses that occurred during a calendar year. Calendar Year Losses do not change as claims develop in subsequent years. Calendar Year Losses include claim activity for the current year claims and additional claim activity for prior year claims that occurred during a given calendar year.
Calendar Year Premium
The combined premium that transpired during a calendar year. Calendar Year Premium, for a given year, does not change as premium adjusts in subsequent years. Calendar Year Premium includes premium activity for the current calendar year only, regardless of the policy period.
The termination of an insurance policy before its expiration date by either the insurance company or the policyholder.
Carrier of Last Resort
The insurance company designated to accept a policyholder after the policyholder has been refused coverage by all other insurance companies. The Carrier of Last Resort is usually a state fund. Not applicable in monopolistic states and in states that have assigned risk pools. WCF receives a federal tax exemption for being Utah’s carrier of last resort.
To pass on to another insurance company (reinsurer) all or part of the insurance written by an insurer (ceding company), to reduce the possible liability of the reinsurer. Ceded premium is the premium paid for the transfer of risk to a reinsurer. Ceded losses is the corresponding losses related to the ceded premium.
The insurance company that transfers risk to a reinsurer.
Certificate of Insurance
A document issued by an insurance company that provides evidence of the existence and terms of a policyholder’s insurance coverage.
A request to an insurance company for payment of a loss covered by an insurance policy.
An individual who submits a claim to an insurance company for an incurred loss.
Claims Outstanding (or Claims Pending)
The total number of open claims at any given time.
The reserves attributed to an individual outstanding claim. Claims Reserves contrasts with bulk reserves that can not be attributed to an individual claim, but are attributed to all outstanding claims. Claims Reserves are equal to total incurred less net payments (gross payments less subrogation).
The average cost per claim. Severity can be based on accident year or policy year, for an individual policy, a group of policies or all policies.
A numerical index by type of business operations used in grouping similar type of risks for rating purposes. The Class Codes are designed so that businesses with similar characteristics are charged the same rate. The NCCI develops and maintains the class codes for workers’ compensation insurance.
The amount of premium that has actually been received as payment.
The sum of the loss ratio and expense ratio. The Combined Ratio indicates whether an insurance company is making a profit on the business it is writing, without taking into account the investment returns on the premium received.
A workers’ compensation policy agreement under which an insurance company promises to pay all compensation and all benefits required of an insured employer under the workers’ compensation act of the state or states listed on the policy
Coverage under a workers’ compensation policy for situations in which an employee not covered under workers’ compensation law could sue for injuries suffered under common law liability.
Indemnity benefits paid to an eligible survivor of a worker whose injuries result in death. The benefits are usually paid until the surviving spouse remarries, or is determined to no longer be dependent on these benefits (often these benefits are paid for the remainder of the spouse’s life). After the re-marriage of the spouse, or in the absence of a surviving spouse, Death Benefits will be paid to any surviving children until the age of 18.
Declarations Page (Dec Sheet)
The portion of a policy describing a risk. Includes the insured’s name and address, policy term, policy premium, and amount of coverage. And policy number
The amount of loss that the policyholder pays in a claim. The policyholder is liable to pay the Deductible before the insurance company is obligated to pay the claim. The policyholder receives a discount by adding the Deductible to the policy. The higher the Deductible, the lower the premium.
Defense and Cost Containment Expenses (D&CC)
The loss adjustment expenses that are related to the defense, litigation, or cost containment of a claim. Includes surveillance, appraisers, private investigators, and fraud investigators, if working in defense of a claim. Also includes rehabilitation nurses and the cost of engaging experts. Prior to 1/1/98, Defense and Cost Containment Expenses were referred to as Allocated Loss Adjustment Expenses (ALAE).
The premium paid at the beginning of the policy which provides for future premium adjustments based on an estimate of the final premium.
A payment to the policyholder by an insurance company out of its surplus or net worth.
Date Of Injury (DOI)
The date of the accident that caused the injury.
The prorata portion of written premium applicable to the expired portion of the policy term for which the insurance was in effect.
The date coverage begins on an insurance policy.
