Workers Comp 101
A.M. Best Co
Founded in 1899, A.M. Best Co. is a full-service credit rating organization dedicated to serving the insurance industry.
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.
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. Accident year premium includes the pro rata portion of premium activity for the accident year.
A person who compiles and analyzes statistics and uses them to calculate insurance risks and premiums.
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.
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
American Medical Association (AMA)
A national physician’s group. The AMA publishes a set of guidelines called “Guides to the Evaluation of Permanent Impairment.”
Americans with Disabilities Act (ADA)
A federal law that prohibits discrimination against people with disabilities. 800-669-4000 or 1-800-669-6820 (TTY).
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.
Arising out of and occurring in the course of employment.
A lawyer representing an injured worker in a workers’ compensation case.
A way of figuring out how much of a permanent disability is due to a work injury and how much is due to other disabilities.
Assigned Risk Adjustment Program
An additional fee placed on Assigned Risk policies (In NCCI jurisdictions) with experience modification factors higher than 1.00.
Assigned Risk Plan – Assigned Risk Pool – State Fund
A state designated program that ensures all employers can have access to workers’ compensation insurance even if insurance companies are not willing to voluntarily write the insurance. Often the last resort option for companies with poor experience ratings. Assigned risk plans usually have higher rates than the voluntary market.
A premium discount provided to members of a trade association that has selected WCF 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.
The final premium for the term of the policy, calculated by auditing actual payroll values for the type of work being performed.
Average Daily Wage (ADW)
A calculation of an injured worker’s average daily earnings. This term is sometimes used to determine entitlement to wage loss benefits following an injury.
Average Weekly Wage (AWW)
A similar calculation to the ADW in determining the entitlement to wage loss benefits by week for a fixed period of time.
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 cannot 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.
Carve-out programs allow employers and unions to create their own alternatives for workers’ compensation benefit delivery and dispute resolution under a collective bargaining agreement.
Carve-Out (PEO Workers’ Compensation Policy)
A hybrid PEO arrangement where the employer maintains their own workers’ compensation policy and does not obtain coverage through the PEO workers’ compensation master policy.
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. A ceded loss 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 cannot 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.
Also called work comp code or class code. Each type of work has risk of injury. Workers’ compensation codes are established that identify the type of work being performed and provide an associate code. Workers’ compensation premium rates are established by codes and are meant to be commensurate with the risk associated with that workplace exposure. Codes descriptions are maintained by NCCI in the SCOPES manual.
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.
An order by a workers’ compensation judge for a lump sum payment of part or an injured worker’s entire permanent disability award.
An injury caused by repeated events or repeated exposures at work.
Benefits paid to surviving dependents when a work injury or illness results in death.
Declarations Page (Dec Sheet)
The portion of a policy describing a risk. It includes the insured’s name and address, policy term, policy premium, and amount of coverage.
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 that provides for future premium adjustments based on an estimate of the final premium.
A process to prevent disability from occurring or to intervene early, following the start of a disability, to encourage and support continued employment.
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 pro rata 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.
Employer’s First Report of Injury
A report that an employer is required to file with its workers’ compensation carrier when one of its employees is injured while working.
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.
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
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. Experience mods are calculated by the NCCI.
The window of time for loss and payroll data used to calculate an experience modification factor for an employer. Traditionally a three-year period, starting four years prior to the effective date of the experience modifier. Rating bureaus may not wait until three years before establishing an experience rating for an employer. If an employer reaches certain, relatively low threshold of workers’ compensation insurance premiums in any one of the three years in the experience period the employer is eligible for experience rating. Each state has different thresholds for premium amounts before a company is eligible for experience rating.
The date coverage ends on an insurance policy.
Being subject to the possibility of a loss.
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 reinsurance 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.
Fair Employment and Housing Act (FEHA)
A state law that prohibits discrimination against people with disabilities.
Family and Medical Leave Act (FMLA)
A federal law that provides certain employees with serious health problems or who need to care for a child or other family member with up to 12 weeks of unpaid, job-protected leave per year. It also requires that group health benefits be maintained during the leave.
Any order, decision or award made by a workers’ compensation judge that has not been appealed in a timely way.
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.
A workers’ compensation insurance policy that cannot be adjusted due to losses that occur during the policy term. Only payroll values affect the premium charge.
Legal proceedings in which a workers’ compensation judge discusses the issues in a case or receives information in order to make a decision about a dispute or a proposed settlement.
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 super cede 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.
Paid losses plus additional loss reserves for anticipated future claims. Many loss sensitive insurance policies adjust premium based on incurred losses rather than solely on paid losses.
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.
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.
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 person or party protected by an insurance policy.
The insurance company or other organization providing insurance coverage and services to an insured.
An experience modification factor that applies across several states. Interstate ratings are calculated by a rating bureau (like NCCI) for employers operating in more than one stated. Most, but not all states (Michigan, Pennsylvania, and Delaware are exceptions), participate in the interstate rating system. Employers can have one experience modifier applying to their operations in most states but a separate modifier calculated by the stand-alone state rating bureau. The separate state modifier(s) apply only to workers’ compensation insurance premiums for the employer’s operations in that stand-alone state.
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 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.
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.
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 Claim
A claim in which an injured worker is determined by a doctor to be unable to work for a period of time. 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 that 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.
The smallest premium charged by an insurer 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)
The organization responsible in many states for determining proper workers’ compensation classifications, experience modification factors, and collecting data used for establishing work com rates. NCCI also writes the manuals used in many states to calculate workers’ compensation premiums, and administers the assigned risk plan in many jurisdictions. NCCI is a private company.
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.
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.
A repeated exposure or event that 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.
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 percent 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
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.
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.
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.
A premium discount, based on size of the premium paid. A premium discount is usually at the discretion of the insurance provider.
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 who 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.
The actual amount of total losses paid by an insurance company.
Amounts received 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 that the ceding company may experience under the policy or policies which it has issued.
An insurance company that has placed reinsurance risk with a reinsurer in the business of buying reinsurance. Also known as ceding company.
A company that assumes the liability of another by way of reinsurance.
Insurance company funds set aside to meet future obligations.
Workers’ compensation written through an assigned risk plan.
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.
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.
Document produced by NCCI that defines workplace exposures and assigns the particular workers’ compensation classification codes.
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. Such entities usually are funded by general state revenues or by assessments on workers’ compensation companies.
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.
Sliding Scale Dividend
A premium adjustment (rebated) after policy expiration, based on the actual loss experience of the insured business. The size of the dividend varies depends on the actual loss ratio of the insured.
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.
Social Security Disability Benefits
Long-term financial assistance for totally disabled persons. These benefits come from the U.S. Social Security Administration. They are reduced by workers’ compensation payments received.
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.
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.
Statewide Average Weekly Wage (SAWW)
A computation of average wages paid to employees in a jurisdiction for a set period of time. It is typically used to calculate the minimum and maximum amounts of workers compensation benefits that an injured employee will be entitled to receive.
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.
Statutory Employee Exclusion Policy
A waiver of insurance coverage, available in some states, 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.
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.
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.
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.
The reinsurance 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 pro rata 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 who 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 its insurance operations, as opposed to investment operations.
The portion of the premium applicable to the unexpired period of the policy.
The process used by insurance companies to decide whether to authorize and pay for treatment recommended by your treating physician or another doctor.
Workers’ compensation insurance written by private insurers outside of the assigned risk plan.
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. Unit 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.