See Professional Employer Organization
Employer’s First Report of Injury (E-1)
A report that an employer is required to file with its workers’ compensation carrier when one of its employees is injured while working. Also known as Labor Commission Form 122. Also see 123
Employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. The bodily injury must arise out of and in the course of the injured employee’s employment by you.
A written amendment attached to a policy modifying the terms of the insurance contract. The modification can only become effective with the agreement of the insured, unless it is clearly made solely for the benefit of the insured.
The premium on a term policy calculated using estimated payroll exposure. Estimated Premium is the policy premium prior to the final premium calculation.
A flat charge added to small account premiums to cover the cost of issuing and servicing a policy.
The percentage of premium used to pay for the acquisition, writing, and servicing of a policy. The Expense Ratio is equal to underwriting expenses divided by written premium. The Expense Ratio shows how much it costs the insurance company to write the premiums.
Experience Modification Factor (E-Mod)
A premium modifier that reflects the loss experience of a policyholder compared with payroll exposure during the same time period. The modifier increases or decreases the current premium depending on how the actual exposure and losses, for the past three years, compares with expected losses for the same amount of exposure. (Currently, to be eligible in Utah for an e-mod, the premium for two of the past three years must have been $3,500 or greater, or the premium for the past year must have been $7,000 or greater). E-Mods are calculated by the NCCI.
The date coverage ends on an insurance policy.
Being subject to the possibility of a loss. See Payroll Exposure.
A provision in workers’ compensation insurance law that extends protection to an employee that is injured in a state other than his state of hire.
The re-insurance of part or all of a single policy. In Facultative Reinsurance, both the primary insurer and the reinsurer have the faculty or option to accept or reject the policy to be reinsured. Compare with treaty reinsurance.
The premium on a term policy calculated using actual payroll exposure. Final Premium is calculated after the policy has expired.
The number of claims occurring. Frequency can be based on accident year or policy year, for an individual policy, a group of policies, or all policies.
A policyholder’s workers’ compensation class code that has the most payroll exposure. The Governing Classification generally describes the main business operation of an employer. The Governing Classification cannot be a standard exception, unless there are no other class codes other than the standard exceptions.
The WCF department that scans and indexes policy and claims documents into TORIS.
A rating established by a claimant’s physician that quantifies a claimant’s physical disability. The Impairment Rating is determined by medical examinations, using American Medical Association (ADA) guidelines. Individual states may have additional guidelines that supercede the ADA guidelines. The Impairment Rating reflects the percentage of a claimant’s whole body impairment.
Incurred But Not Reported (IBNR)
Covered losses that occurred but have not yet been reported to the primary insurance company. A reserve is set up to account for this unknown liability, to more accurately reflect the expected ultimate losses.
Incurred But Unpaid Benefits (IBUB)
The general liability accounts that reflect the reserves that have been booked to pay any future liabilities on outstanding claims and IBNR claims.
When a policy is active and coverage is extended. Reflects the exposure for which an insurance company is providing insurance coverage.
Compensation for a loss.
A claim which includes payments and reserves for lost wages and medical expenses. Indemnity claims occur when an injured worker is out of work long enough to receive compensation for lost wages.
An individual who does a job for another individual, or company, according to a contract and is not an employee of the individual, or company. An independent contractor has significantly more direction and control of how the work is completed, than an employee would have.
Independent Medical Examination (IME)
An examination of an injured worker by a physician selected by the insurance company. Independent Medical Examinations are usually done to determine the appropriateness of a course of treatment, or to provide an evaluation of permanent impairment.
The WCF department that enters the first report of injury and sets the claim up on the system.
A partial payment of premium made by a policyholder for coverage on a term policy. The Installment Premium is determined by dividing the estimated premium into smaller amounts at set intervals during the policy period.
The transfer of risk from one party (insured) to another party (insurer), in which the insurer promises to pay the insured (or others on behalf of the insured) an amount of money, or service, for losses sustained from an unexpected event, during a period of time for which the insured makes a premium payment to the insurer.
The official of a state charged with the duty of enforcing its insurance laws. Also called the superintendent of insurance and director of insurance.
The person(s) or party(ies) protected by an insurance policy.
The insurance company or other organization providing insurance coverage and services to an insured.
Money earned from invested assets. An insurance company’s invested assets usually include reserves and policyholder surplus. Net investment income is investment income less investment expenses. (Does not include realized, or unrealized, gains or losses).
A state regulatory agency that oversees workers’ compensation insurance in the state of Utah. The Labor Commission seeks to assure that employees in the state are covered for industrial injuries by assuring that employers have adequate workers’ compensation coverage. The Labor Commission also oversees the payment of workers’ compensation benefits in the state.
A line of insurance coverage where the occurrence and reporting of a loss and the payout of the claim is often spread out over a long period of time. The uncertainty of the length of the time period makes it difficult to determine the value of the claim when the claim is first reported.
1. The amount an insurer is obligated to pay because of an insured event. 2. An injury caused by an event covered by an insurance company.
Loss Adjustment Expenses (LAE)
All of the costs associated with the settlement of a claim. See Defense and Cost Containment Expenses and Adjusting and Other Expenses.
Loss Conversion Factor (LCF)
A multiplier used in calculating the premium of a retrospectively rated policy to include the cost of settling claims. Incurred losses are multiplied by the Loss Conversion Factor to obtain an amount equal to incurred losses plus loss adjustment expenses.
Loss Cost Multiplier
A factor an insurance company files with the state insurance department that reflects the increase, or decrease, in state rates that the insurance company will charge for workers’ compensation. Currently in Utah, WCF files separate Lost Cost Multipliers for Preferred Rates, Standard Rates, and Non-Standard Rates.
The percentage of losses plus loss adjustment expenses to earned premium. The loss ratio shows how much premium was used to cover losses and the cost to settle the losses.
A report that lists the losses and expenses for the claims filed on a policy for a given period of time. A Loss Run also reports the premium earned for the period of time and the calculated loss ratio. A Loss Run also provides a breakdown of losses by paid, reserves, and subrogation. In addition, losses are broken down further by type of loss (medical and compensation) and type of expense (rehab: vocational rehabilitation and ALAE: defense and cost containment). Only expenses charged to a claim are listed on the loss run.
An amount representing the losses paid plus the change (positive or negative) in outstanding loss reserves within a given period of time. On the annual financial statement, Losses Incurred is the loss paid during the year plus the loss reserves at the end of the year less the loss reserves at the beginning of the year.
Lost Time (or “Time Loss”) Claim
A claim in which an injured worker is determined by a doctor to be unable to work for a period of time (in Utah, the period must exceed three days). These claims involve the payment of disability benefits, in addition to medical costs and other expenses.
Premium calculated by multiplying the exposure by the manual rate. Manual Premium is the premium before experience modification and premium discounts.
The rate used to calculate premium on a policy. The Manual Rate is equal to the state rate multiplied by the appropriate loss cost multiplier (preferred, standard, non-standard) that was filed with the state insurance commissioner.
Maximum Medical Improvement (MMI)
The maximum level of medical improvement of an injured worker’s condition. Once a claimant has obtained MMI, it is expected that significant improvements in the future will be minimal.
Medical Case Management
Professional services for the evaluation, monitoring and coordination of medical treatment of claims with specific diagnosis or requiring high-cost or extensive services.
Medical Only Claim
A claim which includes payments for medical expenses only. A medical only claim occurs when the injured worker was not out of work long enough to receive compensation for lost wages.
Micro Insurance Reserve Analysis (MIRA)
The automated claim reserving system in use at WCF that provides total incurred losses for a claim based on the criteria of a claim. About 90% of the claims are reserved by MIRA. The remaining claims reserves (usually catastrophic claims) are manually reserved to reflect more accurate reserves. MIRA is a software product of HNC Insurance Solutions.
The smallest premium charged by WCF to issue coverage for an annual period.
Premium after the adjustment for experience modification.
Monopolistic State Fund
State operated insurance company that is the sole provider of workers’ compensation insurance in a state. In these states, no other insurance companies are permitted to write workers’ compensation insurance. Currently, there are five Monopolistic State Funds: North Dakota, Ohio, Washington, West Virginia and Wyoming.
Mutual Insurance Company
A company owned and controlled by its policyholders. A Mutual Insurance Company’s surplus may be distributed to its policyholders in the form of a dividend.
National Association of Insurance Commissioners (NAIC)
An organization of state insurance commissioners that promotes uniformity by drafting regulations and model legislation. The NAIC has achieved considerable multi-state uniformity through the annual statement, which insurance company’s use for financial reporting.
National Council on Compensation Insurance (NCCI)
An organization of insurance companies that write workers’ compensation insurance. The NCCI collects statistics to establish rate structures so they can file rating plans with state insurance commissioners. The NCCI also maintains policy information and calculates e-mods for these policies.
Failure to do the correct or prudent thing, whether by omission or commission, in a given situation, resulting in harm to another.
After the application of an offset. Premium, net of reinsurance, is direct premium plus assumed premium, minus ceded premium. Losses, net of re-insurance, is direct losses plus assumed losses, minus ceded losses.
Net Investment Income
Money earned from invested assets less investment expenses. An insurance company’s invested assets usually include reserves and policyholder surplus. (Does not include realized, or unrealized, gains or losses).
Net Investment Income Ratio
The percentage of net investment income to net earned premiums.
Written premium from a business that has been on WCF’s books for the less than 12 months.
The assets that are not permitted by a state to be used in determining the solvency, or financial condition of an insurance company.
Not Otherwise Classified (NOC)
A class code term denoting that the policyholder’s operations cannot be classified more specifically.
See Owner Controlled Insurance Program
A repeated exposure or event which unexpectedly causes loss or damage.
The combined ratio less the net investment income ratio.
Owner Controlled Insurance Program (OCIP)
An insurance program written to cover large construction projects, usually exceeding $100 million in construction value. Under this program, all labor performed under the contract is covered. The program usually includes insurance policies covering workers’ compensation and general liability. Also called “wrap-up” policies.
See Professional Employer Organization
The actual amount of total losses paid by an insurance company.
The payment of premium in periodic installments. The payment periods are usually monthly.
A measurement of the amount of loss possibility to which an employer’s workers are subject. Payroll Exposure is used to calculate the amount of premium that is due on a workers’ compensation insurance policy.
Permanent Partial Disability (PPD)
An injured worker that has a permanent impairment rating of less than 100% after maximum medical improvement has been reached. Benefits for PPD are paid over a specified period of time, spending on the severity of the permanent impairment.
Permanent Total Disability (PTD)
An injured worker whose injuries have rendered him permanently unable to perform the kind of work for which he is qualified, and who cannot perform other work that is reasonably available. In most cases, benefits for PTD are paid for the remainder of the injured worker’s life.
Physician’s First Report of Work Injury (S-1)
A report that a physician files with a workers’ compensation carrier after an injured work is examined by the physician, for the first time, after the accident. Also known as Labor Commission Form 123. See forms
Policies In Force
The total number of policies that are active at a given point in time. Policies In Force is used to calculate claims frequency.
The time period during which a policy is effective or in force.
The year of the inception date of a policy.
Policy Year Experience
The matching of policy year losses with policy year premium. Policy Year Experience changes as losses develop and premium finalizes.
Policy Year Losses
The combined losses on policies with a given policy year. Policy Year Losses for a given year change as claims develop. The ultimate Policy Year Losses is known once all claims that occurred during the given policy year are settled.
Policy Year Premium
The combined premium from policies with a given policy year. Policy Year Premium for a given year changes as premium adjusts in subsequent years. The ultimate Policy Year Premium is known once all premium adjustments are finalized. Policy Year Premium includes the entire premium for a policy in the policy year.
Policyholder Acquisition Costs
The expenses incurred by an insurance company that are directly related to writing a policy.
The excess of an insurance company’s assets above its legal obligations to pay benefits to its policyholders and claimants. The Policyholder Surplus is net worth as stated on the statutory annual blank.
Preferred Provider Organization (PPO)
A formally organized entity consisting of hospitals, physicians, and other healthcare providers. A PPO allows insurance companies to negotiate directly for healthcare services at lower price than would normally be charged. Insurance companies recommend the PPOs they have negotiated with to the insureds.
The price paid by a policyholder to an insurance company in return for insurance coverage.
An examination of a policyholder’s operations, books and records by a premium specialist to determine the actual insurance exposure for the coverages provided.
The premium returned to the policyholder, which is the amount of premium that has been collected over and above the final earned premium.
1. Premium Earned But Not Received (EBNR) – Premium due but not received by the end of the accounting period. 2. Unearned Premium Reserve (UEPR) – Premium paid for coverage beyond the end of the accounting period.
Premium Specialist (also known as Premium Auditor)
An individual that does premium audits for an insurance company.
Payment made to a state, or municipally, by an insurance company based on written premium.
Benefits payable under an insurance policy.
Professional Employer Organization (PEO)
A company that provides outsourced insurance benefits and human resource consulting to other companies. The insurance benefits are provided as part of a group policy. Also known as employee leasing.
The determining of premium rates based on loss experience over a specified past period of time. The state rates for workers’ compensation are prospectively rated based on prior loss experience for the state.
Provider Reimbursement Group (PRG)
The WCF department that processes medical claim payments.
Amounts received by the insurance companies as reimbursement from paid losses. Recoveries include amounts from overpayments, subrogation and second injury fund.
An agreement whereby the reinsurer, for consideration, agrees to compensate the ceding company for all or part of the losses which the ceding company may experience under the policy or policies which it has issued.
An insurance company which has placed reinsurance risk with a reinsurer in the business of buying reinsurance.
A company that assumes the liability of another by way of reinsurance.
Insurance company funds set aside to met future obligations.
Restorative Services Authorization Form (RSA)
A Labor Commission form required for use by any provider (mainly physical therapists and chiropractors) that bill under the restorative services section of the Labor Commission’s fee schedule. The form is used to communicate treatment requests to the insurance carrier, and for the carrier to communicate authorization or denial of treatment.
Retrospectively Rated Policy
A policy where the final premium is determined based on a formula using the current policy period’s incurred losses. The formula elements and factors are included on the policy. Initially, premium is estimated using expected losses. After policy expiration, the premium is adjusted using actual losses. A Retrospectively Rated Policy is similar to self insurance due to the risk assumed by the policyholder, but unlike self insurance the assumed risk under a Retrospectively Rated Policy is limited.
- 1. The individual or organization insured. 2. Uncertainty of financial loss.
Risk Based Capital Requirements (RBC)
The minimum capital standards that an insurance company must meet based on an assessment of the risk associated with the insurance company’s operations.
The intrinsic item insured, e.g. the employee covered by workers’ compensation insurance.
Premium after adjustment for experience modification, safety credits/debits, schedule credits/debits, and association credits, but prior to adjustment for size discount and expense constant. Standard Premium is used in retrospective rating to calculate the basic premium, maximum, and minimum.
Statutory Accounting Principles (SAP)
The rules of accounting and reporting required by state law that must be followed by insurance companies in submitting their financial statements to state insurance departments.
A premium discount, or surcharge, available to policyholders, when manual premium is greater than $10,000. Schedule rating provides up to a 25% discount or surcharge based on the policyholder’s workplace safety programs and risk characteristics.
Second Injury Fund
An insurance fund set up by most states that encourage companies to hire workers that have been handicapped by a prior workplace injury. When a worker has a second injury, after being hired by another company, the current company’s insurance company is responsible for only the costs of the second injury. The Second Injury Fund will pay the difference between the total costs and the costs of the second injury. Second Injury Funds are usually funded by general state revenues or by assessments on workers’ compensation companies. Also known in Utah as the Employers Reinsurance Fund (ERF).
Protecting against losses by setting aside a company’s own money, rather than purchasing an insurance policy. By being self insured, a company saves expenses that an insurance company charges for acquisition, premium tax, and general overhead. Often self insured companies use a third party administrator to administer its claims.
The minimum standard of financial health for an insurance company, where assets exceed liabilities. State laws require insurance regulators to step in when the solvency of an insurance company is threatened and proceed with rehabilitation or liquidation.
Certain employee groups rated separately instead of being included under the main class code. The Standard Exception, for workers’ compensation, are 8810 Clerical Office, 8742 Outside Sales, and 7380 Drivers, unless the main class code description states that one of these employee group are included under the main class code.
Statutory Employee Exclusion Policy
A waiver of insurance coverage, available in Utah, that an independent contractor can purchase as proof to other companies that the contractor has elected to not be covered by workers’ compensation insurance. The waiver also excludes the contractor from being covered by another company’s policy. These exclusion policies are available for purchase from the Utah Labor Commission for a nominal fee.
Stop Loss Provision
A policy provision on a retrospectively rated policy that limits the loss amount for any individual claim that is included in calculating the retrospective premium. A Stop Loss Provision is an additional election, made by the policyholder, for which they are given a higher basic premium factor.
An insurance company’s right to take legal action against a third party responsible for a loss to an insured for which a claim has been paid.
Temporary Partial Disability (TPD)
An injured worker’s status prior to reaching maximum medical improvement has been reached, during which he can perform some work, usually in a modified duty capacity or at fewer than normal hours per day. Benefits for TPD are paid until the worker is released to full duty work, or has reached maximum medical improvement.
Temporary Total Disability (TTD)
An injured worker’s status prior to reaching maximum medical improvement has been reached, during which he is unable to perform any work, as determined by a physician. Benefits for TTD are paid until the worker is released to return to work, or has reached maximum medical improvement.
Term Payroll Report
A payroll report sent to WCF by a term policyholder that reports the actual exposure that occurred during the term period. The report is used to calculate final premium.
An insurance policy that is written with an established expiration date. Coverage only continues if the policy is renewed. The policy is written with estimated premium based on estimated payroll exposures. After expiration, a premium audit will gather actual payroll exposures, from which the final premium can be determined. The difference between the estimated premium and the final premium will be either refunded if estimated is greater than final, or billed if final premium is greater than estimated, assuming the estimated premium has been collected.
The provisions of an insurance policy.
Third Party Administrator (TPA)
The performance of the claims functions related to an insurance plan by a company that is not an original party to the insurance plan. Pinnacle Risk Management Services is a TPA.
Total Incurred Loss
An amount that represents the current expected payout on a claim over the life of the claim. Incurred loss is equal to net paid losses (paid losses less recoveries) plus reserves.
All reserves on outstanding claims, whether known or unknown. Includes case reserves, IBNR reserves, and bulk reserves. Also includes reserves for loss adjustment expenses.
A group of companies in a similar industry that is organized to obtain cost savings. Each Trade Association generally endorses one insurance company as its workers’ compensation insurance carrier of choice in exchange for premium discounts. An association member receives an association credit, or premium discount, if they meet the program’s requirements. See associations discount
The re-insurance of part of the policies written by an insurance company. Treaty Reinsurance may be by participating type, where the insurance company and reinsurer share the risk based on a prorata share agreement, or by excess type, where the reinsurer reimburses the insurance company for claims that exceed a predetermined loss amount. Compare with facultative reinsurance.
Ultimate Net Loss
The total payments resulting from a claim over the life of the claim, plus all related expenses, less recoveries and reinsurance. Total payments reflect that the loss has fully developed, and all loss payments are known.
An individual that decides which applicants are accepted or rejected, what coverage is provided, and what price to charge for the coverage.
Underwriting Profit or Loss
An insurance company’s profit or loss strictly from it’s insurance operations, as opposed to investment operations.
The portion of the premium applicable to the unexpired period of the policy.
The WCF department that determines the medical necessity of services and procedures that has been submitted as necessary for a claimant.
See Statutory Employee Exclusion Policy
Workers Compensation Insurance
Insurance coverage for employees required by law in case of injury or death due to an occupational accident, regardless of employer’s negligence.
Workers Compensation Unit Report
A statistical report that provides information about payroll, premium and losses for a specific policy and state. Unit Reports are used to calculate e-mods for a policyholder. The Units Reports are submitted to the NCCI, or other rating organizations.
See Owner Controlled Insurance Program
The entire amount or premium written during a certain period regardless of which portions have and have not been earned.